GHM Open
Online ISSN : 2436-2956
Print ISSN : 2436-293X
Current issue
Displaying 1-10 of 10 articles from this issue
Policy Forum
  • Masahide Usami
    2024 Volume 4 Issue 2 Pages 54-58
    Published: November 28, 2024
    Released on J-STAGE: December 05, 2024
    Advance online publication: July 27, 2024
    JOURNAL FREE ACCESS

    The Japanese government established the Children and Family Agency in April 2023 and is trying to promote evidence-based policymaking (EBPM). However, the current state of child and adolescent psychiatry in Japan demonstrated some difficulties. School refusal and suicide problems are increasing after the coronavirus disease-2019 (COVID-19) pandemic. These issues need to be addressed, thereby warranting various policies to be developed and implemented. Increasing the number of inpatient medical institutions and establishing a community-based data accumulation system that enables data and knowledge sharing among professionals is essential to improve child and adolescent psychiatric care. Furthermore, EBPM is needed to effectively develop a policy, and specialized experts are necessary to organize data and critically review evidence.

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Original Article
  • Yuta Yokobori, Ngosa Mumba, George Munono Sitali, Motoyuki Yuasa
    Article type: research-article
    2024 Volume 4 Issue 2 Pages 59-68
    Published: November 28, 2024
    Released on J-STAGE: December 05, 2024
    Advance online publication: June 14, 2024
    JOURNAL FREE ACCESS

    Responding to high disease burden of Hypertension (HTN), the Ministry of Health in Zambia, considers improving services related to HTN a national priority. Therefore, this study evaluated the interventions for HTN pharmaceutical treatment by training of health staffs and procurement of necessary medical devices. .We investigated service provision in the outpatient department (OPD) visits among patients aged 40 years and above in randomly selected health facilities in Chongwe district, between May and December 2017, before and after the interventions. The proportion of OPD visits that included standard clinical practices for HTN services significantly increased post-intervention: 45.8% to 71.9% for blood pressure screening, 26.8% to 31.8% for HTN diagnosis, and 14.2% to 20.9% for HTN medication. The proportion of OPD visits at which HTN medication was prescribed increased significantly post-intervention among patients with Grade 2 HTN or above, from 68.3% to 86.0%. The estimated district-wide monthly cost for HTN services in USD was $1,905 at baseline and increased to $2,643 post-intervention. These results suggest that improving HTN service provision is feasible and affordable at the district level. However, because a large number of individuals in need of HTN medication did not access a health facility, further investigation is required to estimate the expected effects and costs under improved access in the future.

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  • Patrick Banda, Yuta Yokobori, Shinobu Ashida, Felix Masiye, Oliver Kao ...
    Article type: research-article
    2024 Volume 4 Issue 2 Pages 69-79
    Published: November 28, 2024
    Released on J-STAGE: December 05, 2024
    Advance online publication: August 19, 2024
    JOURNAL FREE ACCESS

    In Zambia, information on cost of services provided at health facilities are deficient. This study aims to contribute to fill this knowledge gap by estimating the unit costs of health services provided at different levels of health facilities. This costing exercise used cross-sectional data for the year 2016. Fourteen facilities were purposefully selected to represent different levels of health facilities and mix of characteristics. We used an accounting-based approach to calculate the unit costs of health services. Specifically, we employed the top-down approach to allocate total overhead costs incurred over to different services that were provided at the facility. Full costs of health facilities varied substantially between different levels, and even between facilities within the same level (particularly between health centres). The compositions of cost items within any facility were largely dominated by labour and material costs, each of which contributing approximately half the shares, whilst the proportion of capital costs remained small irrespective of the levels. Unit costs of outpatient services in the health centres ranged from ZMW 15 (USD 1.3) to ZMW 30 (USD 2.7) without medical consumables, while inpatient costs were between ZMW250 (USD 22.2) and ZMW 1,300 (USD 115.6) per admission and ZMW 140 (USD 12.4) to ZMW 500 (USD 44.4) per bed-day. Unit costs between services provided at the same facility exhibit fairly comparable pattern. The findings from this study provides useful information of unit costs for referencing in future studies. Further, the variations of unit costs among facilities with different characteristics provides policy relevant information for health administrators and policy makers.

