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The main research question addressed in this paper is the following: What are the consequences of the purge of the communists and their sympathizers for the development of postwar Japanese society during the Allied Occupation (known as the Red Purge)? According to conventional wisdom, the Red Purge was an illegal and unfair suppression regarding the freedom of speech and a threat to the very survival of democracy in Japan. Surveying previous works on the Red Purge demonstrates that not a single work discusses any constructive aspect of the Red Purge. Criticizing this trend in the historiography, Thomas French correctly pointed out that these previous works tended to neglect or undervalue violent and aggressive behaviors of the Japanese Communist Party and its militant policy after mid-1949. This paper goes a little further, trying to find, if any, constructive aspects of the Red Purge. My hypothesis is that the Red Purge had many destructive and biased measures, but it was paradoxically a necessary evil to help establish a law-abiding Japanese society. The architects of the Red Purge, General Douglas MacArthur, Supreme Commander for the Allied Powers, the Japanese government, and corporate executives, were careful not to violate the constitution or labor laws when they executed the Red Purge. They established an important precedent that they had to act in accordance with the constitution and laws. In a paradoxical way, going through the Red Purge actually made Japan a law-abiding country in the long run. This paper tests the validity of this hypothesis. [ABSTRACT FROM AUTHOR]

Purpose: Heterozygous dominant-negative (DN) STAT1 variants are responsible for autosomal dominant (AD) Mendelian susceptibility to mycobacterial disease (MSMD). In this paper, we describe eight MSMD cases from four kindreds in Japan. Methods: An inborn error of immunity-related gene panel sequencing was performed using genomic DNA extracted from whole blood samples. The identified variants were validated using Sanger sequencing. Functional analysis was evaluated with a luciferase reporter assay and co-transfection assay in STAT1-deficient cells. Results: Patient 1.1 was a 20-month-old boy with multifocal osteomyelitis and paravertebral abscesses caused by Mycobacterium bovis bacillus Calmette-Guérin (BCG). Although the paravertebral abscess was refractory to antimycobacterial drugs, the addition of IFN-γ and drainage of the abscess were effective. Intriguingly, his mother (patient 1.2) showed an uneventful clinical course except for treatment-responsive tuberculous spondylitis during adulthood. Patient 2.1 was an 8-month-old boy with lymphadenopathy and lung nodules caused by BCG. He responded well to antimycobacterial drugs. His mother (patient 2.2) was healthy. Patient 3.1 was a 11-year-old girl with suspected skin tuberculosis. Her brother (patient 3.2) had BCG-osis, but their mother (patient 3.3) was healthy. Patient 4 was an 8-month-old girl with left axillary and supraclavicular lymphadenopathy associated with BCG vaccination. Kindreds 1, 2, and 3 were shown to have novel heterozygous variants (V642F, R588C, and R649G) in STAT1, respectively. Kindred 4 had previously reported heterozygous variants (Q463H). A luciferase reporter assay in STAT1-deficient cells followed by IFN-γ stimulation confirmed that these variants are loss-of-function. In addition, with co-transfection assay, we confirmed all of these variants had DN effect on WT STAT1. Conclusion: Four kindred MSMD subjects with 3 novel variants and 1 known variant in STAT1 were identified in this study. AD STAT1 deficiency might be prevalent in Japanese patients with BCG-associated MSMD. [ABSTRACT FROM AUTHOR]

Modern sciences were introduced to Japan from Western countries during the Meiji period. In other words, this was the process of translating Western academic languages into Japanese academic languages. The translation was meant to reuse existing Chinese characters with similar meanings to Western academic languages or create new Chinese characters. Japan was able to rapidly introduce modern Western science during the Meiji period because it already had academic languages comparable to modern Western science; thus, the translation proceeded smoothly. This means that academic ways of thinking that were comparable to modern Western science were developing in Japan. At that time, modern Japanese society first encountered sociology as modern science. Sociology was translated into the Chinese characters "社会学 (Syakaigaku)" and introduced to Japan. The term Syakaigaku first appeared in Japan during the Meiji period; however, before that, early modern Japan had developed several kinds of sociological thought. The purpose of this paper is to examine the history of Japanese thought, especially the new types of Confucianism and Nativism (Kokugaku), in the Edo period in comparison with Western sociology. Various remarkable thoughts similar to those seen in Western sociology are found. This paper then reviews a Nativism scholar, Motoori Norinaga, who was active during the Edo period and influenced Japanese environmental sociology through the folklorist Kunuo Yanagita. Finally, a new sociology, which combines the Western sociological theory of ritual, the Japanese Confucian theory of ritual by Ogyu Sorai, and the narrative theory of Norinaga, is presented. [ABSTRACT FROM AUTHOR]

2004 was the year when the Japanese public's affinity with China dropped dramatically, to 37.6 %, due to anti-Japan riots in China. Now more than 70 % of the Japanese public does not feel an affinity with China. How could such a strong anti-Chinese sentiment influence Japan's policy toward China? This paper considers this question by examining Japan's decision-making process on terminating the much-criticized yen loans to China. Yen loans are a type of Official Development Assistance (ODA) provided by the Japanese government to countries lacking sufficient funds for economic development. China is one of the top yen loan borrowers, and the loans have contributed to China's economic growth and increasing openness. However, in March 2005, Japanese Foreign Minister Nobutaka Machimura told Chinese Foreign Minister Li Zhaoxing that Japan intended to phase out the yen loans before the 2008 Beijing Olympics and reached an agreement on the matter. Two-and-a-half years later, Japan terminated its yen loans to China, as the foreign ministers had agreed. Through mainly firsthand documents and interviews with government officials, this paper will clarify the following two points: (1) While it is true that the Japanese government significantly reduced its yen loan package to China from 2001 onward due to domestic criticism of China, as pointed out by previous studies, it was not planning to terminate the yen loans as of summer 2004. Instead, the Japanese government was contemplating how to keep providing yen loans to China; (2) Foreign Minister Nobutaka Machimura, who was appointed in September 2004, had pushed for the termination of yen loans to China only after anti-Chinese sentiment rose dramatically in summer 2004, because he felt that continuing the much-criticized yen loans would not benefit stable Japan-China relations. This paper sheds light on the background of the termination of yen loans to China, a major milestone in postwar Japan-China relations that had been unclear until now. Having said this, the more important point of this paper may be that it also shows the influence of strong anti-Chinese sentiment on Japan's policies toward China. [ABSTRACT FROM AUTHOR]

This paper analyses how the conceptual and therapeutic formation of Japanese traditional medicine (Kampo) has been socially constructed through interactions with popular interpretations of illness. Taking the example of emotion-related disorders, this paper focuses on the changing meaning of constraint (utsu) in Kampo medicine. Utsu was once a name for one of the most frequently cited emotion-related disorders and pathological concerns during the Edo period. With the spread of Western medicine in the Meiji period, neurasthenia replaced utsu as the dominant emotion-related disorder in Japanese society. As a result, post-Meiji doctors developed other conceptual tools and strategies to respond to these new disease categories, innovations that continue to influence contemporary practitioners. I begin this history by focusing on Wada Tōkaku, a Japanese doctor of the Edo period who developed a unique theory and treatment strategy for utsu. Secondly, I examine. Yomuto Kyūshin and Mori Dōhaku, Kampo doctors of the early twentieth century, who privileged neurasthenia over utsu in their medical practice. The paper concludes with a discussion of the flexibility and complexity of Kampo medicine, how its theory and practices have been influenced by cross-cultural changes in medicine and society, while incorporating the popular experience of illness as well. [ABSTRACT FROM AUTHOR]

During the 3 years of the COVID-19 pandemic, Japanese children had to live with strict mitigation measures at school, such as eating school lunches silently and wearing masks during physical exercise classes, even after those mitigation measures have been relaxed worldwide. Excursions and other school events were frequently cancelled, especially in 2020 and 2021. This study conducts a retrospective survey on school experiences to understand how the strict mitigation measures were related to children's mental health and well-being. Results revealed school excursion cancellation to be associated with a higher risk of developing depressive symptoms {odds ratio [OR] 1.543 [95% confidence interval (CI) 1.109–2.148]}, and high cancellation rate of other school events to be associated with dissatisfaction in school experience [OR 1.650 (95% CI 1.222–2.228)]. In the subsample analysis, we found that girls and children with no extracurricular activities tended to exhibit depressive symptoms due to the cancellation of school excursions. Overall, the study demonstrated that persistent strict mitigation measures at schools might be a key factor in understanding children's mental health and psychological well-being during a long-lasting pandemic. [ABSTRACT FROM AUTHOR]

