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In April 2020, a coronavirus disease (COVID-19) outbreak occurred on the cruise ship Costa Atlantica in Nagasaki, Japan. Our outbreak investigation included 623 multinational crewmembers onboard on April 20. Median age was 31 years; 84% were men. Each crewmember was isolated or quarantined in a single room inside the ship, and monitoring of health status was supported by a remote health monitoring system. Crewmembers with more severe illness were hospitalized. The investigation found that the outbreak started in late March and peaked in late April, resulting in 149 laboratory-confirmed and 107 probable cases of infection with severe acute respiratory syndrome coronavirus 2. Six case-patients were hospitalized for COVID-19 pneumonia, including 1 in severe condition and 2 who required oxygen administration, but no deaths occurred. Although the virus can spread rapidly on a cruise ship, we describe how prompt isolation and quarantine combined with a sensitive syndromic surveillance system can control a COVID-19 outbreak., Emerging Infectious Diseases, 27(9), pp. 2251-2260; 2021

We developed and introduced a browser-based health monitoring system in the outbreak of COVID-19 on a cruise ship in Japan occurred on the Costa Atlantica. This remote monitoring minimized the activity of support staff onboard the ship and prevented their infection.

In recent years, people's demands for medical services are increasing and, simultaneously, the overwork of health professionals has been pointed out. It is important to establish a system with which each medical professional can show higher levels of expertise and work as a team member to provide efficient and safe medical care. For this reason, a list of medical activities which can be performed by not only doctors but also other health professionals was devised by the Director General of the Health Policy Bureau on December 28th, 2007, as the "Promotion of role-sharing between doctors and other medical professionals, clerical staff, etc." In August 2009 the "Committee for the Promotion of Team Approach to Medical Care" was established and it reviewed the situation of collaboration and cooperation with doctors and other medical professionals. In the report "Promotion of Team Approach to Medical Care", which was summarized on March 19th, 2009, "Team Approach to Medical Care" was defined as "appropriate medical care provided by various medical professionals by sharing information and purposes of care while cooperating and complementing each other based on expertise." In May 2010, the "Promotion Council of Team Approach to Medical Care" was established to discuss the scope of practice for nurses and other medical professionals. As a result the council suggested to: 1) Institutionalize a training system for nurses who provide Specified Acts (a part of Assist in Medical Care), 2) Reconsider the scope of practice for radiological technologists, 3) Reconsider the scope of practice for laboratory technicians, and 4) Reconsider the implementation system for dental hygienists. We realized these policies in June 2014.

Both sagittal abdominal diameter (SAD) and waist circumference (WC) highly correlate with visceral adipose tissue (VAT) being linked to an atherogenic lipoprotein profile. However, it is uncertain whether SAD is a better correlate of atherogenic lipoprotein subfractions than WC. We examined relative associations of SAD vs WC with lipoprotein subfractions for US white and Japanese men, concurrently examining the associations of VAT vs subcutaneous adipose tissue with lipoprotein subfractions. A population-based sample of 260 white and 282 Japanese men aged 40 to 49 years was examined for VAT and subcutaneous adipose tissue by computed tomography; SAD and WC by a portable sliding-beam caliper and a measuring tape, respectively; and lipoprotein subfractions by nuclear magnetic resonance spectroscopy. Both SAD and WC were significantly and positively associated with large very low-density lipoprotein and total and small low-density lipoprotein particle concentrations, and inversely associated with large high-density lipoprotein particle concentration for both white and Japanese men. In body mass index-adjusted regression models, the significant associations of SAD remained for both white and Japanese men, whereas those of WC became nonsignificant for white men. When SAD and WC were simultaneously included into the body mass index-adjusted models, the associations of SAD remained significant and statistically stronger than those of WC for both white and Japanese men. Furthermore, the pattern of the associations of SAD with those lipoprotein subfractions was comparable to that of the associations of VAT. Sagittal abdominal diameter was comparable to VAT and stronger than WC in the associations with atherogenic lipoprotein subfractions for middle-aged, nondiabetic, white and Japanese men.

