With the outbreak of COVID‐19, maintaining the healthcare system is a crucial issue. In Japan, the number of COVID‐19 cases is increasing rapidly day by day with a risk of overshooting initial estimations (WHO, 2020a). Public health nurses (PHNs) working in public health centers in prefectures and designated centers in cities or core cities, play a critical role in controlling COVID‐19 (Yoshioka‐Maeda, Honda, Iwasaki‐Motegi, 2020). Providing care for COVID‐19 patients, their families, and the community, the workload of PHNs has been reaching the maximum limit.

Tumor‑infiltrating lymphocytes (TILs) are a significant prognostic factor in triple‑negative breast cancer. However, the clinicopathological significance of TILs in estrogen receptor (ER)‑positive and human epidermal growth factor receptor 2 (HER2)‑negative breast cancer remains unclear. The purpose of the present study was to evaluate the role of TILs in the prognosis of ER‑positive and HER2‑negative breast cancer. A total of 65 consecutive patients with ER‑positive and HER2‑negative breast cancer were examined. TILs in stromal tissue (str‑TILs) were graded using the International TILs Working Group criteria. The association between several clinicopathological factors and TIL grade were investigated, and the prognostic impact of TILs was compared between luminal A‑like and luminal B‑like breast cancer. A total of 51 patients (78.5%) had low‑grade (0‑10%), 11 (16.9%) had intermediate (10‑40%) and 3 (4.6%) had high‑grade (40‑90%) str‑TIL levels. There was a significant association between high levels of Ki67 expression and a high str‑TIL count. Relapse‑free survival was significantly worse in patients with luminal B‑like cancer compared with that in patients with luminal A‑like cancer. Patients with an intermediate or high str‑TIL count had a better prognosis compared with those with a low str‑TIL count. All patients with luminal B‑like cancer and intermediate or high str‑TIL levels developed no recurrence during follow‑up. In conclusion, there was a significant correlation between high‑grade str‑TIL levels and high tumor cell proliferation rate, as well as high levels of Ki67 expression.

Objective: This study aimed to elucidate the experiences of public health nurses (PHNs) in Japan during the first wave of COVID‐19.Design and sample: Twelve PHNs in charge of responding to COVID‐19 in X‐city within Tokyo metropolis in Japan participated in this case study.Measurements: Data were collected through self‐administered questionnaires and semi‐structured interviews on PHNs’ experiences from January 2020 to May 2020.Results: Initially, only infectious disease control division (IDCD) PHNs experienced confusion due to the rapidly increased workload. Managerial PHNs attempted to explain the need for a dispatch system for the IDCD, using available statistical data from other managerial members, within one's maximum understanding of this unprecedented situation. Without having a clear and forward‐looking understanding regarding the purpose and reasons for dispatching, some dispatched PHNs had concerns and frustrations; they did not view the COVID‐19 pandemic as a disaster. In the never‐ending, exhausting work, PHNs managed to modify the provision of conventional services to residents.Conclusions: Despite experiencing confusion, PHNs worked to continuously provide community services, re‐considering the meaning of public health nursing. Prioritizing the work and shifting tasks to other professionals at an early stage of the pandemic may prevent organizational dysfunction.

Unintentional injury in children is a worldwide public health problem, as it increases the health burden and is a leading cause of death among children. It is important to understand the differences between different age groups of children in regard to unintentional injury, in order to effectively implement child safety education. The present study aimed to determine the current trends of unintentional injury in children, and to identify the differences between different age groups of children with regard to unintentional injury. We identified 1,521 children who attended an 18-month health checkup (18-month group), and 1,368 children who attended a 36-month health checkup (36-month group), between January 1, 2014 and December 31, 2014. The rate of hospital visits associated with unintentional injury was 10.6% (161/1,521) in the 18-month group, and 13.1% (180/1,368) in the 36-month group. In both groups, present/past illness was associated with hospital visits, and in the 36-month group, hospital visits were more common in boys than in girls. The number of unintentional injuries that occurred outdoors was higher in the 36-month group than in the 18-month group. Unintentional injuries resulting from accidental ingestion and falls were more common in the 18-month group, while unintentional injuries resulting from turning over were more common in the 36-month group. In conclusion, the number of hospital visits for unintentional injury might be higher, and the number of preventive actions taken by mothers might be lower, among children attending the 36-month health checkup than among those attending the 18-month health checkup.

To examine the age in months at which infants visited outpatient clinics or emergency rooms for the first time for nonfatal injuries and to identify risk factors for the occurrence of these injuries. Retrospective cohort study. We used a health insurance claims database in Japan. Infants born between April 2012 and December 2014 were identified and followed until 12 months of age. We identified their first visit to outpatient clinics or emergency rooms because of nonfatal injuries (wounds/fractures, foreign bodies, and burns). Cox regression analysis was used to examine the association of nonfatal injuries with infants’ sex, birth order, and parental age. We identified 46,431 eligible infants. Of these, 7606 (16.4%) were brought to an outpatient clinic or emergency room for nonfatal injuries within 12 months of birth. Of the 7,606, 21.7% were aged ≤4 months and 44.7% ​≤ ​7 months. First-born infants were more likely to have wounds/fractures and burns. One-fifth of first nonfatal infant injuries occurred within 4 months of age. Healthcare providers should provide early education about injury prevention, especially to caregivers of first-born infants.