In Japan, where a prominent gap exists in what is considered a patient's best interest between the medical and patient sides, appropriate decision-making can be difficult to achieve. In Japanese clinical settings, decision-making is considered an act of choice-making from multiple potential options. With many ethical dilemmas still remaining, establishing an appropriate decision-making process is an urgent task in modern Japanese healthcare. This paper examines ethical issues related to shared decision-making (SDM) in clinical settings in modern Japan from the psychocultural-social perspective and discusses the ideal decision-making process in present Japan. Specifically, we discuss how five psychocultural-social tendencies – "surmise (Sontaku)," "self-restraint (Jishuku)," "air (atmosphere or mood, Kuuki)," "peer pressure (or tuning pressure, Docho-Atsuryoku)," and "community (Seken)"—which have often been referred to as characteristics of present-day Japanese people, may affect the ideal practice of SDM in Japanese clinical settings. We conclude that health care professionals must be aware of the possible adverse effects of the above Japanese psychocultural-social tendencies on the implementation of SDM and attempt to promote autonomous decision-making, thereby allowing patients to make treatment choices that sufficiently reflect their individual and personal views of life, experiences, goals, preferences, and values. [ABSTRACT FROM AUTHOR]

Poly (ADP-ribose) polymerase inhibitors have been increasingly used in ovarian cancer treatment. However, the real-world safety data of these drugs in Japanese patients are limited. This retrospective study included 181 patients with ovarian cancer who received olaparib or niraparib at two independent hospitals in Japan between May 2018 and December 2022. Clinical information and blood sampling data were collected. Regarding patient backgrounds, the olaparib group had higher proportions of patients with serous carcinoma, BRCA positivity, homologous recombination deficiency, and those receiving maintenance therapy after recurrence treatment than the niraparib group. Regarding toxicity properties, the most common reasons for discontinuation in the olaparib group were anemia, fatigue, and nausea, while the reason in the niraparib was thrombocytopenia. Thrombocytopenia caused by niraparib treatment occurred earlier than anemia caused by olaparib treatment. Patients with a low body mass index or who had undergone several previous treatment regimens were more likely to discontinue treatment within the first 3 months. Although we analyzed blood collection data, predicting treatment interruptions due to blood toxicity was challenging. In this study, we revealed the characteristics of patients and the timing of interruptions for each drug, highlighting the importance of carefully managing adverse effects. [ABSTRACT FROM AUTHOR]

There is widespread concern about declining literacy skills in recent young Japanese. The present study investigated how higher-level reading and writing proficiencies are underpinned by basic literacy skills in Japanese adolescents. From a large database of the most popular literacy exams in Japan, we retrospectively analyzed word- and text-level data for middle and high school students who had taken the exams during the same period in the 2019 academic year using structural equation modeling. We extracted main data for 161 students as well as six independent datasets for validation. Our results validated the three-dimensional view of word-level literacy (reading accuracy, writing accuracy, and semantic comprehension) and demonstrated that writing and semantic skills underpinned text writing and reading, respectively. The semantic comprehension of words affected text writing indirectly via text reading; however, it could not replace the direct effect of word writing accuracy. These findings, which were robustly replicated with multiple independent datasets, provided new evidence of dimension-specific relationships between word- and text-level literacy skills and confirmed the unique contribution of word handwriting acquisition to text literacy proficiency. The replacement of handwriting by digital writing (e.g., typing) is a global trend. However, the dual-pathway model of literacy development identified in this study suggests there are advantages in sustaining early literacy education by handwriting for the growth of higher-level language skills in future generations. [ABSTRACT FROM AUTHOR]

We assessed S-268019-b, a recombinant spike protein vaccine with a squalene-based adjuvant, for superiority in its immunogenicity over ChAdOx1 nCoV-19 vaccine among adults in Japan. In this multicenter, randomized, observer-blinded, phase 3 study, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)–naïve participants (aged ≥ 18 years, without prior infection or vaccination against SARS-CoV-2) were randomized (1:1) to receive either S-268019-b or ChAdOx1 nCoV-19 as two intramuscular injections given 28 days apart. Participants who provided consent for a booster administration received S-268019-b at Day 211. The primary endpoint was SARS-CoV-2 neutralizing antibody (NAb) titer on Day 57; the key secondary endpoint was the seroconversion rate for SARS-CoV-2 NAb titer on Day 57. Other endpoints included anti–SARS-CoV-2 S-protein immunoglobulin (Ig)G antibody titer and safety. The demographic and baseline characteristics were generally comparable between S-268019-b (n = 611) and ChAdOx1 nCoV-19 (n = 610) groups. S-268019-b showed superior immunogenicity over ChAdOx1 nCoV-19, based on their geometric mean titers (GMTs) and GMT ratios of SARS-CoV-2 NAb on Day 57 by cytopathic effect assay (GMT [95% confidence interval {CI}] 19.92 [18.68, 21.23] versus 3.63 [3.41, 3.87]; GMT ratio [95% CI] 5.48 [5.01, 6.00], respectively; two-sided p-values < 0.0001). Additionally, NAb measured using a cell viability assay also showed similar results (GMT [95% CI] 183.25 [168.04, 199.84] versus 24.79 [22.77, 27.00]; GMT ratio [95% CI] 7.39 [6.55, 8.35] for S-268019-b versus ChAdOx1 nCoV-19, respectively; p < 0.0001). The GMT of anti–SARS-CoV-2 S-protein IgG antibody was 370.05 for S-268019-b versus 77.92 for ChAdOx1 nCoV-19 on Day 57 (GMT ratio [95% CI] 4.75 [4.34, 5.20]). Notably, immune responses were durable through the end of the study. S-268019-b elicited T-helper 1 skewed T-cell response, comparable to that of ChAdOx1 nCoV-19. After the first dose, the incidence of solicited systemic treatment-related adverse events (TRAEs) was higher in the ChAdOx1 nCoV-19 group, but after the second dose, the incidence was higher in the S-268019-b group. Headache, fatigue, and myalgia were the most commonly reported solicited systemic TRAEs, while pain at the injection site was the most frequently reported solicited local TRAE following both doses in both groups. No serious treatment-related adverse serious TRAEs events were reported in the two groups. S-268019-b was more immunogenic than ChAdOx1 nCoV-19 vaccine and was well tolerated (jRCT2051210151). [ABSTRACT FROM AUTHOR]

This paper examines Ga/No Conversion in Japanese under the Move F theory of movement (Chomsky (1995)). Building on Miyagawa's (1993) analysis, the present paper argues that a genitive phrase raises out of a prenominal gapless clause in either overt or covert syntax. This claim is crucially based on Lasnik's (1999a) analysis of Exceptional Case Marking (ECM) constructions in English, according to which the ECM subject raises into a higher clause either overtly or covertly. It is also demonstrated that when a genitive subject originates in a relative clause, its raising is limited to covert syntax. This non-uniform behavior of the genitive subject is argued to follow from a particular implementation of Attract F. [ABSTRACT FROM AUTHOR]

Femoroacetabular impingement has increasingly been recognized as a cause of primary hip osteoarthritis; however, its epidemiological indications remain unclear. We aimed to clarify the epidemiological indications and factors associated with cam deformity in a large-scale population-based cohort in Japan. Overall, 1480 participants (2960 hips) (491 men, 989 women; mean age, 65.3 years) analyzed in the third survey of the Research on Osteoarthritis/Osteoporosis Against Disability study were included. The α angle and spinopelvic parameters (lumbar lordosis, sacral slope, pelvic tilt, and pelvic incidence) were radiographically measured. Cam deformity was defined as α angle ≥ 60°. Overall, the cam deformity prevalence was 147/2960 (5.0%). Cam deformity prevalence tended to increase with age; in the univariate analysis, a higher percentage of men was observed in the group with cam deformity than in the group without it. No relationship was observed between cam deformity and hip pain. Factors associated with α angle were examined via multiple regression analysis for each gender; α angle was significantly associated with age and BMI in each gender. The α angle and PT were correlated in women. Thus, α angle and cam deformity prevalence increase with age in Japanese individuals. Accordingly, cam deformity can be considered a developmental disease. [ABSTRACT FROM AUTHOR]

