The Group of 20 (G20) Osaka Summit in 2019 was a large step forward for global health diplomacy to build consensus on universal health coverage (UHC). To strengthen multi-stakeholder UHC partnership, Japan involved the research and policy advice network for G20 (Think 20: T20), civil society (Civil 20: C20), private initiatives of medical professional groups (H20), and the pharmaceutical sector. We attempted to identify UHC-related issues addressed and left unaddressed at the G20 Osaka, to bring lessons for future G20. We reviewed the G20 Osaka Leaders' Declaration, policy-related statements, and voices of the relevant G20 engagement groups and sectors. In July 2019, after the G20 Osaka Leaders' Summit, we organized an expert meeting convening Japan-based UHC-related key global health stakeholders. This review provides record of main findings presented in form of classifying the voices expressed in the meeting by UHC-related topics, and definitional ranges of UHC summarized. The T20, H20, and the pharmaceutical sector noted during our expert meeting that the ministerial-level health-finance collaboration was one of the key agendas suggested at the G20. T20 and C20 called for a recognition of health needs of refugees, migrants and other vulnerable groups in achieving UHC. Sexual and reproductive health and rights (SRHR) with a human rights-based approach through UHC was raised by the C20 as an issue unaddressed in G20 Osaka. Variation in operative purposes between global health stakeholders led to a definitional difference in the scope of UHC. The definitional difference could delay progress of UHC attainment. Addressing migrant and refugee health and SRHR within the context of UHC is further needed. Understanding perspectives of various stakeholders will become increasingly important to well-coordinate multi-actor cooperation with adequate social responsibility and transparency in UHC achievement and public-private partnership. In future G20, for UHC in the COVID-19 pandemic and post-pandemic worlds there is need of i) ensuring an integrated yet comprehensive multi-stakeholder approach towards UHC; ii) incorporating important dimensions such as the marginalized population and gender; and iii) ensuring adequate investments toward health information systems and governance to track health data for the vulnerable population and gender-responsive financing.

The aim of this systematic review is to determine the effects of self-management interventions with behavior-change support on medication adherence and smoking cessation in patients with chronic respiratory disease. We also describe the theories of health behavior change and behavior change techniques (BCTs) used to design these interventions and their mode of delivery. The PubMed/MEDLINE, Cochrane Library, CINAHL, and Pedro databases were systematically searched for relevant articles published up to November 2021. Randomized controlled trials (RCTs) that evaluated the effect of self-management interventions with behavior change support on medication adherence, correct inhaler use, and smoking cessation were included. Effect sizes (odds ratios) with 95% confidence intervals were calculated and pooled for random-effect meta-analysis. Of 5,223 articles identified, 15 were RCTs that met the inclusion criteria for the meta-analysis. Five of these RCTs were based on behavior change theory, including social cognitive theory and a transtheoretical model. Between one and eight components of BCTs in Behavior Change Technique (BCT) Taxonomy version1 were included in all interventions. The most frequent BCT components were social support (emotional) (n = 8), instruction on how to perform the behavior (n = 8), and goal setting (behavior) (n = 7). Meta-analysis showed that self-management interventions with behavior change support have positive effects on medication adherence, correct inhaler use, and smoking cessation for more than 6 months after their implementation. This indicates that individually tailored self-management interventions with behavior change support are effective in improving long-term medication adherence and smoking cessation in patients with chronic respiratory disease.

