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The use of electronic patient-reported outcomes has increased recently, and smartphones offer distinct advantages over other devices. However, previous systematic reviews have not investigated the reliability of the Center for Epidemiologic Studies Depression Scale (CES-D), Generalized Anxiety Disorder-7 (GAD-7), and Kessler Screening Scale for Psychological Distress (K6) when used with smartphones, and this has not been fully explored. This study aimed to evaluate the equivalence of the paper and smartphone versions of the CES-D, GAD-7, and K6, which were compared following a randomized crossover design method in 100 adults in Gunma, Japan. Participants responded to the paper and smartphone versions at 1-week intervals. The equivalence of paper and smartphone versions was evaluated using the intraclass correlation coefficient (ICC agreement ). The mean participant age was 19.86 years (SD = 1.08, 23% male). The ICC agreements for the paper and smartphone versions of the CES-D, GAD-7, and K6 were 0.76 (95% confidence interval [CI] 0.66-0.83), 0.68 (95% CI 0.59-0.77), and 0.83 (95% CI 0.75-0.88), respectively. Thus, the CES-D and K6 scales are appropriate for use in a smartphone version, which could be applied to clinical and research settings in which the paper or smartphone versions could be used as needed.

Diabetic retinopathy (DR) is a major microvascular complication of diabetes, affecting a substantial portion of diabetic patients worldwide. Timely intervention is pivotal in mitigating the risk of blindness associated with DR, yet early detection remains a challenge due to the absence of early symptoms. Screening programs have emerged as a strategy to address this burden, and this paper delves into the role of artificial intelligence (AI) in advancing DR screening in Japan. There are two pathways for DR screening in Japan: a health screening pathway and a clinical referral path from physicians to ophthalmologists. AI technologies that realize automated image classification by applying deep learning are emerging. These technologies have exhibited substantial promise, achieving sensitivity and specificity levels exceeding 90% in prospective studies. Moreover, we introduce the potential of Generative AI and large language models (LLMs) to transform healthcare delivery, particularly in patient engagement, medical records, and decision support. Considering the use of AI in DR screening in Japan, we propose to follow a seven-step framework for systematic screening and emphasize the importance of integrating AI into a well-designed screening program. Automated scoring systems with AI enhance screening quality, but their effectiveness depends on their integration into the broader screening ecosystem. LLMs emerge as an important tool to fill gaps in the screening process, from personalized invitations to reporting results, facilitating a seamless and efficient system. However, it is essential to address concerns surrounding technical accuracy and governance before full-scale integration into the healthcare system. In conclusion, this review highlights the challenges in the current screening pathway and the potential for AI, particularly LLM, to revolutionize DR screening in Japan. The future direction will depend on leadership from ophthalmologists and stakeholders to address long-standing challenges in DR screening so that all people have access to accessible and effective screening.

Western countries are currently facing the public health challenge of a rapidly aging population and the associated challenge of providing long-term care services to meet its needs with a reduced working age population. As people age, they will increasingly require both health and social care services to maintain their quality of life and these will need to be integrated to provide cost-effective long-term care. The World Health Organization recommended in 2020 that all countries should have integrated long-term care strategies to better support their older populations. Japan, with the most rapidly ageing society in the world, started to address this challenge in the 1990s. In 2017, it introduced a national policy for integrated long-term health and social care services at a local geographical level for older people. England has recently embarked on its first plan aiming for the integration of services for older people. In this article, we compare these approaches to the integration of long-term care systems, including the strengths of each. The paper also considers the effects of historical, cultural and organizational factors and the emerging role of technology. Finally, we identify critical lessons that can inform strategy development in other countries, and highlight the need to provide more international comparisons.

There is a lack of research on older lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) adults. This systematic review aimed to synthesize Japanese and Swedish qualitative research on LGBTQ adults aged 60 years or older following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Japanese and Swedish articles, published in English, were searched across ASSIA, CINAHL, Medline, PsychINFO, PubMed, Scopus, and Sociological Abstracts databases. Additional searches were conducted to include studies in Japanese or Swedish. There were no papers from Japan, whereas five from Sweden were reviewed. One article was excluded due to the wrong phenomenon. Four articles were included, involving 48 participants aged 60-94 years. We summarized the findings using a deductive thematic synthesis. Two major themes emerged: (a) quality of life, minority joy, and resilience (positive aspects), and (b) discrimination, stigmatization, and minority stress (negative aspects). The participants wished to be acknowledged for their own assets and unique life histories, and to be treated as everyone else. They emphasized the importance of knowledge of LGBTQ issues among nursing staff, so that older LGBTQ people are treated in a competent and affirmative way. The study revealed several important topics for understanding older LGBTQ adults' life circumstances and the severe lack of qualitative studies in Japan and Sweden.

COVID-19, which broke out globally in 2019, is an infectious disease caused by a novel strain of coronavirus, and its spread is highly contagious and concealed. Environmental vectors play an important role in viral infection and transmission, which brings new difficulties and challenges to disease prevention and control. In this paper, a type of differential equation model is constructed according to the spreading functions and characteristics of exposed individuals and environmental vectors during the virus infection process. In the proposed model, five compartments were considered, namely, susceptible individuals, exposed individuals, infected individuals, recovered individuals, and environmental vectors (contaminated with free virus particles). In particular, the re-positive factor was taken into account (i.e., recovered individuals who have lost sufficient immune protection may still return to the exposed class). With the basic reproduction number R0 of the model, the global stability of the disease-free equilibrium and uniform persistence of the model were completely analyzed. Furthermore, sufficient conditions for the global stability of the endemic equilibrium of the model were also given. Finally, the effective predictability of the model was tested by fitting COVID-19 data from Japan and Italy.

The investigation of the impact of the Fukushima accident is still going on although more than ten years have passed since the disaster. The main goal of this paper was to summarize the results of tritium and radiocarbon determinations in different environmental samples, possibly connected with the Fukushima Dai-ichi Nuclear Power Plant (FDNPP) accident. A document containing compiled data may serve as a solid basis for further research in the selected fields. To accomplish such effort, we went through dozens of relevant published papers, reporting 3 H and 14 C activity concentrations in precipitations, groundwater, seawater, river systems, tree rings, and, in some more extraordinary samples, such as herbaceous plants or debris from the damaged reactor buildings. As the referenced results would not be obtainable without adequate analytical techniques, the most common methods for routine measurement of tritium and radiocarbon concentrations are discussed as well. We believe that the correct identification of the affected environmental compartments could help quantify the released 3 H and 14 C activities and track their following fate, which could be especially important for plans to discharge contaminated water from the FDNPP in the upcoming years., Competing Interests: The authors declare no conflicts of interest.

