Measures for co-medicals in postwar Okinawa: scarcity of the personnel for allocating vaccinations

Background

The shortage of doctors in postwar Okinawa has led to the creation of co-medicals. They were called medical service personnel and authorized to handle certain medical treatments. This included tasks such as providing injections and vaccinations under the supervision of the doctor in the health center.

Issue/problem

The system of co-medicals only applied in Okinawa and not in Japan. As such, when Okinawa was reverted back to Japan in 1972, it was proposed to abolish the system. In the current emergency of the new coronavirus pandemic, we are facing a similar situation in terms of the shortage of medical personnel.

Description of the problem

In Japan, like many countries, there is a shortage of health resources due to the COVID-19 pandemic. The focus will be on healthcare personnel, those who have taken on the role of COVID-19 vaccinators in Japan, and a comparison of the situation in other countries.

Results

In Japan, vaccinations are legally limited to being administered by doctors and nurses. However, pharmacists have taken on the role of administering vaccinations in the UK, US, Ireland, Canada, and Italy, thus COVID-19 vaccinations could be easily integrated into these routine procedures.Even vaccinations by medical students have been carried out. In addition, non-healthcare volunteers have been trained as vaccinators in UK and Italy. The coverage has reached 50% in the UK, 42% in the US, and 30% in Canada, whereas 1.8% in Japan in April (Our World in Data, 2021).

Lessons

Although the COVID-19 situation is substantially different from the case of postwar Okinawa, it will be necessary to take resilient measures to solve the medical personnel shortage. Additionally, the strict measures of limiting vaccinations by medical doctors may need to be reconsidered in Japan. Establishing a system of allowing co-medicals to have a shared role could offer innumerable benefits for all.

Key messages

Expanding the task of vaccinations to co-medicals has had beneficial results in several countries. Dividing roles of medical doctor need to be considered.

Assessment of Available Tools for Monitoring Wheat Midge (Diptera: Cecidomyiidae)

Wheat midge, Sitodiplosis mosellana Géhin, is an invasive pest of wheat, Triticum aestivum L. (Poaceae) throughout Canada and the United States. The applicability of available monitoring tools, including sex-pheromone baited traps, yellow sticky cards, and soil core sample surveys, in the northern-most agroecosystem of its invasive range has not been assessed. In this study, the attraction of male wheat midge to two Delta traps (green and orange) baited with one of three pheromone lures (a flex lure and two red septa lures from different sources) were compared. The efficacy of three yellow sticky cards (7 × 12 cm, 14 × 18 cm, and 14 × 18 cm rolled into a cylinder) for capture of male and female midge was assessed. Larvae were extracted from wheat heads sampled at the same sites to determine relationships with earlier adult trap capture. More male adult midges were captured in pheromone-baited traps with a greater surface area and in traps baited with the Scotts flex lure than the Great Lakes IPM septa lure, which had higher and more variable pheromone release rates. The smaller yellow sticky cards captured more male and female midges than the larger yellow sticky cards, regardless of shape. The number of female midges captured on yellow sticky cards predicted the number of larvae in wheat heads. The number of male midges captured in pheromone-baited traps did not predict larval density. Relationships were found between the number of overwintering cocoons recovered in soil core samples and emerging midges the following spring.

[A case of breast cancer with multiple organ metastases responding remarkably to combination therapy of CAF (cyclophosphamide, adriamycin and 5-FU), 5'-DFUR and MPA (medroxyprogesterone acetate)]

A 52-year-old woman complaining of breast tumor was diagnosed as having advanced breast cancer (T4bN1M1-Stage IV), with metastasis of multiple organs (lung, liver, mediastinal and unilateral axillary lymph nodes) after which she underwent tumorectomy. Postoperative adjuvant therapy was performed using combined chemoendocrine therapy (CAF + 5'-DFUR + MPA). Following the endocrine therapy, the metastatic lesions of the liver and lung had disappeared. The adverse effects were not remarkable. Complete remission was continued for 2 years and 3 months, and the patient enjoyed a favorable quality of life.

Surgery of gastric cancer in patients over 80 years old

A retrospective study on postoperative complications and factors affecting prognosis was performed on elderly patients with gastric cancer. We studied the correlation of age, pathological depth, preoperative laboratory data, physical status, duration of surgery, volume of blood loss, blood transfusion, curability, and extent of lymph node dissection to postoperative complications and prognosis in 47 patients with gastric cancer over 80 years old. Preoperative function of lung and liver frequently showed abnormal data. Postoperative complications were noted in 47% of patients, especially in the pulmonary system, liver and heart. Curability and extent of lymph node dissection were the significant factor affecting survival. Some mortalities caused by initial malignancy were recognized in the conservative lymph node dissection in the stage I. The incidence of postoperative complications was not significantly different according to extent of lymph node dissection. Blood transfusion was the only significant factor for the incidence of postoperative complication. The most frequent cause of death was the initial malignancy. We recommend that a low grade lymph node dissection should not be readily chosen for elderly patients in early cases.

[Evaluation of hepatic arterial infusion chemotherapy for gastric cancer]

Hepatic arterial infusion chemotherapy (HAIC) using implantable reservoir was performed for liver metastases of gastric cancer and the therapeutic effects were evaluated. A catheter was placed in the hepatic artery via left subclavian artery or by direct insertion at laparotomy. Cisplatin, adriamycin and 5-FU were administered. The liver metastases of gastric cancer without unresectable primary tumors and hepatectomy were divided into two groups, 16 HAIC cases (11 synchronous, 5 metachronous metastases) and 23 systemic chemotherapeutic cases (10 synchronous, 13 metachronous metastases). As a result, HAIC revealed a 62.5% response rate. The 50% survival period was 395 days for HAIC, and it was significantly prolonged compared with 198 days for systemic chemotherapy (p < 0.01). But 4 among 10 cases responding to HAIC showed subsequent extrahepatic spread of the disease. Treatment of these extra-hepatic lesions is difficult.

Comparing the results of a Monte Carlo analysis with EPA's reasonable maximum exposed individual (RMEI): a case study of a former wood treatment site

In the United States, there are about 250 former sites that treated wood with preservatives that are now in need of some degree of remediation. The soil at many of these sites is contaminated with creosote, polycyclic aromatic hydrocarbons (PAHs), polychlorinated dibenzo-p-dioxins (PCDDs), and polychlorinated dibenzofurans (PCDFs). This paper compares the results of the current USEPA point estimate (deterministic) approach for predicting the health risks associated with exposure to PCDDs/PCDFs in soil with the results of a probabilistic approach which uses a Monte Carlo analysis. At many of these wood treatment sites the hazard posed by the PAHs, and especially pentachlorophenol, can be much greater than that due to PCDD and PCDFs; however, because at this site the health risk associated with PAHs was deemed negligible by ATSDR, only PCDDs/PCDFs were evaluated. Octachlorodibenzo-p-dioxin (OCDD) and octachlorodibenzofuran (OCDF) congeners were evaluated independently from the other congeners due to their prevalence in the environment and the availability of congener-specific data. The results of the reevaluation of the rodent bioassay data for 2,3,7,8-TCDD were considered in the probability distribution for the cancer potency factor. The authors' analyses indicate that when assessing exposure to soil via inhalation, ingestion, and dermal contact, the current regulatory approach used to estimate the reasonable maximally exposed individual (RMEI) (USEPA, Risk Assessment Guidance for Superfund, Vol. 1, Part A, 1989) can predict risks which are 10- to 100-fold greater than the 95th percentile risk predicted by a Monte Carlo analysis.