Cervical cancer is a cancer with evidence-based and cost-effective preventive measures; Human Papilloma Virus (HPV) vaccination for school girls and cancer screening for women. In Cambodia, cervical cancer accounts for an estimated 11.4% and 10.4% of women’s cancer and deaths in 2020, respectively. This study aimed to identify the knowledge of cervical cancer, its information sources, and the experiences of cervical cancer screening among female primary school teachers, who are key influencers of HPV vaccination. A cross-sectional study was conducted using telephone interviews with 100 female primary school teachers in Phnom Penh, the capital of Cambodia. All 100 participants had heard of cervical cancer, 94 (94%) had heard of screening, and 49 (49%) had ever undergone a screening. When asked about their knowledge regarding cause(s), symptom(s), detection, and treatment(s) of cervical cancer, 31%, 44%, 35%, and 55% respondents said "Do not know". Those who did not reply "Do not know" were asked open-ended questions. Many of their answers were judged as “incorrect” by gynecologists. Consequently only 1%, 38%, 63% and 28% of respondents replied with at least one correct answer regarding cause(s), symptom(s), detection and treatment(s) respectively. The most common sources of information were family and friends, followed by doctors, television, and the Internet. Among female primary school teachers with an above-average educational level, their knowledge of cervical cancer was generally low. To promote cervical cancer prevention, it is necessary to provide correct knowledge in a broad and accessible manner through involvement of local medical doctors and healthcare providers.

Pulse wave velocity (PWV) is a potential marker for atherosclerosis severity and/or predictor of future atherosclerotic cardiovascular events. PWV is significantly correlated with carotid-intimal media thickness in patients with diabetes. However, its significance as a surrogate marker for the treatment of atherosclerotic cardiovascular risk in the management of type 2 diabetes has not been fully established. To elucidate the factors that determine the improvement or deterioration of PWV, we studied the association of clinical parameters, parameters for glucose metabolism, serum lipids including each lipoprotein fraction, serotonin as a marker for platelet activation, and change in PWV in 54 patients with type 2 diabetes. Systolic blood pressure and serum levels of non-high-density lipoprotein-cholesterol, low-density lipoprotein-cholesterol (LDL-C), and intermediate-density lipoprotein-cholesterol significantly decreased in the PWV-improved group after 2 months compared with those in the PWV-deteriorated group. The serotonin levels at baseline were significantly lower in the PWV-improved group than in the PWV-deteriorated group. The changes in systolic blood pressure and LDL-C levels were significantly and positively correlated with those in PWV. The serotonin levels at baseline were significantly and positively correlated with changes in PWV. Therefore, amelioration of blood pressure, serum lipid level, and platelet activation might be beneficially associated with PWV change. PWV-guided clinical practice for cardiovascular risk stratification could be useful in type 2 diabetes management.

Convalescent plasma therapy is an important treatment method for patients with severe coronavirus disease (COVID-19). This study was conducted to confirm the safety of this therapy. We conducted an open-label clinical trial to administer convalescent plasma transfusion in a small Japanese cohort. Blood was collected from the recovered COVID-19 patients with high anti-severe acute respiratory syndrome coronavirus 2 (anti-SARS-CoV-2) spike IgG titer and high neutralizing activity and stored in the National Center for Global Health and Medicine Hospital until use. Convalescent plasma was administered to COVID-19 patients who required supplemental oxygen within 3 days of hospitalization. Convalescent plasma was administered to 11 patients with moderate to severe COVID-19. One patient experienced an adverse event, such as redness of the skin around the intravenous injection site within 3 hours after transfusion. Ten patients (91%) showed clinical improvement within 28 days, and one patient died of causes unrelated to plasma therapy. The data suggest that patients with COVID-19 examined in the present study received convalescent plasma without having any significant adverse effects. We plan to conduct a randomized controlled trial to examine the clinical effectiveness of convalescent plasma transfusion in a large Japanese COVID-19 cohort.