(1) Background: The aim of this study is to review the benefits of the 8020 Campaign since its inception. (2) Methods: We followed the PRISMA guideline and collected information regarding the 8020 Campaign through online database searches. (3) Results: Twenty-five studies met the inclusion criteria and were eligible for analysis. The main outcomes of the 25 included studies were reviewed. The quality evaluation demonstrated a range of studies showing a credible relationship between masticatory function, number of teeth, salivary secretion, frequent dental check-ups, and general health concerns. Due to the risk of bias, publication bias, and indirectness, 22 studies were considered that only had "fair" quality. (4) Conclusions: The 8020 Foundation funded several of the studies, and other research papers noted the 8020 Campaign in their papers, however there were no clear explanations for any direct relationship between their findings and the 8020 Campaign. As a result, evidence for the direct effectiveness and benefits assessment of the 8020 Campaign positive outcomes were compromised by confounding social and economic variables over the 30-year period. To fully elucidate how improvement in Japan's oral health was directly related to the 8020 Campaign, a more informed and systematic explanation of the campaign's structure and activities is required., Competing Interests: The authors declare no conflict of interest.

The Brief Job Stress Questionnaire (BJSQ) is used widely in occupational health studies and practice. Summarizing scientific production based on measurement is crucial. This study aimed to systematically review observational studies that used the BJSQ and the New BJSQ to show their usability. A systematic search was conducted for studies investigating relationships between the BJSQ or the New BJSQ subscales and other validated measurements on 13 September 2021, in various literature databases. The BJSQ subscales, scoring methods, and other validated measurements in the studies were qualitatively summarized. In total, 145 published reports between 2003 and 2021 were included. Among the BJSQ subscales, job stressors (n = 95) such as quantitative job overload (n = 65) and job control (n = 64) were most often used. The subscales were utilized to investigate the relationships with several other measurements. Five reports used subscales from the New BJSQ. In the last two decades, the BJSQ and the New BJSQ help measure psychosocial factors (PF) at work and contribute to the publication of scientific papers in the occupational health field. This study would encourage the utilization of the questionnaires for future research and practice.

People are living longer, and our life has become more digital. Hence, the benefits from digital technology, including economic growth, increasing labor productivity, and ensuring health equity in the face of an aging population emerged as a vital topic for countries around the world. Japan, the Republic of Korea (ROK), Singapore, and Thailand are in the top ten rankings in terms of information and communication technology (ICT) development within the Asia Pacific Region and all are facing challenges of population aging. Well-designed national ICT policy and health promotion policies enabled the countries to make significant progress and development in terms of digitalization and healthy aging. This paper aims to answer questions regarding digitization and health promotion: when it started, how it is going, what are the achievements, and what it holds for the future, considering healthy aging and digitalization by reviewing the national ICT policy and health promotion policies of Japan, Korea, Singapore, and Thailand. This paper is expected to help readers build a comprehensive understanding of each country's journey towards building a healthy aging digital society. Furthermore, we hope this paper can be a source for countries to exchange experiences and learn from each other with a joint goal of building a healthy aging digital society.

This article addresses citizens' psychological health disparities in pandemic-stricken Japan from the perspective of positive psychology with a collective/political perspective. Our analysis of three internet surveys in 2020 and 2021 in Japan indicates most people's well-being declined continuously during this period, while some people's well-being increased. As previous studies of health inequality proved about physical health, the objective income/assets level has influenced psychological inequality. This paper demonstrated this relation in Japan, although it is often mentioned as an egalitarian country with comparatively better health conditions. Moreover, psychological levels and changes have been associated with biological, natural environmental, cultural, and social factors. Social factors include economic, societal-community, and political factors, such as income/assets, stratification, general trust, and fairness/justice. Accordingly, multi-dimensional disparities are related to psychological health disparity; tackling the disparities along the multi-layered strata is desirable. Furthermore, subjective perception of fairness/justice is significantly associated with the level of psychological health and mitigating its decrease. Thus, fairness and justice are found to be dynamic and protective factors against the decline of psychological health. While relatively little literature on health inequality analyzes fairness/justice philosophically, this paper highlights these together with income/assets by clarifying the significance of multi-dimensional factors: natural environmental, cultural, socioeconomic, and political.

Addressing global climate change has become a broad consensus in the international community. Low-carbon economic development, as an effective means to address global climate change issues, has been widely explored and practiced by countries around the world. As major carbon emitting countries, there has been much focus on China, Japan and South Korea, and it is of practical significance to study their low-carbon economic development. To further measure their trend of low-carbon economic development, this paper firstly constructs a low-carbon economic efficiency evaluation index system and uses the Slack Based Measure (SBM) model. This is a kind of data envelopment analysis (DEA) method, with undesirable output based on global covariance to measure the low-carbon economic efficiency of 94 provincial-level administrative divisions (PLADs) in China, Japan, and South Korea from 2013 to 2019. Subsequently, this paper uses 10 mainstream machine learning models and combining them with Grid Search with Cross Validation (GridSearchCV) methods, selects the machine learning model with the best prediction effect. The model predicts the low-carbon economic efficiency of PLADs in China, Japan, and South Korea from 2020 to 2024 based on the parameter configuration for the best prediction effect. Finally, according to the research results, this paper proposes targeted advice for regionalized cooperation on low-carbon economic development in China, Japan, and South Korea to jointly address global climate change issues.

