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Objective: The self-report SDQ is widely used globally, hence, the validity of the inter-group comparisons is essential. We examined the structure of the self-report SDQ in a large multinational adolescent sample, tested its measurement invariance across genders and countries and compared youth mental health in 12 European and Asian countries., Method: This study is part of a cross-cultural research on child and adolescent wellbeing and mental health in 12 Asian and European countries EACMHS. The sample (N = 26,306) came from a cross-sectional school-based survey of adolescents. We used confirmatory factor analysis to assess a common measurement model for the self-report SDQ and the measurement invariance of the model across gender and country., Results: Fit indices in the total sample, in each gender and each of the 12 countries separately supported the use of the first order three-factor model (without the reverse-coded items) as a common measurement model for the self-report SDQ. Measurement invariance analyses provided good support for configural, metric and scalar invariance across gender, however, metric invariance across countries was not supported. There were significant gender main effects for all SDQ subscales, except for hyperactivity/inattention. Culture had significant main effects and moderated the magnitude of gender differences in all subscales., Conclusion: The findings support the use of the correlated three-factor model comprising the positive dimension of prosocial behavior and two broad groupings of internalizing and externalizing problems, without the reverse-coded problem items, as a common measurement model for the self-report SDQ internationally., (Copyright © 2024. Published by Elsevier Inc.)

The unmet need for mental health care is a global concern. There is a lack of cross-cultural studies examining adolescent help-seeking behavior from both formal and informal sources, including both high-and lower-income countries. This study investigates mental health help-seeking behavior in eight Asian and European countries. Data from 13,184 adolescents aged 13-15 (51% girls) was analysed using mixed-effects logistic regression with school-wise random intercepts to compare countries and genders. Although a significant proportion of adolescents considered getting or sought informal help, formal help-seeking remained exceptionally low, especially in middle-income countries (< 1%), while it ranged from 2 to 7% in high-income countries. Among adolescents with high emotional and behavioral problems (scoring above the 90th percentile on the Strengths and Difficulties Questionnaire), 1-2% of those in middle-income countries and 6-25% of those in high-income countries sought formal help. Girls generally seek more help than boys. The study shows the most adolescents do not receive formal help for mental health problems. The unmet need gap is enormous, especially in lower-income countries. Informal sources of support, including relatives, peers, and teachers, play a crucial role, especially in lower-income countries., (© 2024. The Author(s).)

Background: Coronavirus disease 2019 (COVID-19) features a hypercoagulable state, but therapeutic anticoagulation effectiveness varies with disease severity. We aimed to evaluate the dynamics of the coagulation profile and its association with COVID-19 severity, outcomes, and biomarker trajectories., Methods: This multicenter, prospective, observational study included patients with COVID-19 requiring respiratory support. Rotational thromboelastometry findings were evaluated for coagulation and fibrinolysis status. Hypercoagulable status was defined as supranormal range of maximum clot elasticity in an external pathway. Longitudinal laboratory parameters were collected to characterize the coagulation phenotype., Results: Of 166 patients, 90 (54%) were severely ill at inclusion (invasive mechanical ventilation, 84; extracorporeal membrane oxygenation, 6). Higher maximum elasticity ( P =0.02) and lower maximum lysis in the external pathway ( P =0.03) were observed in severely ill patients compared with the corresponding values in patients on non-invasive oxygen supplementation. Hypercoagulability components correlated with platelet and fibrinogen levels. Hypercoagulable phenotype was associated with favorable outcomes in severely ill patients, while normocoagulable phenotype was not (median time to recovery, 15 days vs. 27 days, P =0.002), but no significant association was observed in moderately ill patients. In patients with severe COVID-19, lower initial C3, minimum C3, CH50, and greater changes in CH50 were associated with the normocoagulable phenotype. Changes in complement components correlated with dynamics of coagulation markers, hematocrit, and alveolar injury markers., Conclusions: While hypercoagulable states become more evident with increasing severity of respiratory disease in patients with COVID-19, normocoagulable phenotype is associated with triggered by alternative pathway activation and poor outcomes., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Kasugai, Tanaka, Suzuki, Ito, Nishida, Ozaki, Kutsuna, Yokoyama, Kaneko, Ogata, Matsui, Goshima, Hamada, Ishii, Kodama, Jingushi, Ishikura, Kamidani, Tada, Okada, Yamamoto and Goto.)

This study examined associations between self-reported mental health problems, body image, bullying victimisation and school safety in large adolescent samples in Japan and Russia, considering the effects of gender, culture and their interactions. In both Japan and Russia, girls reported a greater number of mental health problems, less bullying victimisation and much higher body dissatisfaction than boys did. Japanese adolescents rated themselves higher on total difficulties, reported less body dissatisfaction and bullying victimisation, and rated their school safety lower than that of Russian youths. Cross-cultural differences in total difficulties and body image were qualified by gender. Body dissatisfaction, bullying victimisation and school safety all independently contributed to adolescent mental health problems. The protective effect of school safety on total difficulties was larger for girls than for boys; the strength of the association between bullying victimisation and adolescent mental health problems differed across genders and cultures. The findings indicate a need for a cross-cultural approach and provide a strong basis for targeted interventions that seek to improve adolescent mental health., (© 2023 International Union of Psychological Science.)

