Progress and challenges for the Japanese immunization program: Beyond the “vaccine gap”

The Japanese immunization program has made considerable recent progress. The introduction of several new vaccines, especially foreign-produced vaccines, and the inclusion of important new vaccines in the National Immunization Program (NIP) are closing the “vaccine gap”, i.e., the delay in the Japanese immunization program relative to programs in other developed countries. Major progress in the Japanese immunization program since 2014 includes (1) elimination of measles in March 2015, (2) introduction of a varicella vaccine as a routine immunization in the NIP in October 2015, and (3) introduction of hepatitis B virus vaccines as routine immunizations in the NIP in October 2016. Despite these promising developments, important issues remain. First, the government withdrew the active recommendation for human papilloma virus vaccines temporarily in 2013. The withdrawal has continued and unresolved despite new scientific evidence confirming the safety of these vaccines. Second, a few important voluntary vaccines, including vaccines for mumps and rotavirus, have not been included in the NIP since their introduction to Japan. Finally, there are concerns related to a shortage of mandatory domestic vaccines, which was caused by a natural disaster in the area where a vaccine-producing factory was located. Additionally, the manufacturer included unauthorized additives in some vaccine products with falsifying the production-process records. To avoid problems related to vaccine shortages, essential vaccines need to be stockpiled, and the future vaccine needs for children should to be discussed. New initiatives must continue to close the vaccine gap, as this will protect children living in Japan from vaccine-preventable diseases.     

Challenges in evaluating Welfare to Work policy interventions: would an RCT design have been the answer to all our problems?

Background  

UK policy direction for recipients of unemployment and sickness benefits is to support these people into employment by increasing 'into work' interventions. Although the main aim of associated interventions is to increase levels of employment, improved health is stated as a benefit, and a driver of these interventions. This is therefore a potentially important policy intervention with respect to health and health inequalities, and needs to be validated through rigorous impact evaluation.     

From empathic mind to moral behaviour: the “who”, “why” and “how”

In this paper, I start by suggesting a new definition of empathy. I go on by answering the question of “Who feels empathy?”. I list some examples of people, illustrating how the level of feeling empathy differs from one category of people to another. It’s actually almost everybody who feels empathy: the baby, the good Samaritan and the other two priests, the tax evader, the psychopath, the judges, juries, lawyers, the politician, the bully adolescent, the therapist, etc.… Then I explain, “Why empathy is experienced/felt differently?”, by drawing on some neuroscience data, and some literature in psychology or philosophy along with some personal suggestions or assumptions. Just to mention one plausible data: we know that the human brain is half developed at birth. It takes twelve to fourteen years for the brain to fully develop. And the frontal lobe continues to develop until the third decade of life! I suggest we must attend to these phases of brain development to learn empathy since that is when the plasticity of the brain and the learning kick-in. Hence, the third section of the paper demonstrates “How can we develop an empathic mind/behaviour given the nature of our empathic brain?”: with some supportive research and studies, I justify the statement that “ideally from early age, and all the way up to adulthood, empathy can be learned through nurturing, education, imitation…, through alternative realities such as mindfulness and awareness, and through therapy, memory improvement, training programs, etc.…” In the conclusion, I assert, using some philosophical thoughts and analogies, that a fully developed empathic behaviour, that embraces all three aspects cognitive, affective and compassionate empathy, being the opposite of indifference, is the vehicle to a peaceful, harmonious and just society.     

Teaching CAM: From “The Ideal” to “The Real”

ABSTRACT

In this reflective essay, principles and practicalities useful in creating and maintaining successful partnerships between university researchers and local K-12 schools are discussed. Prioritizing reciprocal relationships in which each party's interests are advanced, planning for long-term and sustainable collaborations, using clear and transparent communication, and working from a respectful position regarding the norms of the school are put forward as guidelines.     

