Lessons learned from the history of postgraduate medical training in Japan: from disease-centred care to patient-centred care in an aging society.

BACKGROUND: Health workers, the core of health service delivery and a key driver of progress towards universal health coverage, must be available in sufficient numbers and distributed fairly to serve the entire population. In addition, the planning and management of the health workforce must be responsive to the changing needs of society, including changes in age structure and epidemiology. Considering these issues, this paper examines in historical perspective the evolution of postgraduate medical training and practice in Japan, from the late nineteenth century to the present. MAIN TEXT: When the first medical schools were established in the country towards the end of the nineteenth century, Japan was a largely agrarian society, with a population of about 30 million and an average life expectancy of 30-40 years. During the twentieth century, life expectancy and the national population continued to increase in a context of rapid economic growth. Since the 1980s, another demographic transition has occurred: low fertility rates and an aging society. As a result, the inputs and skills required from health professionals have changed considerably over time, posing new challenges to the national health sector and the management of human resources for health. CONCLUSIONS: The case of Japan offers valuable lessons for other countries experiencing a rapid epidemiological and demographic transition. To provide medical care that meets health priorities in the communities, we must consider not only the training of specialists, but also ensure the availability of a large cadre of physicians who possess basic skills and can provide patient-centred care. Furthermore, the Japanese experience shows that a highly hierarchical system and organisational culture are ill-suited to respond quickly to the changing demands of society

For more than money : willingness of health professionals to stay in remote Senegal

The study was funded through a Research Grant for International Health, H25-11, from the Ministry of Health, Welfare and Labour, Japan (http://www.ncgm.go.jp/kaihatsu/), and undertaken as part of the project Réseau Vision Tokyo 2010, funded by the Japan International Cooperation Agency. Acknowledgement The authors would like to express their profound gratitude to the fieldwork team and to the health professionals who responded to the survey questionnaire. Thanks also to four reviewers whose comments have improved the paper. The datasets used and/or analysed in the study are available from the corresponding author on reasonable request.Peer reviewedPublisher PD

Early-term birth and hypoglycaemia

Background : The effect of early-term birth on the development of hypoglycaemia in large-for gestational-age (LGA) neonates is yet to be clarified. This study aimed to clarify the association between hypoglycaemia and early-term birth in LGA neonates. Methods : This single-centre retrospective cohort study evaluated LGA neonates born at term at Tsurugi Municipal Handa Hospital, Japan. Blood glucose levels were measured immediately and at 1, 2, and 4 hours after birth. The association between early-term birth and hypoglycaemia was evaluated using logistic regression analysis. The prevalence of severe hypoglycaemia and hypoglycaemia according to its timing of development was analysed using Fisher’s exact test. Results : In total, 295 neonates were included. Among them, 113 neonates (38.3%) were born at early term and 91 infants (30.8%) had hypoglycaemia. Logistic regression analysis showed a significant association between early-term birth and hypoglycaemia (adjusted odds ratio [95% confidence interval] : 2.691 [1.597 to 4.535]). However, there was no significant between-group difference among those with severe hypoglycaemia. Conclusions : Among LGA neonates, early-term birth is positively associated with neonatal hypoglycaemia. This indicates that among LGA neonates, those born at early term require more careful observation for hypoglycaemia than do those born at later term

Histamine-1 receptor is not required as a downstream effector of orexin-2 receptor in maintenance of basal sleep/wake states

金沢大学医薬保健研究域医学系Aim: The effect of orexin on wakefulness has been suggested to be largely mediated by activation of histaminergic neurones in the tuberomammillary nucleus (TMN) via orexin receptor-2 (OX2R). However, orexin receptors in other regions of the brain might also play important roles in maintenance of wakefulness. To dissect the role of the histaminergic system as a downstream mediator of the orexin system in the regulation of sleep/wake states without compensation by the orexin receptor-1 (OX1R) mediated pathways, we analysed the phenotype of Histamine-1 receptor (H1R) and OX 1R double-deficient (H1R-/-;OX 1R-/-) mice. These mice lack OX1R-mediated pathways in addition to deficiency of H1R, which is thought to be the most important system in downstream of OX2R. Methods: We used H 1R deficient (H1R-/-) mice, H1R -/-;OX1R-/- mice, OX1R and OX 2R double-deficient (OX1R-/-;OX 2R-/-) mice, and wild type controls. Rapid eye movement (REM) sleep, non-REM (NREM) sleep and awake states were determined by polygraphic electroencephalographic/electromyographic recording. Results: No abnormality in sleep/wake states was observed in H1R-/- mice, consistent with previous studies. H1R-/-;OX 1R-/- mice also showed a sleep/wake phenotype comparable to that of wild type mice, while OX1R-/-; OX 2R-/- mice showed severe fragmentation of sleep/wake states. Conclusion: Our observations showed that regulation of the sleep/wake states is completely achieved by OX2R-expressing neurones without involving H1R-mediated pathways. The maintenance of basal physiological sleep/wake states is fully achieved without both H1 and OX1 receptors. Downstream pathways of OX2R other than the histaminergic system might play an important role in the maintenance of sleep/wake states. © 2009 Scandinavian Physiological Society