This review paper provides preliminary analysis and answers to three key questions that were identified by synthesizing qualitative evidence from climate security research in Japan. The questions identified are: (1) Has Japan participated in the global climate security debate at all? (2) Why did climate security struggle to become a major political theme in Japan until 2020? (3) Why did Japan explicitly start dealing with climate security as a policy issue in 2020? We identify and discuss four key reasons relative to the second question. The review provides key details (and general parameters) of these questions that have been overlooked by not only Japanese researchers but also climate security research conducted between 2017 and 2022 in Europe and the United States. Climate security suddenly became a trending topic among Japanese researchers and political elites in 2020; we find evidence that future studies could provide important and more robust insight if an analysis of the above questions is supported by interview data obtained from Japanese government officials. In doing so, researchers will be able to provide valuable insight into the possibility (and extent) that inter-ministerial rivalry between key ministries has impeded domestic progress on climate security action. Furthermore, three separate projects on climate security have been commissioned and recently implemented in Japan. These form the basis for this first systematic literature review of 34 papers and the related research reports resulting from these projects. These papers and reports were retrieved from the electronic databases of Google Scholar, ProQuest, and the National Institute for Environmental Studies in April 2022. While the main limitation of this review paper is that readers are expected to connect these questions to their own experiences at the global level, we reduce the possibility of presenting biased information by identifying and verifying missing details. For example, we had difficulty identifying the method used in one of the co-authored papers and contacted the corresponding author. In summary, sustained discussion in academia and high-politics settings should eventually lead to a greater awareness about climate security.

The introduction of autonomous vehicles has been considered as a possible option for reducing traffic congestion in many transport studies. Many types of models, in particular car-following microsimulation models have been adopted in most studies. The impacts of autonomous vehicles (AVs) on congestion, however, have not yet been concluded. This could be because different researchers use different forms of car-following models to assess these impacts, or because the utilised modelling approaches and their parameters are different in different studies. In particular, two of the important parameters that are associated with car-following models are the used values for maximum acceleration and the average desired time gaps. While the values of these parameters can be adjusted and controlled by the ACC controllers in the AV, they can also be controlled by the users. Therefore, assigning unrealistic values to these parameters could well result in unrealistic conclusions. This paper investigated the impacts of the maximum acceleration and the average desired time gaps on congestion levels using the loss-time indicator. The analysis was carried out on the Hanshin expressway in Japan and was tested and assessed using the Helly (FACC) car-following microsimulation model. This includes estimating the values of the desired time gap from real traffic time-gap distributions. The Hanshin expressway is an urban toll highway of 273 km that extends from Osaka to Kobe, representing the Hanshin area in Japan. The Hanshin highway serves a huge traffic volume that consists of private and freight vehicles that operate within the Hanshin area. This area represents one of three major municipal areas in Japan including Tokyo and Nagoya. A total of 740,000 vehicles per day travel on the expressway. As a result, there is significant congestion on the Hanshin expressway. There have been various plans put in place to ease congestion ranging from building new roads to the implementation of traffic-demand-management measures. However, the predictions of the impacts of such measures do not provide any evidence that they would ease traffic congestion. Other possible measures that could be investigated for easing traffic congestion include technology-based solutions such as autonomous vehicles. The modelling results recommend that the results obtained from microsimulation models should be taken with care, and good attention should be paid to the parameters used and their values in the model. The values assigned to driving-behaviour parameters, the maximum values of acceleration, and the time-gap settings, for example, control the final outcomes of the models.

Our paper presents detailed evolutionary analyses of narcissus viruses from wild and domesticated Narcissus plants in Japan. Narcissus late season yellows virus (NLSYV) and narcissus degeneration virus (NDV) are major viruses of Narcissus plants, causing serious disease outbreaks in Japan. In this study, we collected Narcissus plants showing mosaic or striped leaves along with asymptomatic plants in Japan for evolutionary analyses. Our findings show that (1) NLSYV is widely distributed, whereas the distribution of NDV is limited to the southwest parts of Japan; (2) the genomes of NLSYV isolates share nucleotide identities of around 82%, whereas those of NDV isolates are around 94%; (3) three novel recombination type patterns were found in NLSYV; (4) NLSYV comprises at least five distinct phylogenetic groups whereas NDV has two; and (5) infection with narcissus viruses often occur as co-infection with different viruses, different isolates of the same virus, and in the presence of quasispecies (mutant clouds) of the same virus in nature. Therefore, the wild and domesticated Narcissus plants in Japan are somewhat like a melting pot of potyviruses and other viruses.

This paper aims to provide preliminary evidence on the degree of consensus on the approach to long-term mental health and psychosocial support after a natural hazard event. We conducted an online survey among mental health experts in Japan. The questionnaire was divided into five categories: (A) terminology setting definition of "long-term", (B) priority in activity for long-term mental health support, (C) system and preparedness for better support, (D) transition from acute support to long-term support, and (E) actions to improve preparedness for future disasters. Invitations to participate in the survey were sent by e-mail in November 2017 to mental health experts in Japan, who had participated in workshops related to disaster mental health or trauma care organized by the National Institute of Mental Health over the last 15 years. Out of 1385 experts who received the invitation, a total of 305 participants responded to the survey. Participants were for the most part in agreement regarding focuses and required preparedness and actions for long-term support. There was still low consensus especially on defining the timeframe "long-term". The acute phase and long-term phase were identified as being different in dimension rather than category. Although caution is necessary around the representativeness of these findings, they will provide important scientific evidence for the development of future plans for a qualitative improvement in long-term mental health support.

The gross charge distribution in an electrified cloud has already been estimated by polarity distribution of the electrostatic field on the ground surface. While either a dipole or a tripole charge structure is commonly accepted, the increase-decrease and motion of each point charge in those models are both still unclear. This paper presents a new network of electric field mills for multipoint electrostatic measurement to evaluate the temporal variations of a simple cloud charge model with second-scale resolution. Details of our newly developed equipment are described, with an emphasis on its advantages. This network was deployed in the north Kanto area of Japan and operated during the summer season in 2020. In order to simplify the relationship between cloud charge positions and the horizontal distribution of the measured electrostatic field, an isolated thundercloud is focused on. As an initial analysis, a negative point charge model is applied to an isolated cloud observed on 27 August 2020. The quantity and height of the point charge were estimated as being approximately -20 C and 7 km, respectively. The calculated charge location is generally coincident with the C-band radar echo regions. Significant correspondence is demonstrated between the intensity distribution of the electrostatic fields measured at seven sites and that calculated with estimated point charge. This result indicates the possibility to determine the amounts and positions of cloud charges inside the dipole charge structure based on multipoint measurement of the electrostatic field.