Introduction: Chronic migraine (CM) patients commonly take acute headache medications, often resulting in medication overuse (MO). This post hoc analysis evaluated the efficacy of fremanezumab in CM patients from Japan with and without MO, which is not yet established. Methods: A multicenter, double-blind, parallel-group, phase 2b/3 trial randomized patients (1:1:1) to monthly fremanezumab via subcutaneous injection (initial dose: 675 mg, second/third doses: 225 mg), quarterly fremanezumab (initial dose: 675 mg, second/third doses: placebo), or placebo for 3 months. This post hoc analysis analyzed data from Japanese patients with and without MO (monthly use of acute headache medication ≥ 15 days, migraine-specific acute medication ≥ 10 days, or combination medication ≥ 10 days). Outcomes included the original primary endpoint of average headache days of moderate or greater severity per month (HDs), the proportion of patients with ≥ 50% reduction in HDs and the proportion of patients changing status from with to without MO. Results: Of 479 patients enrolled, 320 (66.8%) had baseline MO. Monthly average HDs were significantly reduced versus placebo with fremanezumab in both patients with MO (mean [standard error] difference vs. placebo: monthly – 2.0 [0.6], p = 0.0012; quarterly – 1.8 [0.6], p = 0.0042) and without MO (– 1.6 [0.8], p = 0.0437; – 1.5 [0.8], p = 0.0441). Significantly more fremanezumab-treated patients with MO (monthly 28/108 [25.9%], p = 0.0040 quarterly 25/99 [25.3%], p = 0.0070) or without MO (18/50 [36.0%], p = 0.0132; and 21/60 [35.0%], p = 0.0126) had ≥ 50% reduction in HDs versus placebo (12/111 [10.8%] and 7/49 [14.3%], respectively). A significantly greater proportion of fremanezumab-treated patients reverted to no MO (monthly 50/108 [46.3%], p = 0.0115; quarterly 44/99 [44.4%], p = 0.0272) vs. placebo (33/111 [29.7%]). Conclusion: Fremanezumab appears effective as preventive migraine treatment in Japanese CM patients with or without MO while also being beneficial in reducing MO. [ABSTRACT FROM AUTHOR]

Purpose: A brimonidine tartrate 0.1%/brinzolamide 1% fixed-dose combination (BBFC) was recently approved for glaucoma and ocular hypertension treatment in Japan. We investigated the efficacy and safety of BBFC used concomitantly with prostaglandin analogs (PG) or a PG/beta-blocker fixed-dose combination (PG/beta FC). Study design: This was a prospective, open-label, multicenter study. Patients and methods: We enrolled Japanese patients with open-angle glaucoma. BBFC (Ailamide) was concomitantly administered to either the PG or the PG/beta FC group, and intraocular pressure (IOP) and safety were evaluated at 4 and 12 weeks. The groups were stratified into low and high IOP baseline groups based on the median baseline IOP. Results: We enrolled 100 patients, 91 of whom completed the 12-week follow-up. The mean ages were 67.1 and 65.7 years in the PG group (n = 45, baseline IOP of 15.7 ± 2.3 mmHg) and the PG/beta FC group (n = 46, baseline IOP of 16.3 ± 2.3 mmHg), respectively. After BBFC administration, IOPs at 4 and 12 weeks were 13.0 ± 2.0 and 13.0 ± 2.6 mmHg (P < 0.0001) in the PG group, respectively, and 13.7 ± 2.4 and 13.7 ± 2.2 mmHg (P < 0.0001) in the PG/beta FC group, respectively. IOP decreased by – 2.0 ± 1.8 mmHg (P < 0.0001) and –1.9 ± 1.4 mmHg (P < 0.0001) in the low baseline PG group (14.1 mmHg) and low baseline PG/beta FC group (14.8 mmHg) at 12 weeks, respectively. Sixteen adverse events were identified, all of which were common and did not affect visual acuity. Conclusions: BBFC can be used concomitantly with PG or PG/beta FC to reduce IOP without serious complications. [ABSTRACT FROM AUTHOR]

To examine the association between hip fracture and associated factors, including polypharmacy, and develop an optimal predictive model, we conducted a population-based matched case–control study using the health insurance claims data on hip fracture among Japanese patients. We included 34,717 hospitalized Japanese patients aged ≥ 65 years with hip fracture and 34,717 age- and sex- matched controls who were matched 1:1. This study included 69,434 participants. Overall, 16 variable comorbidities and 60 variable concomitant medications were used as explanatory variables. The participants were added to early elderly and late elderly categories for further analysis. The odds ratio of hip fracture increased with the number of medications only in the early elderly. AUC was highest for early elderly (AUC, 0.74, 95% CI 0.72–0.76). Use of anti-Parkinson's drugs had the largest coefficient and was the most influential variable in many categories. This study confirmed the association between risk factors, including polypharmacy and hip fracture. The risk of hip fracture increased with an increase in medication number taken by the early elderly and showed good predictive accuracy, whereas there was no such association in the late elderly. Therefore, the early elderly in Japan should be an active target population for hip fracture prevention. [ABSTRACT FROM AUTHOR]

We developed a 3D archive system for Japanese traditional performing arts. The system generates sequences of 3D actor models of the performances from multi-view video by using a graph-cuts algorithm and stores them with CG background models and related information. The system can show a scene from any viewpoint as follows; the 3D actor model is integrated with the background model and the integrated model is projected to a viewpoint that the user indicates with a viewpoint controller. A challenge of generating the actor models is how to reconstruct thin or slender parts. Japanese traditional costumes for performances include slender parts such as long sleeves, fans and strings that may be manipulated during the performance. The graph-cuts algorithm is a powerful 3D reconstruction tool but it tends to cut off those parts because it uses an energy-minimization process. Hence, the search for a way to reconstruct such parts is important for us to preserve these arts for future generations. We therefore devised an adaptive erosion method that works on the visual hull and applied it to the graph-cuts algorithm to extract interior nodes in the thin parts and to prevent the thin parts from being cut off. Another tendency of the reconstruction method using the graph-cuts algorithm is over-shrinkage of the reconstructed models. This arises because the energy can also be reduced by cutting inside the true surface. To avoid this tendency, we applied a silhouette-rim constraint defined by the number of the silhouette-rims passing through each node. By applying the adaptive erosion process and the silhouette-rim constraint, we succeeded in constructing a virtual performance with costumes including thin parts. This paper presents the results of the 3D reconstruction using the proposed method and some outputs of the 3D archive system. [ABSTRACT FROM AUTHOR]

This paper examines the increasingly popular chisan-chisho movement that has promoted the localization of food consumption in Japan since the late-1990s. Chisan-chisho emerged in the context of a perceived crisis in the Japanese food system, particularly the long-term decline of agriculture and rural community and more recent episodes of food scandals. Although initially started as a grassroots movement, many chisan-chisho initiatives are now organized by governments and farmers’ cooperatives. Acknowledging that the chisan-chisho movement has added some important resources and a conceptual framework, we nonetheless point out that chisan-chisho has been refashioned as a producer movement by government as well as the Japan Agricultural Cooperative, capitalizing on local food’s marketing appeal. Chisan-chisho to date has not been able to become a full-fledged citizen-based political mobilization nor address the issue of marginality in the food system. [ABSTRACT FROM AUTHOR]

International assessment studies have shown since decades that Japanese students score highly on math and science tests. As a consequence, many scholars, education policy officials and journalists outside Japan share the opinion that quality of education is ensured and turn to the Japanese educational system to identify educational effectiveness enhancing factors. Simultaneously, a sense of educational crisis exists within Japan, which resulted into numerous education reforms. In this paper, we describe how quality in education has been ensured in Japan, what changes in the assurance of quality are brought forth by the most recent wave of reform measures as well as the reaction of scholars toward these measures. [ABSTRACT FROM AUTHOR]

Background: The stratum-specific likelihood ratio (SSLR) has been widely used as a convenient method to interpret the results of screening surveys. In the present paper, an SSLR analysis is applied to the results of a survey that used the Center for Epidemiologic Studies Depression Scale (CES-D) to identify depressive symptoms in a group of Japanese workers in an attempt to determine score categories that have predictive clinical values in a screening context.Methods: The self-reported CES-D and the Mini International Neuropsychiatric Interview (MINI) were administered to 2,219 workers (84.2% men; age 21-68 years) during a periodical medical examination. The SSLR was calculated to determine strata with optimal discrimination for major depressive disorder (MDD).Results: For MDD, the SSLR was 0.06 (95%CI: 0.02-0.18) for the CES-D score range 0-16, 1.90 (0.78-4.62) for the score range 17-19, and 12.4 (10.2-15.1) for the score above 20.Conclusions: The SSLR shown in this study proposes score categories that guide clinicians in selecting the workers most at risks of having MDD among Japanese workers. [ABSTRACT FROM AUTHOR]