Ensuring equitable access to COVID-19 vaccines for all people has been challenging, hence, establishing relevant vaccination policies is required. This study delineates how vaccination policies have affected equitable access to COVID-19 vaccines. A situation survey was conducted in 201 countries and territories through 156 Japanese diplomatic missions abroad to capture the global state of COVID-19 vaccination policies. Questionnaire responses were received from 159 states (79%) as of March 31, 2021, and data from Japan were incorporated into the analysis. All questionnaire items were open-ended, covering the vaccines in use and five vaccination policies such as vaccine eligibility. Results reveal that first, 81 states (51% out of 160) had not started vaccinations as of February 24, 2021, but by March 31, this number had decreased dramatically to 37 (23%); in particular, the number of states in Africa without vaccination decreased from 40 to 16. Second, 43 (27%) states did not recommend the vaccine for pregnant women. Third, the vaccine was free of charge to the public in 116 states (73%), and 43 states (27%) offered no-fault compensation. Finally, vaccination was voluntary in 124 states (78%). In conclusion, the number of countries that had started vaccination increased by March 2021, especially in Africa, although many African countries seemed to lack access to the mRNA vaccine. To fix the uneven distribution, dose donations were accelerated since middle of July. Reviewing worldwide vaccine policies is useful not only for this pandemic but also to strengthen vaccination systems for preparedness for the next pandemic.

The sensitivity of immunoassay for antibodies to SARS-CoV-2 may decrease over time. We compared three serology assays against SARS-CoV-2 nucleocapsid protein using serum samples of 20 health care workers with a history of mild PCR-confirmed coronavirus disease 2019 (COVID-19) at various timing since diagnosis. Overall, the sensitivity (95% confidence interval) was 95.0 (75.1-99.9), 60.0 (36.1-81.0), and 45.0 (23.1-68.5) for the Roche, Sysmex, and Abbott assays, respectively. The sensitivity of all these assays exceeded 80 for those diagnosed within 6 months, whereas it varied considerably for those diagnosed more than 6 months ago: 88.9 (Roche) versus 0 (Abbott). The present data provide a reference for researchers planning serological studies and interpreting these data. Such assay difference in terms of detection durability can be used, if used in combination, for the estimation of the timing of previously undetected infection.

It is difficult to coordinate the working hours of busy clinical nurses and provide lectures, but e-learning can be used during their spare time. Therefore, this study aimed to share our experience in developing and implementing the neurology simulation program e-learning version (Neuro Sim-e). Needs analysis was conducted, and the Neuro Sim-e was developed. Four evaluation questionnaires: attention, relevance, confidence, and satisfaction (ARCS) etc., were examined. We developed the Neuro Sim-e, which consists of three scenarios. The subjects were 20 nurses. Regarding the "attention", "relevance", "reliability", and "satisfaction" of the Neuro Sim-e, 70.0%, 95.0%, 65.0%, and 90.0% of the respondents answered "rather agree" or higher, respectively. The Neuro Sim-e obtained positive feedback via ARCS evaluation and provided adequate results as an overall assessment. It is too early to conclude whether it is as effective as or better than a mannequin-based simulation, but this study provided learning materials that nurses could use in their spare time.

The World Health Organization (WHO) has been utilizing Emergency Use Listing (EUL) to expand access to medical products during the COVID-19 pandemic. EUL is a risk-based procedure for assessing and listing unlicensed vaccines, medicine, and in vitro diagnostics. To determine whether Japanese medical products acquired EUL relating to COVID-19, we conducted desk research as a part of a new project. Results showed that thirteen of twenty-eight in vitro diagnostic products were from China and three of ten vaccines on EUL were from India. However, only one vaccine manufactured in Japan was on EUL. A common weakness of Japanese companies in the global public procurement market was a lack of knowledge on qualification systems for medical products. We hypothesized holistic approaches from private companies and systematic supports from public sectors are required for a response to an emergency. These activities could lead to contribute to global health issues through sustainable businesses.

Benefiting from the Japanese Government's welcoming of foreign visitors, our facility was able to accept and respond to large number of foreign tourists (1,493) to undergo a comprehensive health checkup (Ningen Dock) in 2019. However, coronavirus disease 2019 (COVID-19) completely precluded the acceptance of tourists for two years starting in from 2020. In August 2020, our hospital policy was changed to actively accept foreign residents in Japan for comprehensive health checkups. In this article, we analyzed the foreign residents who use our facility in detail and we investigated the characteristics of foreign residents from the viewpoint of a comprehensive health checkup.