Failing Siracusa: governments’ obligations to find the least restrictive options for tuberculosis control

One of the world’s leading causes of death, tuberculosis (TB) remains a stigmatized and feared disease. Prevention, diagnosis, and adherence to TB treatment remain a challenge for many people, including migrants, those with alcohol and drug dependency, sex workers, people living with the human immunodeficiency virus, and individuals with disabilities. Low levels of TB treatment literacy and ignorance of transmission risks are common, and—along with inadequate funding for treatment support—contribute to patients’ non-adherence to treatment. Recent cases involving the detention of individuals with TB in Kenyan and Canadian correctional facilities illustrate the circumstances under which individuals interrupt treatment and how health authorities seek restrictive measures to oversee and compel treatment. The legitimacy of restrictive measures is often defended by international public health authorities in relation to the non-binding Siracusa Principles. Yet in practice, as illustrated by examples from Kenya and Canada, government authorities and local laws sometimes do not fully meet, or entirely disregard, the requirements in the Siracusa Principles that restrictions on rights in the name of public health be strictly necessary and the least intrusive available to reach their objective. In addition, more specific standards are required at the international level to guide states’ development and use of rights-restricting measures to address TB.     

Paying for Cures: Perspectives on Solutions to the “Affordability Issue”

Curative therapies and other medicines considered “game-changing” in terms of health gain can be accompanied by high demand and high list prices that pose budget challenges to public and private payers and health systems—the so-called affordability issue. These challenges are exacerbated when longer term effectiveness, and thus value for money, is uncertain, but they can arise even when treatments are proven to be highly cost-effective at the time of launch. This commentary reviews innovative payment solutions proposed in the literature to address the affordability issue, including the use of credit markets and of staged payments linked to patient outcomes, and draws on discussions with payers in the United States and Europe on the feasibility or desirability of operationalizing any of the alternative financing and payment strategies that appear in the literature. This included a small number of semistructured interviews. We conclude that there is a mismatch between the enthusiasm in the academic literature for developing new approaches and the scepticism of payers that they can work or are necessary. For the foreseeable future, affordability pressures will continue to be handled by aggressive price bargaining, high co-pays (in systems in which this is possible), and restricting access to subgroups of patients. Of the mechanisms we explored, outcomes-based payments were of most interest to payers, but the costs associated with operating such schemes, together with implementation challenges, did not make them an attractive option for managing affordability.     

Moving Beyond “Health Education”: Participatory Filmmaking for Cross-Cultural Health Communication

In the process of developing short films with women in Australian Aboriginal (Yol?u) communities in northeast Arnhem Land, questions arose about how the content and the process of production were defined and adjusted to suit both parties. This research examines how filmmakers take roles as health educators and how Yol?u women as the “actors” define and direct the film. It explores ways that the filmmakers tried to ensure that Yol?u identity was maintained in a biomedical agenda through the use of storytelling in language. An important dialogue develops regarding ownership and negotiation of health information and knowledge, addressing this intersection in a way that truly characterizes the spirit of community-based participatory research. Although the filmmaking processes were initially analyzed in the context of feminist and educational empowerment theories, we conclude that Latour’s (2005) theory of actor networks leads to a more coherent way to explore participatory filmmaking as a health education tool. The analysis in this work provides a framework to integrate health communication, Indigenous women’s issues, and filmmaking practices. In contrasting participatory filmmaking with health promotion and ethnographic film, the importance of negotiating the agenda is revealed.     