Purpose: A longitudinal study was conducted to examine the effects of handwashing and gargling education for children on the prevention of respiratory tract infections (RTIs) in children in Japan. Methods: The study included 38,554 children born in 2010 who were enrolled in a longitudinal study. Information on children's hygiene education regarding handwashing and gargling was collected in a survey at the age of 3.5 years. Based on parents' reports of doctors' diagnoses, airway infections and influenza events in the 12-month duration before the survey were evaluated for RTIs at the ages of 4.5 and 9 years. Poisson regression with robust variance was performed to examine the effects of hygiene education on RTIs prevention. The supplementary analysis was stratified by household income. Results: Children were categorized into different groups: 38% in the handwashing and gargling group, 29% in the handwashing group, 0.1% in the gargling group, and 9.7% in the no-education group. Exclusions were made for non-respondent children (23%) and those in the gargling group. Hygiene education was associated with decreased influenza at the age of 4.5 years in the handwashing (adjusted RR [aRR] = 0.8; 95% CI, 0.8–0.9) and handwashing and gargling groups (aRR = 0.8; 95% CI, 0.8–0.9) compared with no education. However, no preventive effects on airway infections at the age of 4.5 and 9, influenza at the age of 9, or hospitalization between the ages of 3.5 and 9 years were detected. Handwashing and gargling could significantly prevent influenza in low-income households (aRR = 0.7; 95% CI, 0.6–0.8). Conclusions: Gargling education was widespread and mostly combined with handwashing education in Japan. Hygiene education significantly affected prevention of influenza infections at the age of 4.5 years, especially in low-income households. What is Known: • Previous intervention studies showed handwashing and gargling are effective in preventing respiratory tract infections. What is New: • We conducted a longitudinal study on handwashing and gargling education in Japanese children and found that handwashing and gargling were widely practiced together. • Handwashing and gargling education were related to a reduction in influenza, particularly in low-income households. [ABSTRACT FROM AUTHOR]

Understanding voters' conception of ideological labels is critical for political behavioral research. Conventional research designs have several limitations, such as endogeneity, insufficient responses to open-ended questions, and inseparability of composite treatment effects. To address these challenges, we propose a conjoint experiment to study the meanings ascribed to ideological labels in terms of policy positions. We also suggest using a mixture model approach to explore heterogeneity in voters' understandings of ideological labels, as well as the average interpretation of labels. We applied these approaches to conceptions of left–right labels in Japan, where the primary issue of elite-level conflicts has been distinctive compared with other developed countries. We found that, on average, while Japanese voters understand policy-related meanings of "left" and "right," they primarily associate these labels with security and nationalism, and, secondarily, with social issues; they do not associate these labels with economic issues. Voters' understandings partly depend on their birth cohort, but observed patterns do not necessarily coincide with what many researchers would predict regarding generational differences in Japanese politics. Mixture model results suggest that some individuals tend to associate left–right labels with security and nationalism policies, while others link them to social policies. Over one-third of respondents seemed to barely understand the usage of left–right labels in policy positions. Our study improves upon existing methods for measuring voter understanding of ideological labels, and reconfirm the global diversity of meanings associated with left–right labels. [ABSTRACT FROM AUTHOR]

Although infection with the methicillin-resistant Staphylococcus aureus (MRSA) clone USA300 is extremely rare in Japan, the uniquely evolved clone ΨUSA300 has been reported in Japan. An outbreak of a distinct USA300 clone was recently reported in an HIV/AIDS referral hospital in Tokyo. The present study investigated the evolutionary origin and genetic diversity of USA300-related clones causing regional outbreaks among people living with HIV (PLWHIV) in Tokyo. MRSA isolates collected from PLWHIV in an HIV/AIDS referral center in Tokyo were subjected to whole-genome sequencing and their genetic features were compared with those of previously described USA300 MRSA genomes. Of the 28 MRSAs isolated in 2016–2019, 23 (82.1%) were identified as USA300, with 22 (95.6%) of the latter identified as ΨUSA300. Although the genomic structure of ΨUSA300 was identical to the structures of reference USA300 strains, one clade (cluster A) was found to have acquired 29 previously identified lineage-specific mutations in a stepwise manner. The estimated divergence dates of ΨUSA300 and Cluster A were 2009 and 2012, respectively. These findings suggested that the ΨUSA300 clone had spread among PLWHIVs in Tokyo in the early 2010s, with stepwise acquisition of lineage-specific nonsynonymous mutations. [ABSTRACT FROM AUTHOR]

Caesarean section (CS) birth is widely reported to be a risk factor for childhood obesity. Although susceptibility to childhood obesity is influenced by race and ethnicity, it is unclear whether this risk of childhood obesity with CS birth also applies in the Japanese population. We investigated the impact of CS birth on obesity at 3 years of age in Japanese children. We obtained data from 60,769 mother–toddler pairs in the Japan Environment and Children's Study, a large-scale birth cohort study. Obesity was determined by body mass index measured at 3 years of age. Analysis revealed that 11,241 toddlers (18.5%) had a CS birth and that 4912 toddlers (8.1%) were obese. The adjusted risk ratio for obesity at 3 years of age when born by CS compared with vaginal delivery, estimated using inverse probability of treatment weighting, was 1.16 (95% confidence interval 1.08–1.25). These results suggest that CS birth modestly increases the risk of obesity at 3 years of age in Japanese children. [ABSTRACT FROM AUTHOR]

Introduction: Molnupiravir is an oral antiviral drug that received special approval for emergency use in Japan on December 24 2021 for infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This post-marketing surveillance (PMS) is underway to investigate the safety and effectiveness of molnupiravir in daily clinical practice in Japan. The interim PMS data collected from December 27 2021 to June 15 2022 are reported in this publication. Methods: This survey included adult Japanese patients treated with molnupiravir. For safety, adverse drug reactions (ADR) were assessed by physicians. Effectiveness was assessed by the composite endpoint of (1) hospitalization or (2) death in outpatients and by the composite endpoint of (3) death or (4) initiation of oxygen administration/mechanical ventilation in inpatients hospitalized for any reasons and without oxygen administration at the start of molnupiravir administration. The observation period was through 29 days from the start of molnupiravir administration. Results: Of the 1031 patients in the safety analysis set, 68 (6.60%) patients reported ADRs and four (0.39%) patients reported serious ADRs. The main ADRs observed were diarrhoea [26 patients (2.52%)], rash [six patients (0.58%)], dizziness [five patients (0.48%)], and faeces soft [four patients (0.39%)]. In the effectiveness analysis from the start date of molnupiravir administration to day 29, there were 16/612 (2.61%) hospitalizations and no deaths. Oxygen administration was newly initiated in 9/199 (4.52%) inpatients after the initiation of molnupiravir administration; 2/199 (1.01%) inpatients died. Conclusion: This interim analysis of molnupiravir in daily clinical practice use in Japan supports the safety and effectiveness profile of molnupiravir under pandemic conditions in which Omicron was the dominant SARS-CoV-2 variant. The results of this PMS will provide valuable information for daily clinical practice use. [ABSTRACT FROM AUTHOR]

Background: Part 1 of the DORA study, a 2019 international clinical trial of glecaprevir and pibrentasvir (G/P) treatment in adolescents with chronic hepatitis C virus (HCV) infection, demonstrated high efficacy and safety. However, few reports have considered real-world experience with G/P treatment in adolescents with chronic HCV. The present prospective multicenter study assessed real-world efficacy and safety of G/P treatment in Japanese adolescents with chronic HCV. Methods: Subjects between 12 and 17 years old who were treatment-naïve or previously managed with interferon-based regimens were prospectively enrolled and treated with G/P (300 mg/120 mg) once daily for 8 or 12 weeks. The primary efficacy endpoint was sustained virologic response at 12 weeks after treatment completion (SVR12). Adverse effects and laboratory abnormalities were assessed. Results: Twenty-five Japanese patients (15 female) were enrolled from 13 pediatric centers in Japan. Median age was 13 years (range 12–17). Numbers of patients with genotypes 1b, 2a, 2b, and 2b/1b were 6, 12, 6, and 1, respectively. Twenty-two were treatment-naïve, while three had experienced interferon-based treatments. All patients completed G/P treatment (24 for 8 weeks and 1 for 12). Twenty-four achieved SVR12 (96%). Most adverse events were mild. None were serious. G/P significantly decreased serum alanine aminotransferase, γ‐glutamyltransferase, and Wisteria floribunda agglutinin-positive Mac-2-binding protein concentrations. No negative effects on growth or maturation were apparent at 12 weeks. Conclusions: Under real-world conditions, G/P treatment of Japanese adolescents with chronic HCV was highly efficacious and well tolerated. [ABSTRACT FROM AUTHOR]

The novel coronavirus disease pandemic is threatening not only physical but also mental health. Although some recent quantitative studies have been conducted and revealed the influence of the pandemic on mental health and its relevant factors, it is impossible to obtain and explore all possible variables strongly related to mental health. Therefore, we attempted to adopt a bottom-up approach using text mining of participants' narratives. We examined how participants' descriptions of daily life during the pandemic were categorized into various topics, and which topics were related to their mental health in a sample of 776 Japanese citizens in the general population over 18 years old. Results of a topic modeling with 2,594 unique words provided nine topics (mask, physical symptoms, children, infection anxiety, disinfection items, economic influence, remote work, going out, and change of lifestyle). Those who wrote about economic influence, physical symptoms, and disinfection items experienced lower life satisfaction and higher depression and negative affect, whereas those who mentioned their children were likely to have higher life satisfaction. This study highlighted that monitoring the mental health of individuals with economic impacts and physical symptoms may reduce the damage of COVID-19. [ABSTRACT FROM AUTHOR]