Background: The associations of serum omega-6 (n−6) fatty acids with lipoprotein subclasses at the population level are uncertain. Objective: We aimed to examine associations between major n−6 fatty acids [ie, linoleic acid (LA, 18:2n−6) and arachidonic acid (AA, 20:4n−6)] and the lipoprotein subclasses VLDL, LDL, and HDL. Design: We conducted a cross-sectional study in 1098 participants using population-based data from US white, Japanese American, Japanese, and Korean men aged 40–49 y. Serum fatty acids were analyzed by capillary gas-liquid chromatography. Lipoprotein subclasses were measured by nuclear magnetic resonance spectroscopy. Multiple linear regression models as a function of each fatty acid were used after adjustment for age, population, body mass index, pack-years of smoking, alcohol consumption, diabetes, hypertension, and omega-3 (n−3) and trans fatty acids. Results: Serum LA was inversely associated with large VLDL (β = −0.62, P < 0.001), total LDL (β = −22.08, P < 0.001), and small LDL (β = −31.89, P < 0.001) particle concentrations and VLDL size (β = −0.72, P < 0.001). Serum LA was positively associated with large HDL particle concentration (β = 0.21, P < 0.001) and HDL size (β = 0.03, P < 0.001). The patterns of association of AA with large VLDL and large HDL particle concentrations were comparable with those of LA. Conclusions: At the population level, higher serum concentrations of LA were significantly associated with lower concentrations of total LDL particles. Higher serum concentrations of LA and AA were significantly associated with a lower concentration of large VLDL particles and a higher concentration of large HDL particles. These associations were consistent across the population groups. This trial was registered at clinicaltrials.gov as {"type":"clinical-trial","attrs":{"text":"NCT00069797","term_id":"NCT00069797"}}NCT00069797.

Background and Purpose— Recent studies reported the differential effect of docosahexaenoic (DHA) and eicosapentaenoic acids (EPA). We examined the differential association of DHA and EPA with carotid intima-media thickness (IMT) in Japanese individuals in Japan and in U.S. white individuals and explored whether DHA or EPA contributes to the difference in IMT between the two groups. Methods— A population-based cross-sectional study in 608 Japanese and U.S. white men aged 40 to 49 was conducted to assess IMT, serum DHA, EPA, and other cardiovascular risk factors. Results— Japanese compared to U.S. whites had significantly lower IMT (mean±SD, 618±81 and 672±94 μm for Japanese and whites, respectively; P 2-fold higher levels of DHA and EPA. DHA, but not EPA, had an inverse association with IMT in both Japanese and U.S. whites. The inverse association remained only in Japanese men after adjusting for risk and other factors. The significant difference in multivariable-adjusted IMT became nonsignificant after further adjusting for DHA (mean difference, 17 μm; 95% CI, −8 to 43; P =0.177) but not EPA. In this multivariable-adjusted model, DHA but not EPA was a significant predictor of IMT ( P =−0.032 versus 0.863, respectively). Conclusions— These data suggest that DHA may have a more potent antiatherogenic effect than EPA, especially in levels observed in the Japanese, independent of risk factors.

The association of serum polyunsaturated fatty acids (PUFAs) with lipids in different populations is not known.Our aim was to examine the association of serum n-6 (omega-6) or n-3 (omega-3) PUFAs with triglycerides or HDL-cholesterol concentrations in 261 white, 285 Japanese, and 212 Japanese American men aged 40-49 y.We used a population-based cross-sectional study. Of the original sample (n = 926), those taking lipid-lowering medications or who had diabetes (n = 168) were excluded. Serum fatty acids were analyzed by capillary gas-liquid chromatography. Multiple regression models as a function of tertile groups of each PUFA were used.Serum n-6 PUFAs were significantly inversely associated with triglycerides across populations after adjustment for age, body mass index, pack-years of smoking, and ethanol consumption [beta = -0.39 (P0.001), -0.38 (P0.001), and -0.33 (P0.001) in whites, Japanese, and Japanese Americans, respectively]. Marine n-3 PUFAs were significantly inversely associated with triglycerides across populations [beta = -0.15 (P0.001), -0.22 (P0.001), and -0.13 (P0.001) in whites, Japanese, and Japanese Americans, respectively]. n-6 PUFAs were significantly positively associated with HDL cholesterol in whites (beta = 4.49, P0.001) and Japanese (beta = 3.73, P0.01). Marine n-3 PUFAs were significantly positively associated with HDL cholesterol in Japanese (beta = 2.15, P0.05), and eicosapentaenoic acid was significantly positively associated with HDL cholesterol in whites (beta = 2.68, P0.01).Serum n-6 and n-3 PUFAs are inversely associated with triglycerides across populations.