With the information society caused by the spread of the internet, various information efforts have also been made in the health and public health fields. From artificial intelligence (AI), big data, the Internet of Things (IoT) to block chain technology, various methods of utilization are examined and expected in the health care field.
Meanwhile, in connection with the amendment of the revised Personal Information Protection Act in 2017, it seems that the handling of personal information protection in medical research severely seems to be tightened, data with personal information can be used by the new next generation medical infrastructure law, and systems to use these data are starting.
In order to conduct health policy based on scientific evidence, it is necessary to interpret information by making good use of the latest information technology.
Information technology has been heralded as a potential silver bullet for problems pertaining to the health care system in Japan. Therefore, the government has made various efforts to exploit the potential of the technology. Nevertheless, information sharing of patient data across medical institutions is still uncommon. Information technology rarely contributes to the quality of medical care, but not to say it is absent. Such a situation is partly ascribed to the lack of human resources that nurture the innovation and popularization of information technologies in healthcare. Accordingly, the government's IT Strategic Headquarters recommended establishing a foundation for human resources development to support informationization of regional healthcare systems, in ”Priority Policy Program ―2007„.
This recommendation led the National Institute of Public Health to found a program, the Information and communication technology Coordinator Training Program (ICTP), targeting local government officials, in 2010. This program comprises three days of schooling and two months of distance learning. Accordingly, it is impractical to educate officials to master all the topics, healthcare, information systems, and their administration in such a short period. Therefore, the program aims at accommodating a community,
instead, for local government officials who are in charge of informatization of healthcare so that they can share the challenges faced and their solutions. Since its establishment, the program has graduated more than 280 officials in eight years, and they have voluntarily formed a community. Further, we have constructed a comprehensive list of projects for informatization of healthcare in Japan. The community is expected to serve for public policy through further growth in the future.
To promote activities for ICT conversion in the field of health and medical care in Japan, telemedicine and medical big data are particularly emphasized. Nowadays, efforts are under way to strengthen the foundation including the preparation of guidelines related to the doctor's law and the creation of NDB open data.
PDCA through organization-crossing becomes important because health medical welfare programs are closely related. Niikawa health center cooperated with the Toyama prefectural office in inclusive care and data health by this thesis, and the kinds of analysis tools and publication data utilized were introduced. PDCA by organization crossing is related to 1) cooperation in the organization of health centers, 2) bidirectional cooperation with the prefectural office and health centers, 3) cooperation with health centers and cities and towns, 4) cooperation with health centers and related groups. Strategies according to the situation of the area are necessary for and purpose of PDCA by organization-crossing. PDCA using analysis tools and publication data becomes important to inclusive care and data health. To promote health governance, I proposed four measures.
By the increased information security, we performed questionnaires to realize current status of local government’s network system, especially convenience, usability, deterioration of internet connection environment, complexity of downloading/receiving file from the internet, etc. We conducted questionnaires to all the director of public health center of Japan in 2017.
From the questionnaire, there was many comments about the increased security issues. 66% knew about the distance training of the National Institute of Public Health. Moreover, 72% was able to access the remote training address of public health center director's computer. Furthermore, movie viewing availability was only 40%.
Although 47% is permitted for distance training, only 24% of the work is secured except for office desks, for on weekdays, due to telephone calls, customer response, most of them are supposed to take classes such as nighttime etc. Regarding viewing of motion pictures, we also speculated that most them are difficult to view, both network connection and timing.
It is now clear that due to the high security at the local government network system, system redesigning is required for the accurate action at the health crisis outbreak.
Data health initiatives require that we are able to derive evidence from an observational database using Real World Data (RWD) collected exclusively. As the issues related to database design, RWD requires integration into the standard information model and controlled terminologies, inter-organization calibration on such as measurement results, identification and tracking of patient individuals, and bias problems related to data sources. Regarding these issues, standardization of ETL method from RWD, definition of standardized database structure, developing proper methodology to define cohorts, identification of the sources of RWD data and development of quality measures, and ensuring coverage on all cohorts and time series are the highest priority research topics of the medical big data era. We focused on methodologies for defining a common data model for an observational research database and proper phenotyping for the medical informatics concerned. We have investigated the PheKB repository that publishes phenotyping methods in the eMERGE project, and the OMOP Common Data Model and standard vocabulary developed by in OHDSI project. We also propose that rather than trying to implement international CDM in a single step, we should set up two projects. One is promoting the development of a CDM consortium so that electronic medical vendors properly integrate their EHR system and DWH regarding Japanese standard terminologies. The other is that the researcher should develop the mapping tools that map between domestic and international CDM and Terminologies leveraging the CDM.
Clinical Innovation Network (CIN) is a new strategy supported by Ministry of Health, Labour, and Welfare, Japan, to improve the initiative of clinical development. This strategy enables efficient clinical trial by utilizing patient registry that is a primary key source of Real World Data (RWD). CIN is a concept that promotes post-marketing surveillance and clinical trials. Since 2009, the muscular dystrophy patient registration system (Registry of Muscular Dystrophy: Remudy) is being operated. To use the registry internationally, it is necessary to set the same collection items. Standards on collection items are established from the Global Rare Disease Registry Data Repository (GRDR) in the United States and the European Union Committee of Experts on Rare Diseases (EUCERD) in Europe as the minimum collection items for the registry; however, there are no standards such as GRDR and EUCERD in Japan. Clinical Data Interchange Standard Consortium (CDISC) is a non-profit organization that proposes global standards for data sharing, exchange, reuse in medical research, and related areas of healthcare. CDISC has high versatility and defines CDISC standards applicable to clinical trial data of various diseases, diabetes, Alzheimer’s and so on. In 2017, CDISC also published the Duchenne Muscular Dystrophy Therapeutic Area User Guide (TAUG-DMD) data category for Duchenne muscular dystrophy. In a cross-sectional study, problems such as missing data due to missing collection items and differences in responses for each study occur; therefore, it is important to use data standards such as CDISC standards for building registries. Considering the ease of data collection in clinics, it is crucial to have a viewpoint of both the clinical and data standards. Therefore, in order to promote the utilization of RWD, it is imperative to develop and disseminate international standards for registries. Currently, we are working on a survey and reviewing the international standards such as TAUG-DMD, GRDR, and EUCERD with an aim to standardize the collection items encompassing various patient registries.