The coronavirus disease (COVID-19) pandemic has aggravated anxiety and depression worldwide, particularly in patients with chronic illnesses and mental disorders. Using validated questionnaires, in this paper, we examine the psychological effects of the pandemic in Japan in detail. The General Mental Health Scale (GHQ), the State-Trait Anxiety Inventory (STAI), and the Center for Epidemiologic Studies Depression Scale (CES-D) were used to assess mental health, state and trait anxiety, and depression, respectively. The survey was completed during the patients' first visits to the clinic of Psychosomatic Internal Medicine from November 2018 to April 2021. The Mann-Whitney U test was used to compare data from 226 participants before and during the COVID-19 pandemic. The GHQ total, GHQ subscales of "social dysfunction" and "anxiety and dysphoria", and state anxiety scores were significantly higher during than before the pandemic. The GHQ total, some GHQ subscales, and state anxiety scores were significantly higher among male than female participants during the pandemic. The GHQ total, some GHQ subscales, CES-D, and state anxiety scores in those aged 10-39 years were significantly higher. Thus, the COVID-19 pandemic may have caused mental health changes in many individuals based on their gender, age, and with time.

This paper presents the details of our research and the activities involved. Japan is one of the most advanced countries in medicine worldwide. However, in terms of technology, knowledge sharing, and successor development, Japanese medicine lags behind other developed countries, and these matters require addressing. The country is also facing a shortage of doctors, among other things, and this medical problem will surely become critical in the near future. In this study, we aim to help solve such problems from the medical engineering viewpoint, analyze and create systems based on the experience of doctors from the engineering viewpoint, and make it easy for patients to understand orthodox and general statistical analysis methods. We perform a visualization and quantitative medical data analysis and examine diagnostic support. We consider sleep apnea syndrome (SAS), and orthostatic dysregulation (OD) in children in this study. This research aims to detect SAS early, identify people with pre-SAS who are likely to become SAS in the near future, and identify OD. We analyze and identify these diseases through statistics and a multivariate analysis and create a dedicated analysis system for them. Our research and system development will allow specialists to make informed diagnoses, reproduce empirical rules, improve work efficiency, and improve patients' health awareness. This research has only looks at two diseases, but these methods can be expected to be applied to other diseases.

The tourism environment is the basis of sustainable development in the tourism economy. Exploring the coupling relationship between tourism economy and ecological environment systems can promote not only ecology-based tourism, but also contribute to the sustainable development of tourism economy. Based on data from Nagasaki Prefecture, Japan, from 2010-2019, this paper aims to introduce an indicator system and develop an integrated approach to assess the coupling and coordination between the tourism economy and the environment. The indicator system consists of two levels, six aspects, and eighteen indicators, based on entropy method. A Pressure-State-Response (PSR) model framework of the coupling and coordination mechanism of tourism economy and ecological environment was constructed based on the development status of Nagasaki Prefecture in Japan. Then, the degree of coupled coordination of its tourism economy and ecological environment is evaluated, providing a comprehensive evaluation index of the system. In conclusion, suggestions for promoting the sustainable development of tourism and environment in Nagasaki Prefecture, Japan, are proposed. The purpose of this research is to reveal dynamic trends that exist between the coupled development of tourism economy and the ecological environment. A further aim of this paper is to provide a reference for macro policy formulation in small and medium-sized cities regarding the sustainable development of the tourism economic system and ecological environment system.

This paper focuses on clarifying the relationship between noise exposure and the prevalence of highly annoyed people due to transportation noise in Japan. The authors accumulated 34 datasets, which were provided by Socio-Acoustic Survey Data Archive and derived from the other surveys conducted in Japan. All the datasets include the following micro-data: demographic factors, exposure, and annoyance data associated with specific noise sources. We performed secondary analyses using micro-data and established the relationships between noise exposure ( L den ) and the percentage of highly annoyed people (%HA) for the following noise source: road traffic, conventional railway, Shinkansen railway, civil aircraft, and military aircraft noises. Among the five transportation noises, %HA for the military aircraft noise is the highest, followed by civil aircraft noise and Shinkansen railway noise. The %HA for conventional railway noise was higher than that for road traffic noise. To validate the representativeness of the exposure-response curves, we have discussed factors affecting the difference in annoyance. In addition, comparing the Japanese relationship with that shown in the "Environmental Noise Guidelines for the European Region," we revealed that Japanese annoyance is higher than the WHO-reported annoyance.

As a result of population growth and the development of tube wells, humans' exposure to arsenic has increased over the past few decades. The natural course of organ damage secondary to arsenic exposure is not yet well understood. In Toroku, Japan, an arsenic mine was intermittently operated from 1920 to 1962, and residents were exposed to high concentrations of arsenic. In this paper, we analyzed 190 consecutive residents for whom detailed records of neurological symptoms and findings were obtained from 1974 to 2005. All participants were interviewed regarding the presence of general, skin, hearing, respiratory, and neurological symptoms. Neurological symptoms were classified into extremity numbness or pain, constipation, dyshidrosis, sensory loss, and muscle atrophy. Superficial and vibratory sensation was also evaluated. More than 80% of participants experienced extremity numbness, and numbness was the most common neurological symptom. Numbness was associated with superficial sensory disturbance, and was correlated with the subsequent development of other neurological symptoms, including autonomic and motor symptoms. No previous studies have investigated the natural course of chronic arsenic intoxication; thus, these data serve as a guide for detecting early symptoms due to arsenic exposure.

The development and enhancement of occupational health services (OHS) at the national level is central to ensuring the sustainable health, well-being and work engagement of the working population. However, due to differences in national health, social security and occupational safety and health systems, the content, capacity, coverage and provisions of OHS vary considerably across national contexts. Obtaining a better understanding in terms of such similarities and variations internationally is essential as such comparative information can help inform evidenced-based decision-making on OHS at both policy and practice levels. This paper therefore reviews and analyses the key policies, standards and approaches in OH systems and services, using both academic and grey literature, across 12 industrialised countries (Australia, Canada, Finland, France, Germany, Ireland, Italy, Japan, The Netherlands, Poland, United Kingdom and the United States of America). It provides a detailed overview and categorization of OHS in these selected countries in terms of the legal and policy context, organisation and financing and coverage and staffing while specifically discussing variations aimed at psychosocial risk management and the promotion of mental health and well-being at work. It draws conclusions on key development needs of OHS internationally to ensure psychosocial risk management and mental health promotion are prioritised effectively in a preventive manner.