A Comprehensive Framework for Human Resources for Health System Development in Fragile and Post-Conflict States

Noriko Fujita and colleagues offer a comprehensive framework for human resource system development, based upon experiences in three fragile and post-conflict health systems: Afghanistan, the Democratic Republic of Congo, and Cambodia

Assessment of Space Programs and Policies for Regional Cooperation in the Asia Pacific Region

International space cooperation in the Asia Pacific region have entered a new stage. Today a lot of nations in this region have actively developed space capabilities, and have come to use them for a variety of purposes. In addition to the long-experienced spacefaring nations such as Japan, India, and China, many emerging nations like Malaysia, Philippine, Singapore, Indonesia, Vietnam, Thailand, South Korea, etc., have made active efforts to develop space technology and applications and to undertake their space programs. Such space applications as earth observation, satellite communication, and positioning emerged in this region have tremendous potentials as a driving force for peaceful development and prosperity of the Asia Pacific region in many facets: disaster management, climate change study, national and regional security, environment management, agriculture, urban planning, geospatial program, land management, as well as the advancement of science and technology. Against this backdrop, many nations also seek to establish national space policy with an aim to set out the vision and goals of nation’s space programs. The University of Tokyo and National Institute of Advanced Studies have created a research network, Space Policy and Law Network in Asia Pacific (SPLANAP), among researchers and experts in the Asia Pacific region and started a research project to examine space policy and program directions in the region. In particular, as the first step of this research project, a comparative analysis of space programs and policy perspectives in Japan and India has been taken up to examine commonalities and uniqueness in space policies of both nations and to identify potential opportunities for the future cooperation between the two nations. Based on the previous work in this research project, this study aims to move to the next phase of the research and to extend the scope of the analysis by including several other nations, such as Malaysia, Philippine, and Singapore. While updating information on the recent developments in space programs and policy in Japan and India, as well as adding new analyses from the perspectives of the above mentioned three nations, this study will examine common interests and potential opportunities for regional space cooperation from a wider point of view

Involvement of Bruton's Tyrosine Kinase in FcεRI-dependent Mast Cell Degranulation and Cytokine Production

We investigated the role of Bruton's tyrosine kinase (Btk) in FcεRI-dependent activation of mouse mast cells, using xid and btk null mutant mice. Unlike B cell development, mast cell development is apparently normal in these btk mutant mice. However, mast cells derived from these mice exhibited significant abnormalities in FcεRI-dependent function. xid mice primed with anti-dinitrophenyl monoclonal IgE antibody exhibited mildly diminished early-phase and severely blunted late-phase anaphylactic reactions in response to antigen challenge in vivo. Consistent with this finding, cultured mast cells derived from the bone marrow cells of xid or btk null mice exhibited mild impairments in degranulation, and more profound defects in the production of several cytokines, upon FcεRI cross-linking. Moreover, the transcriptional activities of these cytokine genes were severely reduced in FcεRI-stimulated btk mutant mast cells. The specificity of these effects of btk mutations was confirmed by the improvement in the ability of btk mutant mast cells to degranulate and to secrete cytokines after the retroviral transfer of wild-type btk cDNA, but not of vector or kinase-dead btk cDNA. Retroviral transfer of Emt (= Itk/Tsk), Btk's closest relative, also partially improved the ability of btk mutant mast cells to secrete mediators. Taken together, these results demonstrate an important role for Btk in the full expression of FcεRI signal transduction in mast cells