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Brief Report
  • Yusuke Inada, Ami Kawaguchi, Kayo Kunimoto, Tomoyuki Hara, Yutaka Inab ...
    Article type: brief-report
    2024 Volume 4 Issue 2 Pages 80-83
    Published: November 28, 2024
    Released on J-STAGE: December 05, 2024
    Advance online publication: May 23, 2024
    JOURNAL FREE ACCESS

    Infantile hemangiomas (IHs) are the most common benign tumors of infancy, occurring in approximately 5-10% of the population. Among what appear to be typical IHs with proliferative and involuting phases, we noticed that there are also IHs that are already present at birth and regress without proliferating. We therefore aimed to determine the frequency and clinical characteristics of this type of IH. A retrospective study was conducted on 176 lesions of 137 Japanese patients with IH. As a result, six lesions (3.4%) in three patients with IH (2.1%) were already present at birth and lacked subsequent proliferation. Analysis of the clinical characteristics of IHs without proliferation revealed that they are significantly less common in the head and neck region, which is the preferred site of the tumor, than typical IHs with proliferation (0% vs. 42.9%, p < 0.05 by Fisher's exact test). This suggests that when the clinical course of IH is uncommon, their distribution can also be atypical. Furthermore, all of the IHs without proliferation were superficial types, and there were no deep types in this cohort. This study demonstrates that the clinical course of IH can be diverse, and that very rarely there can be a type of IH that does not grow after birth. It may be necessary to consider conducting a detailed interview for the growth history at the first visit for the possibility of such a type of IH without proliferation, as it is likely that they can be followed up without the need for treatment.

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  • Yuki Horie, Chieko Ishiguro, Wataru Mimura, Megumi Maeda, Fumiko Murat ...
    Article type: brief-report
    2024 Volume 4 Issue 2 Pages 84-90
    Published: November 28, 2024
    Released on J-STAGE: December 05, 2024
    Advance online publication: August 19, 2024
    JOURNAL FREE ACCESS

    Japan's government developed the Health Center Real-time Information-sharing System on COVID-19 (HER-SYS), the national COVID-19 surveillance system, which relies on manual data entry. Following the COVID-19 vaccination campaign, physicians were mandated to report COVID-19 cases with vaccination history via HER-SYS. However, concerns have arisen regarding the accuracy of this vaccination history. This study aimed to assess the validity of vaccination history recorded in HER-SYS. We used data from HER-SYS provided by three municipalities. The study cohort comprised COVID-19 cases registered in HER-SYS from February 2021 to March 2022. The validity of vaccination history in HER-SYS was assessed by cross-referencing with the Vaccination Record System (VRS) of these municipalities. We calculated sensitivity to gauge the extent of missing data in HER-SYS, and positive predictive value (PPV) to evaluate the accuracy of data entered into HER-SYS. Of the 19,260 COVID-19 cases included in the study cohort, HER-SYS and VRS identified 3,257 and 8,323 cases, respectively, as having the first-dose vaccination history. Cross-referencing identified 3,093 cases as true positives in HER-SYS. The sensitivity was 37.2% (95% confidence interval [CI]: 36.1−38.2) and the PPV was 95.0% (95% CI: 94.2−95.7). Collection of vaccination data by HER-SYS was found to be inadequate to obtain information on vaccination history of COVID-19 cases. This suggests that real-time data linkage across different systems such as HER-SYS and VRS would reduce the burden of manual data entry during the pandemic and lead to appropriate infection control measures based on more accurate information.

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Correspondence
  • Keigo Sekihara, Kayoko Natsume, Tomoya Tajiri, Motohisa Shibata, Takam ...
    2024 Volume 4 Issue 2 Pages 91-94
    Published: November 28, 2024
    Released on J-STAGE: December 05, 2024
    Advance online publication: June 14, 2024
    JOURNAL FREE ACCESS

    Anomalous systemic arterial blood supply to the basal lung (ABLL) is a rare congenital malformation. Although surgical resection is the standard treatment, the surgical techniques for aberrant arteries remain poorly discussed. Herein, we evaluated the efficacy of our direct suture closure technique in preventing aneurysmal changes in aberrant artery stumps through a retrospective review of the medical records of patients who underwent surgical resection of ABLL at our institution between January 2013 and January 2023. The diagnosis of ABLL was based on enhanced computed tomography (CT) findings. To treat ABLL, we performed lateral thoracotomy through the 5th intercostal space via a ~10 cm skin incision. After anatomical pulmonary resection, the aortic stump of the aberrant artery was sutured directly with a felted non-absorbable thread. In one patient, we further examined the postoperative blood flow using 4D-flow magnetic resonance imaging. Overall, 5 consecutive patients, including four (80%) females with a median age at operation of 59-year-old, were assessed. The median operative time was 166 min, and the median blood loss was 34 ml. There were no cases of perioperative mortality or morbidity, and the median hospital stay was 8 days. No vortex flow was observed in 4D-flow evaluation of blood flow. Histological changes were observed in the aberrant artery, including fibrous intimal thickening, atherosclerosis, intramural thrombus, and collection of foam cells and lymphocytes. Thus, we present this technique as a safe treatment for ABLL that allows for the preservation of blood flow and complete resection of abnormal vessels.