When a disaster occurs during a pandemic, it would be a case of concurrent crises (synonymous to cascading disasters or compounding disasters). The single-hazard approach to disaster response system is not suited for this scenario. As shown from the experiences of the Philippines, India, Japan, and the Republic of Korea, the conventional single-hazard approach needed to integrate new measures, including basic skills training on handling COVID-19 for disaster responders; additional stockpiles of face coverings, disinfectants, tents, and personal protective equipment (PPE); social distancing at evacuation centers; updating of standard operation procedures (SOPs) and guidelines for disaster response to adapt to the concurrent crises situations. Building on the reports presented by the member countries of Asian Disaster Reduction Center (ADRC), this paper highlights three evolving disaster response practices during the COVID-19 pandemic: (i) digitalization of some aspects of disaster response, including early warning, surveillance, and impact assessment; (ii) dispersed evacuation to enforce social distancing, including other measures such as testing, tracing, and isolating infected individuals; (iii) remote psychological first aid to disaster-impacted individuals who are already experiencing anxieties from the pandemic. Indicative outcomes of the evolving response practices are discussed, including whether these could serve as entry points to transition the disaster response system from a single-hazard approach towards a multihazard approach.

Red yeast rice has been used to produce alcoholic beverages and various fermented foods in China and Korea since ancient times; it has also been used to produce tofuyo (Okinawan-style fermented tofu) in Japan since the 18th century. Recently, monacolin K (lovastatin) which has cholesterol-lowering effects, was found in some strains of Monascus fungi. Since statins have been used world-wide as a cholesterol-lowering agent, processed foods containing natural statins are drawing attention as materials for primary prevention of life-style related diseases. In recent years, large-scale commercial production of red yeast rice using traditional solid-state fermentation has become possible, and various useful materials, including a variety of monascus pigments (polyketides) that spread as natural pigments, in addition to statins, are produced in the fermentation process. Red yeast rice has a lot of potential as a medicinal food. In this paper, we describe the history of red yeast rice as food, especially in Japan and East Asia, its production methods, use, and the ingredients with pharmacological activity. We then review evidence of the beneficial effects of red yeast rice in improving lipid metabolism and the circulatory system and its safety as a functional food.

Little attention has been paid to the impacts of institutional-human-environment dimensions on the outcome of Coronavirus disease 2019 (COVID-19) abatement. Through the diagnostic social-ecological system (SES) framework, this review paper aimed to investigate what and how the multifaceted social, physical, and governance factors affected the success level of seven selected Asia-Pacific countries (namely, South Korea, Japan, Malaysia, Singapore, Vietnam, Indonesia, and New Zealand) in combatting COVID-19. Drawing on statistical data from the Our World In Data website, we measured the COVID-19 severity or abatement success level of the countries on the basis of cumulative positive cases, average daily cases, and mortality rates for the period of 1 February 2020 to 30 June 2020. A qualitative content analysis using three codes, i.e., present (P), partially present (PP), and absent (A) for each SES attribute, as well as score calculation and rank ordering for government response effectiveness and the abatement success level across the countries, was undertaken. Not only did the standard coding process ensure data comparability but the data were deemed substantially reliable with Cohen's kappa of 0.76. Among 13 attributes of the SES factors, high facility adequacy, comprehensive COVID-19 testing policies, strict lockdown measures, imposition of penalty, and the high trust level towards the government seemed to be significant in determining the COVID-19 severity in a country. The results show that Vietnam (ranked first) and New Zealand (ranked second), with a high presence of attributes/design principles contributing to high-level government stringency and health and containment indices, successfully controlled the virus, while Indonesia (ranked seventh) and Japan (ranked sixth), associated with the low presence of design principles, were deemed least successful. Two lessons can be drawn: (i) having high number of P for SES attributes does not always mean a panacea for the pandemic; however, it would be detrimental to a country if it lacked them severely, and (ii) some attributes (mostly from the governance factor) may carry higher weightage towards explaining the success level. This comparative study providing an overview of critical SES attributes in relation to COVID-19 offers novel policy insights, thus helping policymakers devise more strategic, coordinated measures, particularly for effective country preparedness and response in addressing the current and the future health crisis., Competing Interests: The authors declare no conflict of interest.

Volatile organic compounds (VOCs) are commonly found in consumer products, including furniture, sealants and paints. Thus, indoor VOCs have become a public health concern, especially in high-income countries (HICs), where people spend most of their time indoors, and indoor and outdoor air exchange is minimal due to a lack of ventilation. VOCs produce high levels of reaction with the airway epithelium and mucosa membrane and is linked with pulmonary diseases. This paper takes a stock of the literature to assess the strength of association (measured by effect size) between VOCs and pulmonary diseases with the focus on asthma and its related symptoms by conducting a meta-analysis. The literature was searched using the PubMed database. A total of 49 studies that measured VOCs or VOC types and pulmonary health outcomes were included in the analysis. The results of these studies were tabulated, and standard effect size of each study was computed. Most studies were conducted in high-income countries, including France ( n = 7), Japan ( n = 7) and the United States ( n = 6). Our analysis suggests that VOCs have a medium-sized effect on pulmonary diseases, including the onset of asthma (effect size (or Cohen's d) ~0.37; 95% confidence interval (CI) = 0.25-0.49; n = 23) and wheezing (effective size ~0.26; 95% CI = 0.10-0.42; n = 10). The effect size also varied by country, age and disease type. Multiple stakeholders must be engaged in strategies to mitigate and manage VOC exposure and its associated pulmonary disease burden.

The increasing prevalence of delayed and missed diagnoses for dementia constitutes major public concern. In this regard, inadequate knowledge and poor understanding of the condition may create a barrier to timely dementia screening. This cross-sectional study assessed dementia literacy, then identified the association between dementia literacy and willingness to undergo routine dementia screening among community-dwelling older adults in two urban areas of Japan. More specifically, structured questionnaires were distributed to a total of 854 individuals aged ≥ 65 years. A multivariate logistic regression was then used to explore the factors associated with dementia literacy and willingness to undergo routine dementia screening. Results showed that younger respondents and respondents who received dementia information from television/radio and/or paper-based sources were more likely to have high dementia literacy. While less than half of participants were willing to undergo routine dementia screening, those with higher dementia literacy were more willing to do so (albeit, not a statistically significant difference). Although there are pros and cons to routine dementia screening, it is necessary to implement such a system to detect dementia and cognitive impairment. Further, assessments should also attempt to gain information about individual beliefs and understandings related to dementia information.