Welcome to the “New” Journal of Nutrition for the Elderly

In 2011, the earliest segment of the baby boom generation turned 65 years of age. This event marks the beginning of a new phase of growth of the older adult population in the United States and is in line with what is referred to worldwide as “population aging.” By 2030, older adults will comprise 20% of the U.S. population. With the impending increase in the older adult population, the United States is unprepared to handle the accompanying social and economic impact of growing rates of age-related diseases such as diabetes, hypertension, and cardiovascular disease. These diseases have nutritional determinants and, as such, they signify the need for effective preventive nutrition initiatives to address population aging in the United States. Comparatively, the European Union (EU) is projected to reach an older adult population of 24% by 2030. In this special article we evaluate nutrition initiatives for older adults in the United States and also examine nutrition initiatives in the European Union in search of an ideal model. However, we found that available data for EU initiatives targeted at population aging were limited. We conclude by offering the proposal of a physician-based model that establishes the primary care physician as the initiator of nutrition screening, education, referrals, and follow-up for the older adult population in the United States as a long-term goal. Apropos of the immediate future, we consider barriers that underscore the establishment of a physician-based model and suggest objectives that are attainable. Although the data are limited for the European Union, this model may serve to guide management of chronic diseases with a nutritional component in economies similar to the United States worldwide.     

“A delicate diplomatic situation”: tobacco industry efforts to gain control of the Framingham Study

BackgroundThe Framingham Heart Study (henceforth Framingham) is among the gold standards for epidemiological research. Being a prospective cohort study of 5,000+ men and women, it provided early findings about the causes of coronary heart disease (CHD), following a cohort over the course of 24 years. After US government funding ended, the tobacco industry funded Council for Tobacco Research (CTR) provided continued funding for analyses related to smoking.ObjectiveThis study sought to understand the tobacco industry's motivation and activities in funding Framingham.Study Design and SettingWe analyzed previously undisclosed tobacco industry documents, conducting iterative searches of the Legacy Tobacco Documents Library (http://legacy.library.ucsf.edu/), and assembled a historical case study.ResultsCTR funded Framingham to obtain full access to Framingham data. CTR planned for long-time industry consultant Carl Seltzer to reanalyze them to suggest that tobacco-related morbidity and mortality primarily resulted from “constitutional” factors, such as age or ethnicity. Once data were obtained, CTR terminated funding for the Framingham principal investigator, who disagreed with Seltzer. Seltzer's critical analyses of subsequently published work by the Framingham team created confusion about the association between CHD and cigarette smoking.ConclusionResearchers accepting tobacco industry funding risk losing control of data, analysis, and publication.     

Modernized education of traditional medicine in Korea: is it contributing to the same type of professionalization seen in Western medicine?

In Korea, the teaching of traditional medicine (TM) has been institutionalized for more than five decades, and accordingly the formulated educational system has a structure similar to that of Western medicine (WM). The authors therefore assumed that TM and WM students would share similar attitudes and values regarding professionalism. To test this hypothesis, we administered a questionnaire to TM students nationwide, and compared the results with those of WM students. We found that, despite the large differences in philosophy, concepts, and clinical content between the medical disciplines, the professional socializations of TM and WM students were progressing in a similar way.     

“A community system”: A critical foundation for the epidemic prevention and control of SARS-CoV-2

In response to COVID-19 that has constituted a global pandemic, countries around the world have successively adopted a myriad of prevention and control measures. As the first country with the COVID-19 outbreak, the Chinese government has adopted a series of timely and strict prevention and control measures against the spread of the SARS-CoV-2, which has effectively slowed down the spread of the SARS-CoV-2 and created a valuable window for the international community to overcome the epidemic. China's experience in combating the COVID-19 has shown that building a community prevention and control system is essential to control the spread of coronavirus. As the backbone of the epidemic prevention and control system, the community prevention and control system plays an important role in improving the pattern of disorderly medical treatment, screening suspected patients, preventing the input of pathogens, ensuring residents' medical needs, stabilizing public sentiment, reducing disease fear, and maintaining residents' national security. At the same time, it also exposed the problems of the community prevention and control epidemic system in terms of infrastructure, human resources, and internal systems. Based on this, this article suggests that we should improve the hardware facilities of community, improve the internal mechanism of the community, strengthen the stability of the community talent team, improve the level of linkage between the community and other departments to prevent and control the spread of SARS-CoV-2, effectively use information technology and actively mobilize social forces to help community prevention and control COVID-19.