Introduction: Many individuals with type 2 diabetes (T2D) experience suboptimal glycemic control. Treatment intensification options include fixed-ratio combination products containing a basal insulin and a glucagon-like peptide-1 receptor agonist, such as iGlarLixi (insulin glargine 100 U/mL and lixisenatide). This study aimed to provide real-world evidence of the effect of iGlarLixi in Japanese clinical practice. Methods: SPARTA Japan was a non-comparative, observational study conducted at 27 institutions in Japan. Anonymized individual-level data from adults with T2D receiving iGlarLixi in routine clinical practice were retrospectively collected. The primary study objective was to assess the impact of iGlarLixi on the change in glycated hemoglobin (HbA1c) at 6 months' post-treatment initiation, with preplanned subanalyses to determine the influence of baseline characteristics. Secondary and exploratory endpoints included assessment of the proportion of individuals achieving HbA1c targets, change in body weight, and incidence and severity of hypoglycemia and gastrointestinal events. Results: The full analysis set included 432 individuals, with data available at 6 months for 426. Of the 432 individuals, the mean (SD) age at baseline was 61.6 (12.8) years and the majority had a T2D duration of ≥ 10 years [mean (SD) 13.3 (10.4) years]. At 6 months, HbA1c had significantly decreased versus baseline (–0.85%; P < 0.0001), with a greater decrease in those aged < 65 years, with a shorter duration of T2D and higher baseline HbA1c. A significant increase in the proportion of participants achieving age-specific HbA1c versus baseline was observed. Mean body weight decreased by 0.5 kg (P = 0.0034 versus baseline). There were few hypoglycemia and gastrointestinal events (in individuals with HbA1c data); no severe hypoglycemic events were reported. Conclusions: The results of this real-world study indicate that iGlarLixi may improve glycemic control without serious adverse events in Japanese individuals with T2D who have suboptimal glycemic control on current treatment regimens and switch to iGlarLixi. Trial registration: UMIN-CTR Trials Registry, UMIN000044126; registered 10 May 2021. Plain Language Summary: The first medicines for treating diabetes that many individuals with type 2 diabetes receive are administered orally; however, for most individuals, these oral drugs are not enough to achieve blood glucose targets as their disease progresses. Treatment intensification options include adding an injectable therapy, such as a glucagon-like peptide-1 receptor agonist or basal insulin, or the combination of both, the use of which has been studied extensively and has been shown to be a simple and well-tolerated option. Here, we report the findings of a study that retrospectively evaluated the outcomes of 432 Japanese individuals who took iGlarLixi, which consists of the glucagon-like peptide-1 receptor agonist lixisenatide and basal insulin glargine 100 U/mL as a fixed-ratio combination (i.e., combined as a single subcutaneous injection), over 6 months of treatment. We found that iGlarLixi improved blood glucose levels in these individuals, and was associated with few hypoglycemia or gastrointestinal adverse events. These results suggest that iGlarLixi may offer an effective option for improving glycemic control in Japanese individuals with type 2 diabetes who require treatment intensification because their blood glucose goals have not been achieved with oral drugs alone or co-administered with a glucagon-like peptide-1 receptor agonist or basal insulin. [ABSTRACT FROM AUTHOR]

TogoVar (https://togovar.org) is a database that integrates allele frequencies derived from Japanese populations and provides annotations for variant interpretation. First, a scheme to reanalyze individual-level genome sequence data deposited in the Japanese Genotype-phenotype Archive (JGA), a controlled-access database, was established to make allele frequencies publicly available. As more Japanese individual-level genome sequence data are deposited in JGA, the sample size employed in TogoVar is expected to increase, contributing to genetic study as reference data for Japanese populations. Second, public datasets of Japanese and non-Japanese populations were integrated into TogoVar to easily compare allele frequencies in Japanese and other populations. Each variant detected in Japanese populations was assigned a TogoVar ID as a permanent identifier. Third, these variants were annotated with molecular consequence, pathogenicity, and literature information for interpreting and prioritizing variants. Here, we introduce the newly developed TogoVar database that compares allele frequencies among Japanese and non-Japanese populations and describes the integrated annotations. Genomic database: Genetic variation patterns in Japan A comprehensive database of genome sequence differences found in Japanese individuals is helping researchers uncover the genetic basis of diseases occurring in the Japanese population. Nobutaka Mitsuhashi from the Database Center for Life Science in Chiba, Japan, and colleagues describe the development of TogoVar, a web-based resource that includes genetic data from more than 200,000 Japanese individuals, plus many others of non-Japanese ancestry for comparison. From the millions of tracked DNA differences, many associated with disease, researchers can search for genetic variants of interest and find information on variant frequency, clinical importance, genomic context, related publications, and more. First established in 2018, TogoVar (https://togovar.org) now provides a one-stop shop for researchers looking to interpret genomic variation data in Japanese populations. [ABSTRACT FROM AUTHOR]

A better understanding of the reasons for bequests can be pivotal for fiscal policy and wealth inequality management, as the different motives underlying bequest behavior have varied implications. This study examines bloodline-based indirect reciprocity in bequest attitudes over three generations. In doing so, it extends the family tradition model to a bloodline-based family tradition model. This extended model suggests that the source of the inheritance impacts the amount of the bequest left to one's children or spouse. To test the hypothesis, this study empirically analyzes survey data from the 2009 wave of the Preference Parameters Study for Japan. The results suggest that with some socioeconomic characteristics controlled for, those who have received an inheritance from their parents are more likely to intend to bequest as much as possible to their children, while Japanese females (males) who have received an inheritance from their spouse's parents are more likely to intend to bequest as much as possible to both their children and their spouse (their spouse only). Hence, the source of the inheritance does matter in bequest attitudes, suggesting bloodline-based indirect reciprocity in bequest attitudes. [ABSTRACT FROM AUTHOR]

Introduction: This study aimed to update cost-effectiveness and public health impact estimates of the two-dose recombinant zoster vaccine (RZV) compared with no vaccination against herpes zoster (HZ) in the Japanese population aged 65 years. List price of the vaccine and latest RZV efficacy and waning estimates were incorporated. Methods: A multicohort static Markov model with a cycle length of 1 year was used to follow a hypothetical cohort of one million people aged 65 years over their remaining lifetime (base case). Age-stratified vaccine efficacy and waning rates were updated on the basis of the latest clinical trial data (interim ZOE-LTFU; NCT02723773). First-dose coverage was assumed at 40%, and second-dose compliance was assumed at 95%. Costs and outcomes were discounted at 2% annually, and the incremental cost-effectiveness ratio (ICER) was calculated from payer and societal perspectives. The societal perspective considered productivity loss due to suffering HZ, or due to suffering HZ and time required for vaccination. Sensitivity analyses explored the overall uncertainties in the model. Scenario analyses for Japanese adults aged 50, 60, 70, 80, ≥ 50, and ≥ 65 years (main scenario) were conducted. An ICER below ¥5–6 million/quality-adjusted life-year (QALY) was considered cost-effective. Results: RZV was estimated to prevent 71,423 HZ cases and 15,858 post-herpetic neuralgia (PHN) cases per million people aged 65 years compared with no vaccine in Japan. The ICER was ¥4,205,515 from a payer perspective and was most sensitive to assumptions regarding vaccine efficacy waning, proportion of patients with HZ developing PHN, and HZ incidence. From societal perspectives, ICERs were ¥3,854,192 (productivity loss from suffering HZ only) and ¥4,622,212 (productivity loss from suffering HZ and time required for vaccination). Overall, the results were considered robust under extensive sensitivity and scenario analyses. Conclusion: Vaccination against HZ with RZV is cost-effective compared with no vaccination in Japanese adults aged 65 years. [ABSTRACT FROM AUTHOR]

Objective: The medication-overuse headache (MOH) prevalence has not been investigated in a general Japanese population. We performed questionnaire-based survey and revealed MOH prevalence and its characteristics. We also performed clustering to obtain insight for MOH subgrouping. Methods: In this cross-sectional study, the 15–64-year-old population was investigated in Itoigawa during their COVID-19 vaccination under the national policy. MOH was defined as ≥ 15 days/month plus self-report of use of pain medications ≥ 10 or 15 days/month in the last 3 months. Ward method and k-means + + were used to perform clustering MOH patients. Results: Among 5865 valid responses, MOH prevalence was 2.32%. MOH was common among females and the middle-aged. Combination-analgesic is the most overused as 50%. MOH had aggravation by routine physical activity, moderate or severe pain, and migraine-like, compared to non-MOH. The 136 MOH patients could be grouped into 3 clusters. Age and frequency of acute medication use were essential factors for clustering. Conclusions: This is the first study of MOH prevalence in Japan. Most MOH characteristics were similar to previous reports worldwide. Public awareness of proper headache treatment knowledge is still needed. Clustering results may be important for subtype grouping from a social perspective apart from existing clinical subtypes. [ABSTRACT FROM AUTHOR]