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  • Yumi Funato, Akio Kimura, Wataru Matsuda, Tatsuki Uemura, Kentaro Koba ...
    2024 Volume 4 Issue 2 Pages 95-98
    Published: November 28, 2024
    Released on J-STAGE: December 05, 2024
    Advance online publication: August 19, 2024
    JOURNAL FREE ACCESS

    Triptans are recommended as a treatment for moderate to severe migraines; however, barriers to administration include contraindications or possible side effects. In contrast, metoclopramide, which is frequently used as an antiemetic in the emergency department setting, has shown efficacy in alleviating migraine pain. This study investigated the non-inferiority of intravenously (IV) administered metoclopramide 10 mg compared with subcutaneously (SQ) administered sumatriptan 3 mg for alleviating migraine pain. In this single-center, open-label, cluster-randomized controlled trial, patients presenting to the emergency department with migraine attacks were allocated to either the IV metoclopramide 10 mg group or the SQ sumatriptan 3 mg group. The primary outcome was change in numerical rating scale (NRS) score for headache at 1 h after baseline. The non-inferiority margin was set as −1.0 NRS points. Thirty-six patients were enrolled over a period of 3 years, starting from July 2019. Reduction in NRS at 1 h was 4.1 (95% confidence interval [CI]: 2.8, 5.4) in the metoclopramide group and 5.2 (95% CI: 4.2, 6.1) in the sumatriptan group, with a mean difference of −1.1 (95% CI: −2.7, 0.4), indicating that metoclopramide was not non-inferior to sumatriptan. Four patients required rescue medication: 3 (18%) in the metoclopramide group and 1 (7%) in the sumatriptan group (p = 0.34). There were no serious adverse events in either group. One hour after metoclopramide administration, migraine pain was reduced compared with baseline, but metoclopramide did not demonstrate non-inferiority for alleviating acute migraine pain compared with sumatriptan.

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  • Eugene Arbis, Maria Nerissa Dominguez, Jose Eduardo Chua, Rajendra Pra ...
    2024 Volume 4 Issue 2 Pages 99-102
    Published: November 28, 2024
    Released on J-STAGE: December 05, 2024
    Advance online publication: August 19, 2024
    JOURNAL FREE ACCESS

    This study aimed to describe the experience of scaling up hepatitis B virus (HBV) testing and treatment services during the COVID-19 pandemic in Central Luzon, Philippines. In 2019, service delivery networks (SDN) were established across all health system levels, linking tertiary and secondary care to primary units. Routine screening began at primary healthcare facilities, increasing HBV case detection. Community outreach improved public screening. However, the pandemic severely disrupted services, leading to the implementation of telephone hotlines and courier services for chronic treatment support. A pilot project review from August 2019 to September 2020 revealed that over 50,000 individuals were screened, with over a thousand testing positive for HBV. Thirteen percent of positive cases were eligible and enrolled for treatment. The pilot demonstrated successful scaling of HBV testing and treatment and the ability to adapt service delivery during the pandemic.

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  • Crystal Amiel Estrada, Masahide Usami, Naoko Satake, Ernesto Gregorio ...
    2024 Volume 4 Issue 2 Pages 103-107
    Published: November 28, 2024
    Released on J-STAGE: December 05, 2024
    Advance online publication: August 19, 2024
    JOURNAL FREE ACCESS

    COVID-19 adversely affected mental health care and service delivery globally. Continuing its thrust on improving child and adolescent mental health, the National Center for Global Health and Medicine conducted a training program in collaboration with the University of the Ryukyus, University of the Philippines Manila, the National Center for Mental Health, and the Philippine Society of Child and Adolescent Psychiatry in 2020 and 2021 to discuss the situation, challenges, and good practices in mental health treatment, care, and promotion for children and adolescents during the COVID-19 pandemic. Composed of 15 on-demand lectures and a webinar on three general mental health themes, the training identified the need for strengthening the provision of care not only in specialized health facilities but also in empowering communities in addressing children and adolescent mental health concerns. Collaboration between different stakeholders is needed to ensure child and adolescent well-being during public health emergencies.

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  • Shiori Nagatani, Kazuki Miyazaki, Toyomitsu Tamura, Kyoko Koto-Shimada ...
    2024 Volume 4 Issue 2 Pages 108-111
    Published: November 28, 2024
    Released on J-STAGE: December 05, 2024
    Advance online publication: August 19, 2024
    JOURNAL FREE ACCESS

    The quality of national licensing examinations is critical to ensuring a competent health workforce. This communication analyzes the process of improving examination questions for nurses and midwives in the Lao People's Democratic Republic (Lao PDR). Following the Ministry of Health's 2014 amendment to the Law on Health Care and the 2015 approval of the Strategy on Healthcare Professional Licensing and Registration System, a national licensing examination was initiated. Supported by the Japan International Cooperation Agency, the Nursing and Midwifery Board has conducted the annual examination since 2019, with 2,000 candidates participating to date. A continuous quality improvement cycle involving statistical analysis, revision, and new question creation has been implemented. Results showed significant improvement in key indicators such as correct answer rates and pointbiserial correlations. These efforts highlight the importance of continuous quality improvement and collaboration between educators and clinicians, providing a model for enhancing healthcare professional licensing examinations.

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