Nowadays, for numerous reasons, smart farming systems focus on the use of image processing technologies and 5G communications. In this paper, we propose a tracking system for individual cows using an ear tag visual analysis. By using ear tags, the farmers can track specific data for individual cows such as body condition score, genetic abnormalities, etc. Specifically, a four-digit identification number is used, so that a farm can accommodate up to 9999 cows. In our proposed system, we develop an individual cow tracker to provide effective management with real-time upgrading enforcement. For this purpose, head detection is first carried out to determine the cow's position in its related camera view. The head detection process incorporates an object detector called You Only Look Once (YOLO) and is then followed by ear tag detection. The steps involved in ear tag recognition are (1) finding the four-digit area, (2) digit segmentation using an image processing technique, and (3) ear tag recognition using a convolutional neural network (CNN) classifier. Finally, a location searching system for an individual cow is established by entering the ID numbers through the application's user interface. The proposed searching system was confirmed by performing real-time experiments at a feeding station on a farm at Hokkaido prefecture, Japan. In combination with our decision-making process, the proposed system achieved an accuracy of 100% for head detection, and 92.5% for ear tag digit recognition. The results of using our system are very promising in terms of effectiveness.

This paper describes the methods of the Wave 1 (2018) International Tobacco Control (ITC) Japan Survey. The respondents were adults aged 20 years and older in one of four user groups: (1) cigarette-only smokers who smoked at least monthly and used heated tobacco products (HTPs) not at all or less than weekly, (2) HTP-only users who used HTPs at least weekly and smoked cigarettes not at all or less than monthly, (3) cigarette-HTP dual users who smoked at least monthly and used HTPs at least weekly, and (4) non-users who had never smoked or who smoked less than monthly and used HTPs less than weekly. Eligible respondents were recruited by a commercial survey firm from its online panel. Respondents were allocated proportionally to sample strata based on demographic, geographic, and user type specifications benchmarked to a national reference. Survey weights, accounting for smoking/HTP use status, sex, age, education, and geography, were calibrated to benchmarks from a nationally representative survey in Japan. Response rate was 45.1% and cooperation rate was 96.3%. The total sample size was 4615 (3288 cigarette smokers, 164 exclusive HTP users, 549 cigarette-HTP dual users, and 614 non-users). The 2018 ITC Japan Survey sampling design and survey data collection methods will allow analyses to examine prospectively the use of cigarettes and HTPs in Japan and factors associated with the use of both products and of transitions between them.

This bibliometric study evaluated the scientific impact of papers dealing with osteoporosis detected by dental panoramic radiographs by performing citation analysis and cited reference analysis. Retrospective data was extracted from the Web of Science Core Collection database and imported into VOSviewer, CRExplorer, and CitNetExplorer for analyzing semantic contents, cited references, and temporal citation network. The 280 relevant papers identified were cited 4874 times, having an h-index of 38 and 17.4 citations per paper. The top five major contributing countries were Japan ( n = 54, 19.3%), USA ( n = 43, 15.4%), Brazil ( n = 38, 13.6%), Turkey ( n = 38, 13.6%), and the UK ( n = 32, 11.4%). Citation per paper correlated with publication count among the authors and institutions. Mandibular cortical width was the most frequently used and most cited measurement index. References published during the 1970s and 1980s have built the foundation for the development of research that investigates the potential associations between osteoporosis and radiographic measurements on panoramic radiographs. Osteoporosis detection by dental panoramic radiographs is a perennially investigated research topic with global contributions. Panoramic radiographs are considered early detection and screening tools for osteoporosis by worldwide research.

Little scientific evidence exists on ways to decrease the psychological stress experienced by disaster responders, or how to maintain and improve their mental health. In an effort to grasp the current state of research, we examined research papers, agency reports, the manuals of aid organisations, and educational materials, in both English and Japanese. Using MEDLINE, Ichushi-Web (Japanese search engine), Google Scholar, websites of the United Nations agencies, and the database of the Grants System for Japan's Ministry of Health, Labour, and Welfare, 71 pertinent materials were identified, 49 of which were analysed. As a result, 55 actions were extracted that could potentially protect and improve the mental health of disaster responders, leading to specific recommendations. These include (1) during the pre-activity phase, enabling responders to anticipate stressful situations at a disaster site and preparing them to monitor their stress level; (2) during the activity phase, engaging in preventive measures against on-site stress; (3) using external professional support when the level of stress is excessive; and (4) after the disaster response, getting back to routines, sharing of experiences, and long-term follow-up. Our results highlighted the need to offer psychological support to disaster responders throughout the various phases of their duties.

This paper presents a novel bed-leaving sensor system for real-time recognition of bed-leaving behavior patterns. The proposed system comprises five pad sensors installed on a bed, a rail sensor inserted in a safety rail, and a behavior pattern recognizer based on machine learning. The linear characteristic between loads and output was obtained from a load test to evaluate sensor output characteristics. Moreover, the output values change linearly concomitantly with speed to attain the sensor with the equivalent load. We obtained benchmark datasets of continuous and discontinuous behavior patterns from ten subjects. Recognition targets using our sensor prototype and their monitoring system comprise five behavior patterns: sleeping, longitudinal sitting, lateral sitting, terminal sitting, and leaving the bed. We compared machine learning algorithms of five types to recognize five behavior patterns. The experimentally obtained results revealed that the proposed sensor system improved recognition accuracy for both datasets. Moreover, we achieved improved recognition accuracy after integration of learning datasets as a general discriminator.

After the recession in Japan in the 1990s, Japanese art exhibitions began to appear. The purpose of these exhibitions was to revitalize these areas through the presentation of art (attracting visitors and tourists). Correspondingly, this study explores the significance of exhibition-driven tourism in Japan. The Echigo-Tsumari Art Triennial (ETAT) was used as a case to study how exhibition-driven tourism has impacted sustainable tourism, economics, and the population. The current paper collected panel data from 1900 to 2018. These panel data were analyzed by descriptive statistics and a correlation analysis (a one-way ANOVA and a Pearson correlation analysis in SPSS26). The empirical analysis showed that the Echigo-Tsumari Art Triennial (exhibition-driven tourism) had positive impacts on sustainable tourism, economics, and the population; its correlations with Niigata were also clear. This study generated results that are valuable from both academic and industry perspectives (exhibition-driven tourism), as this field has not been extensively researched. The current paper also presents the theoretical and practical implications of the statistical results.