In this study, we investigated whether the risk preference systematically changed during the spread of COVID-19 in Japan. Traditionally, risk preference is assumed to be stable over one's life, though it differs among individuals. While recent studies have reported that it changes with a large event like natural disasters and financial crisis, they have not reached a consensus on its direction, risk aversion, or tolerance. We collected panel data of Japanese individuals in five waves from March to June 2020, which covered the period of the first cycle when COVID-19 spread rapidly and then dwindled. We measured risk preference through questions on the willingness to pay for insurance. The main results are as follows: First, people became more risk tolerant throughout the period; and second, people were more averse to mega risk than moderate risk, with the former correlating more strongly with the individual's perception of COVID-19. The first result may be interpreted as "habituation" to repeated stress, as is understood in neuroscience. [ABSTRACT FROM AUTHOR]

Background: Axicabtagene ciloleucel (axi-cel) is an autologous chimeric antigen receptor T-cell based anti-CD19 therapy. The ZUMA-1 study, multicenter, single-arm, registrational Phase 1/2 study of axi-cel demonstrated high objective response rate in patients with relapsed/refractory large B-cell lymphoma. Here, we present the results of the bridging study to evaluate the efficacy and safety of axi-cel in Japanese patients (JapicCTI-183914). Methods: This study was the phase 2, multicenter, open-label, single-arm trial. Following leukapheresis, axi-cel manufacturing and lymphodepleting chemotherapy, patients received a single infusion of axi-cel (2.0 × 106 cells/kg). Bridging therapy between leukapheresis and conditioning chemotherapy was not allowed. The primary endpoint was objective response rate. Results: Among 17 enrolled patients, 16 received axi-cel infusion. In the 15 efficacy evaluable patients, objective response rate was 86.7% (95% confidence interval: 59.5–98.3%); complete response/partial response were observed in 4 (26.7%)/9 (60.0%) patients, respectively. No dose-limiting toxicities were observed. Grade ≥ 3 treatment-emergent adverse events occurred in 16 (100%) patients—most commonly neutropenia (81.3%), lymphopenia (81.3%) and thrombocytopenia (62.5%). Cytokine release syndrome occurred in 13 (81.3%) patients (12 cases of grade 1 or 2 and 1 case of grade 4). No neurologic events occurred. Two patients died due to disease progression, but no treatment-related death was observed by the data-cutoff date (October 23, 2019). Conclusion: The efficacy and safety of axi-cel was confirmed in Japanese patients with relapsed/refractory large B-cell lymphoma who have otherwise limited treatment options. Trial registration: JapicCTI-183914. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to (1) describe characteristics of aggressive care at the end of life (EOL) and (2) identify factors associated with specialized palliative care use (SPC) and aggressive care at the EOL among Japanese patients with advanced cancer. Methods: This single-center, follow-up cohort study involved patients with advanced cancer who received chemotherapy at Tohoku University Hospital. Patients were surveyed at enrollment, and we followed clinical events for 5 years from enrollment in the study. We performed multivariate logistic regression analysis to identify independent factors related to SPC use and chemotherapy in the last month before death. Results: We analyzed a total of 135 patients enrolled between January 2015 and January 2016. No patients were admitted to the intensive care unit, and few received resuscitation or ventilation. We identified no factors significantly associated with SPC use. Meanwhile, younger age (20–59 years, odds ratio [OR] 4.10; 95% confidence interval [CI] 1.30–12.91; p = 0.02) and no receipt of SPC (OR 4.32; 95% CI 1.07–17.37; p = 0.04) were associated with chemotherapy in the last month before death. Conclusion: Younger age and a lack of SPC were associated with chemotherapy at the EOL in patients with advanced cancer in Japan. These findings suggest that Japanese patients with advanced cancer may benefit from access to SPC. [ABSTRACT FROM AUTHOR]

Specialized guidelines are required for the health behaviors of vulnerable populations such as children. This is especially true during the COVID-19 pandemic, wherein major lifestyle changes have occurred, especially among young children. The present study aims to use longitudinal data to understand changes in the physical activity, screen time, sleep, and mental health of preschoolers in Japan during the COVID-19 pandemic, compared to pre-pandemic period. Subjective and objective measures were used to assess the variables of interest longitudinally. It was found that physical activity, adherence to WHO-recommended screen time, and prosocial behaviors decreased significantly. On the other hand, sedentary time and hyperactivity increased. Our results are consistent with findings from other countries. The implications with respect to outdoor playtime, screen-time in the context of online learning during the pandemic, and the effects of parents' mental health on preschool-aged children are discussed. [ABSTRACT FROM AUTHOR]

Stroke is a principal cause of mortality in China and Japan. High systolic blood pressure (SBP) was considered a chief risk factor for stroke mortality. Herein, we evaluated temporal trends of high SBP-attributable stroke mortality in China and Japan between 1990 and 2017. Data on stroke mortality were retrieved from the Global Burden of Disease Study 2017 (GBD 2017). Using the age-period-cohort method, we computed overall net drifts, local drifts, longitudinal age curves, and cohort/period rate ratios (RRs) for high SBP-attributable stroke mortality. The age-standardized mortality rates (ASMRs) displayed decreasing trends for high SBP-attributable stroke mortality. The annual net drift values were − 1.4% and − 3.5% in Chinese men and women versus − 3.1% and − 4.9% in Japanese men and women. The local drift values in both countries were < 0 among all age groups but were lower in women than in men. The longitudinal age curves showed a greater high SBP-attributable stroke mortality in men than in women across all age groups. Similar decreasing patterns were shown in the period and cohort RRs in both sexes with women having a quicker decline than men. In China and Japan, the ASMRs, as well as the period and cohort RRs of high SBP-attributable stroke mortality, decreased between 1990 and 2017 in both sexes and across all age groups. Yet, the prevalence of high SBP remained worrisome in both countries. Thus, SBP control should be encouraged to prevent stroke mortality. [ABSTRACT FROM AUTHOR]

According to a survey by Japan's Ministry of Health, Labor, and Welfare in 2017, 3.6% of Japanese adults-equivalent to about 3.2 million people-have suffered from problem gambling at some point in their lifetime. This study examines the relationship between financial literacy, financial education, and gambling behavior (measured as gambling frequency) among the Japanese population. We hypothesize that financially literate and financially educated people who use their knowledge to make sound financial decisions are less likely to gamble. The data used in this study are from a nationwide survey in Japan from the Preference Parameters Study of Osaka University in 2010 (n = 3687). To control for endogeneity bias between financial literacy and gambling behavior, we use the education of respondents' fathers as an instrumental variable. The results from the probit-instrumental variable model show that financial literacy has a significantly negative relationship with gambling frequency, while financial education has no significant relationship with gambling frequency. Our findings suggest that problem gambling may be mitigated by promoting financial literacy, but no such conclusion can be drawn for financial education. [ABSTRACT FROM AUTHOR]

Alongside the EU–Japan Economic Partnership Agreement (EPA), a Strategic Partnership Agreement (SPA) between the EU and Japan entered into force in 2019. Whereas the EPA enshrines the existing interconnectedness between the Japanese and European economies, the SPA remains more aspirational. With an emphasis on shared norms and values and recognising an increasingly hostile external environment, the EU and Japan are seeking to deepen and broaden their security cooperation. For the period 1990–2017, EU–Japan security cooperation is mapped for a broad range of security domains. During this period, cooperation has increased notably in domains such as economic security, cyber-security and civil protection. In other areas, such as military, regional, energy and human security as well as terrorism, the scope of cooperation lags behind. Looking forward, the SPA not only reflects a renewed interest and level of ambition in the EU and Japan but also provides them with a platform to extend security cooperation to address their global and regional challenges. [ABSTRACT FROM AUTHOR]