Objectives: The purpose of this study is to grasp recent global deal trends on academic drug discovery by comprehensively and quantitatively analyzing the deals between academia and industry in the US and Europe.
Methods: During 2010-2015, academic drug discovery deals in the US, the UK, France, Italy, and Spain were analyzed using Cortellis Deals Intelligence database provided by Clarivate Analytics Co., Ltd.
Results: 1) Total number of deals related to academic drug discovery was 703. Private sector company was a main buyer of the deals (672 deals, 95.6% of total deals）2) Most of the deals were licensing (669 deals, 95.2% of total deals). The 669 deals showed the below characteristics. 3) Oncology-related deals had the greatest percentage of total, followed by deals related to immunology-inflammation-vascular disease, diabetes, and peripheral and central nervous system diseases. 4) Technology deals related to low molecular weight compound, diagnostics, and therapeutic antibodies were dominant and these deals accounted for 45 % of total. 5) Most deals were signed at the basic research and preclinical development stage. Recent deals tended to be dominantly signed at the basic research stage. 6) Fifteen percent of total deals were signed with option.
Conclusions: So far as the authors know, this paper presents the first comprehensive deal analysis about academic drug discovery and demonstrates overall trends in the US and Europe.
Objectives: This study aims to reveal the current status regarding the regulation of long-term care workers to provide basic information to address the issue of quality of long-term care in low and middle-income countries from the Asia-Pacific region that face rapid aging.
Methods: We conducted interviews with administrative officers and reviewed literature and online information related to aging policy from Fiji, Sri Lanka, Thailand, and Vietnam. Data were classified into categories, such as job title, license, job description, and competent authority.
Findings: Sri Lanka had Protection of the Rights of Elders Act and Thailand had National policy on long-term care, which were the basis of the regulation of the long-term care workers such as the licensure and education program. In those two countries, there were licenses involved in the long-term care management work in the community and home-based care as well as caregiver who provide the care. In Fiji and Vietnam where had no regulation on long-term care workers, it was empirically perceived that nurses were engaged in medical assistance, while caregivers supported the daily activities of patients. In Fiji, there was the course to obtain the certificate of caregiver in the college, but the people who graduated the course tended to migrant to foreign countries.
Conclusion: The regulation system of long-term care workers have not developed or under the process of the development in target countries. Towards quality of long-term care in low and middle income countries, it would be the challenge to develop the sustainable system with available resource.
Objective: To investigate the management of hypertension including measures against arteriosclerosis by analyzing data from residents undertaking a Japan Health Insurance Association (JHIA; called Kyoukai Kenpo) health examination for lifestyle-related disease prevention at the Ehime Prefecture Imabari Public Health Center.
Method: This study of 9,709 people was conducted in 2012 at the Ehime Prefecture Imabari Public Health Center as part of JHIA’s health examinations to help prevent lifestyle-related diseases. The subjects were classified into four groups: normotensive, untreated hypertensive, normotensive taking antihypertensive medication, and hypertensive taking antihypertensive medication. (The latter three groups were defined as the “three hypertension groups”.) The normotensive group was compared with the three hypertension groups with the results expressed as mean values of the examination data using two-way analysis of variance. The responses in the health examination questionnaire between the normotensive group and three hypertension groups were compared using an age-adjusted odds ratio. The history of stroke, heart disease, and chronic kidney disease, and risk factors in men aged 50–75 years were inferred.
Results: The proportion of people with inadequately controlled hypertension greater than 139/89 mmHg represented half the hypertensive taking antihypertensive medication group. The mean values for abdomen circumference, triglyceride level, liver function, and blood glucose level were significantly higher in all three of the hypertension groups in both men and women than in the normotensive group. The mean value for HDL cholesterol was significantly lower in the women in all three of the hypertension groups and the men in the normotensive taking antihypertensive medication group than the normotensive group. The age-adjusted odds ratio of the “yes” response for the following three items in the health examination questionnaire was significantly higher in the three hypertension groups than the normotensive group: “weight increased more than 10 kg from age 20”, “eating speed is faster than others”, and “drink alcohol every day or drink a lot”. The results of multiple logistic regression analysis show the men aged 50–75 years in the hypertensive taking antihypertensive medication group have a history of stroke, heart disease, and chronic kidney disease. Further, the J-curve effect was observed in those aged 50–75 years taking antihypertensive medications in which coronary artery disease increases due to excessive lowering of diastolic blood pressure.
Conclusion: This research clarified that the factors constituting metabolic syndrome accumulated more in the three hypertension groups compared with the normotensive group. Consequently, we suggest that preventing the onset or exacerbation of arteriosclerotic diseases is achieved not only by medication for each disease but also by the need for a radical improvement in the treatment of metabolic syndrome such as reducing visceral fat．