In this paper, we use a bivariate choropleth map to investigate the relationship between mortality from cardiovascular disease (CVD) and gross domestic product (GDP) per capita, by sex, in Japanese prefectures from 1996 to 2015. The overall results show a decline in age-standardized CVD mortality rates in all prefectures, for both men and women, and suggest that GDP per capita has varied over the period. We also observed that the relationship between CVD mortality rates and GDP per capita at the prefecture level does not have an overall pattern of the same or inverse association, but is instead a heterogeneous relationship. We argue that this study provides useful clues to policy makers for establishing effective measures for public health planning and the prevention of deaths from CVD. As demonstrated by this study, mapping of the CVD burden in Japan helps to clarify regional differences in life expectancy and health status across regions and identify prefectures where more targeted policy attention may be needed.

Background and Objectives: When children accidentally ingest foreign bodies, they may be unable to communicate adequately; it is often difficult to identify the causative foreign body unless someone is watching over them. In such instances, to identify the causative foreign body during clinical practice, we aimed to determine if it varies according to age. Materials and Methods: From April 2013 to June 2018, 252 records of pediatric patients with a confirmed diagnosis of foreign-body ingestion were retrospectively examined in a Japanese university hospital. Comparisons among multiple age groups, according to type of ingested foreign body, were analyzed using Kruskal‒Wallis tests. The differences between the individual data were tested using the Steel‒Dwass test. Results: The median age of the patients was 15 months, and of the total patients, 140 were boys (55.5%). The types of foreign bodies ingested were as follows, in order of frequency: cigarettes ( n = 44, 17%, median age: 12 months), plastics ( n = 43, 17%, median age: 11 months), chemicals ( n = 27, 11%, median age: 13 months), internal medicines ( n = 26, 10%, median age: 33 months), and metals ( n = 26, 10%, median age: 35 months). The median age was significantly different among the types of causative foreign bodies ( p < 0.01). The patient age for the ingestion of cigarettes was significantly younger than that for ingesting metals or coins. The age for ingesting internal medicines was significantly older than that for ingesting plastics, cigarettes, paper, or chemicals ( p < 0.01). Conclusions: The causative foreign body ingested differed according to age. This will be valuable information for physicians that encounter pediatric patients who may have ingested an unknown foreign body in Japanese pediatric emergency or general practice settings.

The phenomenon named kodokushi , meaning death alone without the care or company of anyone inside temporary housing, appeared after the Kobe earthquake in Japan in 1995 with some 250 cases. This paper analyzes the evolution of Japanese temporary houses-to attempt to prevent the problem of kodokushi -from the point of view of management, how services and activities are organized, and design. We will use case studies as our methodological tool, analyzing the responses in 1995 Kobe (50,000 THs), 2004 Chūetsu (3000 THs), 2011 Tōhoku (50,000 THs), and 2016 Kumamoto (4000 THs). This article shows how the Japanese THAs follow a single design that has undergone very little variation in the last 25 years, a design which promotes the social isolation of their residents, making recovery-from the psychological perspective-and helping the most vulnerable members of society, more difficult. In small scale disasters (Chūetsu) applying organization and management measures was able to correct the problems caused by design and there were no cases of kodokushi : in large-scale disasters (Tōhoku), however, the difficulties to implement the same measures resulted in the reappearance of new cases at rates similar to Kobe's. Our main conclusion is that the design of Japanese THAs must be reconsidered and changed to respond to the real needs of the most vulnerable groups., Competing Interests: The authors declare no conflict of interest.

Landscape architecture and urban design disciplines could benefit from soundscape thinking in order to enhance experiential qualities in their projects, though the available tools are not yet fully developed nor tested. The present research aims to substantiate one of the available tools, Soundscape Actions, and thereby increase the understanding of soundscape design. The study focuses on the Japanese garden tradition, which is known for high preference ratings, tranquil qualities and consideration for sound and other sensory experiences. An autoethnographic approach was used to conduct field studies in 88 gardens in Japan, the majority of which are located in urban areas with potential noise disturbance. The studies are based on observations in situ, supported by video documentation, field recordings and readings of sound pressure levels (SPL). A total of 19 Soundscape Actions are described and discussed in the paper. They are structured around three main categories: localisation of functions, reduction of unwanted sounds and introduction of wanted sounds. The study provides concrete examples of how the tool can be used to enhance tranquil qualities, particularly focusing on small green spaces in dense urban settings, involving the (simultaneous) reduction of unwanted sounds and enhancement of wanted sounds/effects. The autoethnographic approach allowed for the phenomenological perspective to be brought forward, which contributed new insights regarding the design tool. The findings are discussed in relation to health and soundscape research, focusing on multisensory experiences, masking strategies and potentials for implementation and future developments of the design tool.

Purpose: Very few studies have examined the influential factors of survivors' feelings of happiness in the context of nuclear accidents. This paper aims to fill this gap with reference to the recovery process in Fukushima City following the 2011 Tohoku Earthquake Tsunami in Japan., Methods: Open access data were sourced from the 2015 Social Survey on Living and Disaster Recovery (SSLDR) (N = 1439) of Fukushima citizens. Pearson's Chi-square Test and the t-test were employed to examine gender differences with regard to happiness and exploratory variables. Following this, a multiple linear regression analysis was conducted to investigate the determinants of happiness., Results: The results showed that, compared to females, male respondents were unhappier and reported more property loss and less neighborhood connectedness. Individuals' mental and physical health and neighborhood connectedness were found to be significantly correlated with their happiness. However, the disaster-related variables of people's evaluation of recovery achievement, concerns around the health impacts of radiation, property loss in the disaster, and experiences of casualty, had no effects on happiness., Conclusion: These findings indicate that policies and countermeasures dealing with disaster recovery over the long term should continuously focus on health issues and social relationships.