Introduction: No study has compared the effects of sodium–glucose cotransporter 2 inhibitors (SGLT2is) and dipeptidyl peptidase 4 inhibitors (DPP4is) on patients' quality-of-life (QOL). Methods: We enrolled 253 drug-naïve Japanese patients with type 2 diabetes mellitus (T2DM), randomly assigned them into a dapagliflozin (SGLT2i) group or DPP4i group in approximately 1:1 ratio, and monitored them for 24 weeks. The primary endpoint was the proportion of subjects indicating improvement in the "overall quality of life" domain of SHIELD-WQ-9 at week 24. Secondary endpoints included other domains of SHIELD-WQ-9, DTR-QOL, EQ-5D-5L, medication preference, medication adherence, diet therapy adherence, body weight, body mass index (BMI), abdominal circumference, HbA1c, and frequency of adverse events. Results: The proportion of subjects indicating improvement in the "overall quality of life" domain of SHIELD-WQ-9 at week 24 was higher in the dapagliflozin group (28.4%) than in the DPP4i group (18.6%) (p = 0.08). The proportion of subjects indicating improvement in the "physical health" domain of SHIELD-WQ-9 at week 24 was significantly higher in the dapagliflozin group (42.2%) than in the DPP4i group (23.7%) (p = 0.004). Total scores and domain 1 scores of DTR-QOL showed greater improvement in the dapagliflozin group (14.3 ± 15.6 and 15.5 ± 20.8, respectively) than in the DPP4i group (10.2 ± 15.6 and 10.3 ± 19.5, respectively) (both p = 0.05). EQ-5D-5L scores had significantly improved in the DPP4i group (0.023 ± 0.088) (p = 0.005); the intergroup difference was not significant (p = 0.14). Body weight (p < 0.001), BMI (p < 0.001), and abdominal circumference (p = 0.019) had significantly decreased in the dapagliflozin group compared with the corresponding values in the DPP4i group. Conclusion: Dapagliflozin showed a comparable or more favorable benefit on Japanese patients' QOL compared with DPP4is. Dapagliflozin was well tolerated. It significantly reduced body weight, which was significantly correlated with improvement in the patients' QOL. This study demonstrates that dapagliflozin can be used as a first-line drug for T2DM in Japan with a beneficial impact on patients' QOL. Trial Registration: University Hospital Medical Information Network Clinical Trial Registry (UMIN000030514); Japan Registry of Clinical Trials (jRCTs051180165). [ABSTRACT FROM AUTHOR]

Introduction: Reliable quality of life (QoL) measures and utility values are needed for patients with type 2 diabetes mellitus (T2DM) with a variety of comorbid conditions to help facilitate cost-effectiveness modeling. This study aimed to evaluate the Diabetes Treatment-Related Quality of Life (DTR-QOL) and EuroQol 5-dimension 5-level (EQ-5D-5L) questionnaires in patients with T2DM with and without diabetes complications and comorbidities in Japan. Methods: This was an observational survey study involving 1000 patients with T2DM, at least 20 years old, receiving treatment at Nara University Hospital or Takamura Internal Medicine Clinic in Japan. Patients completed the DTR-QOL and EQ-5D-5L questionnaires and clinicians completed an accompanying case report form. The DTR-QOL and EQ-5D-5L are scored on a scale of 0–100 and 0–1, with 100 and 1 representing the best possible scores, respectively. Results: Out of 1000 recruited patients, 978 were included in the final analysis. Patients reported an average EQ-5D-5L value of 0.92 ± 0.11. Utility values corresponded to the degree of severity of health conditions while few differences were observed when stratified by the HbA1c 7% threshold, age, or BMI level, nor did the values correspond to the degree of clinical risk factors. Patients reported an average total DTR-QOL score of 79.26 ± 13.26. The DTR-QOL was sensitive to detect differences in patients with T2DM with a variety of complications and comorbidities, risk factors, and treatments. Conclusion: This is the largest study to report QOL values for patients with diabetes in Japan and the first to include a variety of comorbid diabetic conditions. These findings may be useful for cost-effectiveness modeling of patients with T2DM in Japan. [ABSTRACT FROM AUTHOR]

Purpose: Several studies of Western patients with age-related macular degeneration (AMD) have investigated reading performance that improved at high levels of illumination; however, the relation between reading performance and macular function has not been evaluated in detail in Japan. The goals of this study were to evaluate the effect of different levels of illumination on reading performance in Japanese patients with AMD and determine the factors, such as macular function, that affect these results. Study design: Cross-sectional study. Methods: We prospectively included 39 patients with bilateral AMD or maculopathy. We evaluated reading performance; reading acuity (RA), critical print size (CPS), and maximal reading speed (MRS) using charts with Japanese sentences based on the MNREAD-J in 500–7500 lx. Patients were classified into two groups based on the presence of a central scotoma (CS) or no CS (NCS) diagnosed by microperimetry. Results: The RA improved significantly in 500–7500 lx in both groups (NCS, p = 0.001; CS, p = 0.046). The RA improvement differed significantly (2000 lx, p = 0.021; 5,000 lx; p = 0.021; 7500 lx, p = 0.047) between 500 lx and other illumination levels only in the NCS group and then plateaued over 2000 lx. The CPS and MRS did not improve significantly at any illumination level. Conclusions: These results suggest that the difference in macular function was related to improvement in the RA with increased illumination in Japanese patients with AMD. [ABSTRACT FROM AUTHOR]

Background: Nivolumab, an anti-programmed death-1 agent, showed survival benefits in Asian patients, including Japanese, with gastric/gastro-esophageal junction (G/GEJ) cancer. We report the analysis of the Japanese subpopulation from ATTRACTION-2 that evaluated nivolumab versus placebo in unresectable advanced or recurrent G/GEJ cancer after ≥ 2 chemotherapy regimens.Methods: Data from the Japanese subpopulation in the randomized, double-blind, placebo-controlled, phase 3 trial were analyzed (data cutoff, February 25, 2017). Primary endpoint was overall survival (OS); secondary endpoints included progression-free survival (PFS) and objective response rate (ORR).Results: Among the overall study population of 493 patients, 226 (nivolumab 152; placebo 74) were enrolled from 28 sites in Japan. In the Japanese subset, median OS was longer with nivolumab versus placebo (5.4 months, 95% CI 4.6-7.4 versus 3.6 months, 95% CI 2.8-5.0). The risk of death was lower in the nivolumab versus placebo group (hazard ratio 0.58, 95% CI 0.42-0.78; p = 0.0002). Incidences of serious adverse events were 23% (35/152) and 25% (18/72) in the nivolumab and placebo groups, respectively. In the Japanese ITT population, 22% of nivolumab-treated and 28% of placebo-treated patients received prior ramucirumab treatment. Overall, clinical activity of nivolumab was observed regardless of prior ramucirumab use. In the nivolumab group, ORR and PFS were numerically higher in patients with prior ramucirumab use than in those without.Conclusions: In the Japanese subpopulation, patients receiving nivolumab had longer OS, similar to the overall population, with a manageable safety profile. The interaction between nivolumab and ramucirumab will be clarified in ongoing clinical trials. [ABSTRACT FROM AUTHOR]

Objectives: The purpose of this study was to assess the relationship between economic security and self-rated health for elderly Japanese residents living alone.Design: A secondary analysis of a cross-sectional study.Setting: N City, H. Prefecture, Japan.Participants: Survey questionnaires were distributed to 2,985 elderly residents living alone, aged ≥70 years, of which, 1,939 (65.0%) were returned and treated as valid responses.Measurements: The survey included questions about gender, age, number of years spent in N City, self-rated health, economic security, number of years spent living alone, reason for living alone, life satisfaction, cooking frequency, frequency of seeing a doctor, long-term care service usage, as well as whether they enjoyed their lives, participated in social organizations.Results: Of the respondents, 1,563 (80.6%) reported that they were economically secure, and 376 (19.4%) responded that they were insecure. The odds ratio predicting poor self-rated health for the economically insecure participants was significantly high (odds ratio: 3.19, 95%, Confidence Interval (CI): 2.53−4.02, and P < 0.001). Similarly, the adjusted odds ratio for poor self-rated health was significantly high for the economically insecure participants in multivariate analyses controlling for factors such as age, gender, cooking frequency, and social participation (adjusted odds ratio: 2.21, 95%, CI: 1.70−2.88, and P < 0.001). Furthermore, a similar trend was observed in stratified analyses based on gender and age groups.Conclusion: Economic security predicted self-rated health independently of confounders, including social participation and cooking frequency, among the elderly Japanese living alone in communities. [ABSTRACT FROM AUTHOR]

Japanese mortality due to colorectal cancer is on the rise, surpassing 49,000 in 2015. Many new treatment methods have been developed during recent decades. The Japanese Society for Cancer of the Colon and Rectum Guidelines 2016 for the treatment of colorectal cancer (JSCCR Guidelines 2016) were prepared to show standard treatment strategies for colorectal cancer, to eliminate disparities among institutions in terms of treatment, to eliminate unnecessary treatment and insufficient treatment, and to deepen mutual understanding between health-care professionals and patients by making these Guidelines available to the general public. These Guidelines were prepared by consensus reached by the JSCCR Guideline Committee, based on a careful review of the evidence retrieved by literature searches, and in view of the medical health insurance system and actual clinical practice settings in Japan. Therefore, these Guidelines can be used as a tool for treating colorectal cancer in actual clinical practice settings. More specifically, they can be used as a guide to obtaining informed consent from patients and choosing the method of treatment for each patient. As a result of the discussions held by the Guideline Committee, controversial issues were selected as Clinical Questions, and recommendations were made. Each recommendation is accompanied by a classification of the evidence and a classification of recommendation categories based on the consensus reached by the Guideline Committee members. Here we present the English version of the JSCCR Guidelines 2016. [ABSTRACT FROM AUTHOR]