Background: This paper describes the health and economic burden of cardiovascular diseases (CVD) in Mexico and other mega-countries through a review of literature and datasets., Methods: Mega-countries with a low (Nigeria), middle (India), high (China/Brazil/Mexico), and very high (the U.S.A./Japan) human development index were included. The review was focused on prevalence of dyslipidemias and CVD economic impact and conducted according to the PRISMA statement. Public datasets of CVD indicators were explored., Results: Heterogeneity in economic data and limited information on dyslipidemias were found. Hypertriglyceridemia and hypercholesterolemia were higher in Mexico compared with other countries. Higher contribution of dietary risk factors for cardiovascular mortality and greater probability of dying prematurely from CVD were observed in developing countries. From 1990-2016, a greater decrease in cardiovascular mortality in developed countries was registered. In 2015, a CVD expense equivalent to 4% of total health expenditure was reported in Mexico. CVD ranked first in health expenditures in almost all these nations and the economic burden will remain significant for decades to come., Conclusions: Resources should be assured to optimize CVD risk monitoring. Educational and medical models must be improved to enhance CVD diagnosis and the prescription and adherence to treatments. Long-term benefits could be attained by modifying the food system.

Implementing smoking bans is a worldwide common practice for tobacco control. However, if the policy prohibits smoking partially rather than comprehensively, it may increase nonsmokers' exposure to secondhand smoke (SHS) in nonprohibited places. This paper investigates how a partial smoking ban affected nonsmokers' SHS exposure (measured by frequency of having exposure to SHS in days per month) in households, workplaces, and restaurants by examining the case of a partial smoking ban introduced in a large Japanese prefecture in 2013. Using data from the National Health and Nutrition Survey (NHNS) in 2010, 2013, and 2016 (n = 30,244) and the Comprehensive Survey of Living Conditions (CSLC) from 2001 to 2016 (n = 2,366,896), this paper employs a difference-in-differences (DID) approach. We found that the partial smoking ban significantly increased their SHS exposure in households and workplaces by 2.64 days and 4.70 days per month, respectively, while it did not change nonsmokers' SHS exposure in restaurants. The results imply that the smoking ban displaced smokers from public places to private places. We also found that neither smokers' smoking status nor smoking intensity changed significantly after implementing the partial smoking ban. Comprehensive smoking bans are needed to better protect nonsmokers from SHS exposure.

The Pregnancy and Birth Survey of the Fukushima Health Management Survey is a questionnaire survey that has been conducted annually since 2011 in Fukushima Prefecture. Since 2016, the survey has been available online as well as in paper form. This study aimed to determine whether making the survey available online improved response rates and to identify the characteristics of paper and online survey respondents and their results. Using LimeSurvey, we constructed an online survey environment that enabled responses via computer or mobile device. Respondents could choose whether to respond on paper or online. The response rate for the 2016 survey was 51.8%, an increase of 3.5% over the previous year. Of these responses, 15.8% were made online. Online respondents were mostly primiparous. Further, while there was no difference in the percentage of respondents who provided free responses, the amount written was higher in paper surveys than in online surveys. The combination of paper and online surveys increased convenience for respondents and contributed to improved response rates. In addition, paper surveys were superior in terms of allowing respondents to express their feelings and opinions.

Cancer patients' return-to-work rates in Japan and their methodological quality have been little reported. We conducted a systematic review to explore the recent return-to-work rates and to assess the methodological quality of the existing literature. We selected 13 papers (2 in English and 11 in Japanese) published between 2005 and 2017. The return-to-work rates ranged from 53.8% to 95.2%. Of the selected papers, 12 papers employed a cross-sectional design, possessing high risk of selection bias due to participant selection. A total of 8 papers did not fully report the subjects' sex, age, employment status at cancer diagnosis, cancer site, stage, and treatment, suggesting high risk of selection bias due to confounding variables. High or unclear risk of attrition bias due to incomplete outcome data was detected in 12 papers in which data on return to work were not collected from all participants. High risk of reporting bias due to selective outcome reporting was pointed out in 6 studies in which the subjects' employment status at return to work or the duration between cancer diagnosis and assessment of return to work was unclear. Future studies must reduce the risk of selection, attrition, and reporting biases for specifying accurate return-to-work rates.

With the increasing scarcity of traditional energy sources, global warming and environmental degradation, the increased use of renewable energy (RE) has become an effective path for sustainable development. Therefore, countries are paying more and more attention to the development of the RE industry, and the world trade in renewable energy products (REPs) is developing rapidly. First of all, this paper defines REPs, refines the scope of REPs, and proposes the "Equalization Technology Classification" method for the technology classification of REPs. Second, based on the United Nations Comtrade (COMTRADE) data, the export technology structure of China's REPs from 2007 to 2016 was empirically measured. Finally, a comparative study was conducted on the renewable energy product (REP) export technologies of major REP exporting countries (or regions) in the world. We found that (1) China's exports of REPs are mainly medium-high and medium technical complexity products, and that there are few high technical complexity products; (2) the export technology structure of China's REPs is deteriorating, and its overall technical level is in the middle of the global industrial value chain. The export technology of China's REPs has a gap compared with that of Denmark, Hong Kong China, and Singapore; (3) the technological competition of the world's REPs is becoming increasingly fierce. The growth rates of REP technologies in South Korea, Japan, and Malaysia's REPs are significantly higher than that of China.

The adverse health effects from hot weather and heat waves represent significant public health risks in vulnerable areas worldwide. Rising temperatures due to climate change are aggravating these risks in a context of fast urbanization, population growth and societal ageing. However, environmental heat-related health effects are largely preventable through adequate preparedness and responses. Public health adaptation to climate change will often require the implementation of heat wave warning systems and targeted preventive activities at different levels. While several national governments have established such systems at the country level, municipalities do not generally play a major role in the prevention of heat disorders. This paper analyzes selected examples of locally operated heat-health prevention plans in Japan. The analysis of these plans highlights their strengths, but also the need of local institutions for assistance to make the transition towards an effective public health management of high temperatures and heat waves. It can also provide useful elements for municipal governments in vulnerable areas, both in planning their climate change and health adaptation activities or to better protect their communities against current health effects from heat.

The unstable isomeric compounds 5-hydroxy-7-prop-2-en-(E)-ylidene-7,7adihydro-2H-cyclopenta[b]pyran-6-one (1) and 5-hydroxy-7-prop-2-en-(Z)-ylidene-7,7adihydro-2H-cyclopenta[b]pyran-6-one (2), previously described as antimicrobial metabolites from the sponge Ulosa sp., were isolated and identified as major components of the ascidian Diplosoma virens. In this paper, full spectral data for 2 and complete 13CNMR data for 1, based on 2D NMR measurements, are provided for the first time. Compounds 1 and 2 showed cytotoxity against HCT116 cells (human colorectal cancer cells) by triggering apoptotic cell death.