Purpose: Dairy products have been reported to have various beneficial effects on human health. Although some previous studies have shown relationships between dairy consumption and depressive symptoms, the results of these studies were not consistent. This study aimed to investigate the association between frequency of low- and whole-fat dairy consumption, and depressive symptoms.Methods: This cross-sectional study enrolled 1159 Japanese adults aged 19-83 years. Dietary intake was assessed using a brief self-administered diet history questionnaire. Depressive symptoms were evaluated by a self-rating depression scale (SDS) (the presence of depressive symptoms was defined as an SDS score ≥45 points). Logistic regression models were used to analyze the association between the frequency of low- and whole-fat dairy consumption and depressive symptoms.Results: Higher frequency of low-fat dairy consumption was associated with a lower prevalence of depressive symptoms. In the final adjusted model, the odds ratios and 95% confidence intervals for prevalence of depressive symptoms when no consumption of low-fat dairy was compared to moderate (1-3 times per week) and high (≥4 times/week) frequencies of low-fat dairy consumption were 0.96 (0.71, 1.30) and 0.51 (0.35, 0.77), respectively (p for the trend = 0.004). No relationships were observed between the consumption of whole-fat dairy and depressive symptoms.Conclusions: The current results indicate that a higher frequency of low-fat dairy consumption may be associated with a lower prevalence of depressive symptoms. [ABSTRACT FROM AUTHOR]

Background: Only limited epidemiological evidence exists regarding the relationship between age and gastroesophageal reflux disease (GERD) among Japanese patients with type 2 diabetes mellitus.Aim: The purpose of the present study is to investigate this issue among Japanese patients with type 2 diabetes mellitus.Methods: A multicenter cross-sectional study was conducted in 847 Japanese patients with type 2 diabetes mellitus. Subjects were divided into quartiles according to age: (1) 19 ≤ age < 56, (2) 56 ≤ age < 64, (3) 64 ≤ age < 71, and (4) 71 ≤ age < 89. GERD was defined as present when a subject had a Carlsson-Dent self-administered questionnaire (QUEST) score ≥4.Results: The prevalence of GERD was 31.5 %. Younger age was independently associated with a higher prevalence of GERD: the adjusted odds ratios (95 % confidence intervals) for GERD in relation to age < 56, 56 ≤ age < 64, 64 ≤ age < 71, and ≥71 were 3.73 (2.16-6.53), 1.98 (1.21-3.27), 1.66 (1.05-2.68), and 1.00 (reference), respectively (P for trend = 0.001). Among 201 patients with PPI or histamine H2-receptor antagonist (H2RA), less than 56 years of age was independently positively associated with GERD: the adjusted OR was 5.68 (95 % CI 1.55-22.18) (P for trend = 0.02).Conclusions: Younger age may be independently positively associated with GERD among Japanese type 2 diabetes mellitus patients, regardless of the use of PPI or H2RA. [ABSTRACT FROM AUTHOR]

Purpose: The aims of the present study were to characterize the pharmacokinetics of fostamatinib in two phase I studies in healthy Japanese subjects after single- and multiple-dose administration, and to evaluate the utility of dried blood spot (DBS) sampling. Methods: In study A, 40 Japanese and 16 white subjects were randomized in a double-blind parallel group study consisting of seven cohorts, which received either placebo or a fostamatinib dose between 50 and 200 mg after single and multiple dosing. Pharmacokinetics of R406 (active metabolite of fostamatinib) in plasma and urine was assessed, and safety was intensively monitored. Study B was an open-label study that assessed fostamatinib 100 and 200 mg in 24 Japanese subjects. In addition to plasma and urine sampling (as for study A), pharmacokinetics was also assessed in blood. Results: Mean maximum plasma concentration ( C) and area under total plasma concentration-time curve (AUC) increased with increasing dose in Japanese subjects. Steady state was achieved in 5-7 days for all doses. C and AUC were both higher in Japanese subjects administered a 150-mg single dose than in white subjects. This difference was maintained for steady state exposure by day 10. Overall, R406 blood concentrations were consistent and ∼2.5-fold higher than in plasma. Minimal (<0.1 %) R406 was excreted in urine. Fostamatinib was well tolerated at all doses. Conclusions: Fostamatinib pharmacokinetics following single- and multiple-dose administration was approximately dose proportional at all doses ≤150 mg and greater than dose proportional at 200 mg in Japanese subjects. Japanese subjects administered fostamatinib 150 mg had higher exposure than white subjects. R406 could be measured in DBS samples and distributed into red blood cells, and DBS sampling was a useful method for assessing R406 pharmacokinetics. [ABSTRACT FROM AUTHOR]

Japan's population is aging at an unprecedented rate. Combined with the tradition of family responsibility for elder care, this rapid population aging has resulted in middle-aged Japanese people being much more likely today than in past decades to face the responsibility of caring for their elderly parents alongside their other major roles. Using nationally representative Japanese data, this study assessed the individual and combined implications of caregiving and other role involvements for the well-being of middle-aged men and women. Some evidence was found for deleterious psychological consequences of the caregiver role. However, in contrast to expectations, the interaction between the roles of caregiver and worker was positively associated with well-being among both men and women. The results suggest the importance of middle-aged adults being able to keep working when they have to care for their aging parents. Another important finding was significant gender differences in the psychological consequences of holding multiple family- and work-related roles and in combining these with the caregiver role. Further analysis showed that the spousal role was also negatively associated with depressive symptoms and positively associated with satisfaction for men but not for women. Gender differences in the findings appear to reflect the significant gender asymmetry in role experiences in Japan. [ABSTRACT FROM AUTHOR]

The World Health Organization Fracture Risk Assessment Tool (FRAX(®)) was recently developed to estimate the 10-year absolute risk of osteoporotic fracture among the general population. However, the evidence for its use in chronic kidney disease patients has been lacking, and the association between the FRAX(®) and mortality is unknown. Therefore, a hospital-based, prospective, cohort study was conducted to evaluate the predictive ability of the FRAX(®) for mortality in hemodialysis patients. A total of 252 patients who had been started on maintenance hemodialysis, 171 men and 81 women, with a mean age of 67 ± 14 years, was studied. The endpoint was defined as all-cause death. The Cox proportional hazards model was used to calculate hazard ratios and 95 % confidence intervals. During the mean follow-up period of 3.4 ± 2.7 years, 61 deaths occurred. The median (interquartile range) of the FRAX(®) for major osteoporotic fracture was 6.9 (4.6-12.0) % in men and 19.0 (7.6-33.0) % in women. Cumulative survival rates at 5 years after starting dialysis, with the FRAX(®) levels above and below the median, were 51.9 and 87.9 %, respectively, in men and 67.4 and 83.7 %, respectively, in women. Overall, in men, the multivariate Cox regression analyses revealed that the log-transformed FRAX(®) remained an independent predictor of death after adjusting by confounding variables. However, in women, the significant association between the FRAX(®) value and the outcome was eliminated if age was put into these models. Among Japanese hemodialysis patients, the FRAX(®) seems to be useful for predicting death, especially in men. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to report lifetime and 4-week low back pain (LBP) prevalence and examine factors associated with chronic LBP and back pain disability over a lifetime in a Japanese adult population. Methods: In February 2011, 1,063,083 adults aged 20-79 years registered as internet research volunteers were randomly selected to participate in a questionnaire survey. The data from 65,496 respondents were analyzed to calculate age-standardized lifetime and 4-week prevalence. Chronic LBP and back pain disability were defined as LBP lasting for ≥3 months and a consecutive ≥4-day-long absence, respectively. Factors associated with chronic disabling back pain over a lifetime were examined by multiple logistic regression modeling. Results: The lifetime LBP prevalence was 83 % and 4-week prevalence was 36 %; majority of the respondents had disability-free LBP. Smoking [adjusted odds ratio (aOR): 1.17; 95 % CI: 1.05, 1.30], lower educational level (aOR: 1.21; 95 % CI: 1.09, 1.34), history of disabling back pain among family members and/or significant others (aOR: 1.46; 95 % CI: 1.27, 1.67), occupational LBP (aOR: 1.34; 95 % CI: 1.16, 1.55), traffic injury (aOR: 2.81; 95 % CI: 2.07, 3.81), compensated work injury (aOR: 2.42; 95 % CI: 1.92, 3.05), radiating pain (aOR: 4.94; 95 % CI: 4.45, 5.48), low back surgery (aOR: 10.69; 95 % CI: 9.02, 12.68), and advice to rest upon back pain consultation (aOR: 3.84; 95 % CI: 3.36, 4.40) were associated with chronic disabling back pain over a lifetime. Conclusions: LBP is common in Japan as in other industrialized countries. The association between the advice to rest and chronic disabling back pain supports recent treatment guidelines emphasizing continuation of daily activities. [ABSTRACT FROM AUTHOR]