Both coronavirus disease 2019 (COVID-19) and heat stroke have symptoms of fever or hyperthermia and the difficulty in distinguishing them could lead to a strain on emergency medical care. To mitigate the potential confusion that could arise from actions for preventing both COVID-19 spread and heat stroke, particularly in the context of record-breaking summer season temperatures, this work offers new knowledge and evidence that address concerns regarding indoor ventilation and indoor temperatures, mask wearing and heat stroke risk, and the isolation of older adults. Specifically, the current work is the second edition to the previously published guidance for handling heat stroke during the COVID-19 pandemic, prepared by the "Working group on heat stroke medical care during the COVID-19 epidemic," composed of members from four organizations in different medical and related fields. The group was established by the Japanese Association for Acute Medicine Heatstroke and Hypothermia Surveillance Committee. This second edition includes new knowledge, and conventional evidence gleaned from a primary selection of 60 articles from MEDLINE, one article from Cochrane, 13 articles from Ichushi, and a secondary/final selection of 56 articles. This work summarizes the contents that have been clarified in the prevention and treatment of infectious diseases and heat stroke to provide guidance for the prevention, diagnosis, and treatment of heat stroke during the COVID-19 pandemic., (© 2023 The Authors. Acute Medicine & Surgery published by John Wiley & Sons Australia, Ltd on behalf of Japanese Association for Acute Medicine.)

Aim: The study aimed to determine the current status of face mask use, deep body temperature measurement, and active cooling in patients suffering from heat stroke and heat exhaustion in Japan., Methods: This was a prospective, observational, multicenter study using data from the Heatstroke STUDY 2020-2021, a nationwide periodical registry of heat stroke and heat exhaustion patients. Based on the Bouchama heatstroke criteria, we classified the patients into two groups: severe and mild-to-moderate. We compared the outcomes between the two groups and reclassified them into two subgroups according to the severity of the illness, deep body temperature measurements, and face mask use. Cramer's V was used to determine the effect sizes for a comparison between groups., Results: Almost all patients in this study were categorized as having degree III based on the Japanese Association for Acute Medicine heatstroke criteria (JAAM-HS). However, the severe group was significantly worse than the mild-to-moderate group in outcomes like in-hospital death and modified Rankin Scale scores, when discharged. Heat strokes had significantly higher rates of active cooling and lower mortality rates than heat stroke-like illnesses. Patients using face masks often use them during labor, sports, and other exertions, had less severe conditions, and were less likely to be young male individuals., Conclusions: It is suggested that severe cases require a more detailed classification of degree III in the JAAM-HS criteria, and not measuring deep body temperature could have been a factor in the nonperformance of active cooling and worse outcomes., (© 2023 The Authors. Acute Medicine & Surgery published by John Wiley & Sons Australia, Ltd on behalf of Japanese Association for Acute Medicine.)

Differential hypoxia may occur after the initiation of femorofemoral veno-arterial extracorporeal membrane oxygenation (VA ECMO) if cardiac function improves while severe respiratory failure is still present, one of the most difficult problems encountered during VA ECMO. Reconfiguration to veno-arterio-venous ECMO (V-AV ECMO) is one of several methods of dealing with differential hypoxia. V-AV ECMO requires triple cannulation and careful management of the reinjection flow, but the risk of bleeding is lower than in a surgical procedure, such as central ECMO or a subclavian artery graft. Herein, we reported a patient with a massive pulmonary embolism who received VA ECMO, which was reconfigured to V-AV ECMO 3 days later when differential hypoxia occurred. A drainage cannula was newly inserted via the right internal jugular vein, and an existing drainage cannula was used for reinjection after repositioning it caudally. V-AV ECMO is an effective and feasible treatment for differential hypoxia despite the paucity of the procedure to date., (© 2022. The Japanese Society for Artificial Organs.)

Regarding extracorporeal membrane oxygenation (ECMO) support against hemorrhagic conditions, there seems to be a dilemma when deciding between maintaining the circuit patency by systemic anticoagulation and increasing the risk of bleeding. We herein report two cases of diffuse alveolar hemorrhage (DAH) caused by myeloperoxidase (MPO) anti-neutrophil cytoplasmic autoantibody-associated vasculitis (AAV) successfully treated with venovenous (VV)-ECMO support, both initially started without systemic anticoagulation. Under anticoagulation-free ECMO management, we should consider the shortcomings of frequent circuit exchange and hemorrhagic diathesis related to circuit-induced disseminated intravascular coagulation (DIC).

There has been a lack of studies on bullying in non-western low-income and middle-income countries. This study reported the prevalence of traditional victimization, cybervictimization, and the combination of these, in 13 European and Asian countries, and explored how psychiatric symptoms were associated with victimization. The data for this cross-sectional, school-based study of 21,688 adolescents aged 13-15 were collected from 2011 to 2017. The main outcomes were traditional and cybervictimization obtained from student self-reports. The Strengths and Difficulties Questionnaire was used to assess psychiatric symptoms. Generalized estimating equation and logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (95% CIs). The mean prevalence of any victimization was 28.9%, of traditional victimization only, this was 17.7%, and for cybervictimization only this was 5.1%. Cybervictimization occurred both independently, and in combination with, traditional victimization. The mean prevalence of combined victimization was 6.1%. The mean proportion of those who were cyberbullied only among those who were either cyberbullied only or bullied both traditionally and in cyber was 45.1%. The rates of prevalence varied widely between countries. In the total sample, those who experienced combined victimization, reported the highest internalizing symptoms (girls, OR 1.25, 95% CI 1.22-1.29; boys, OR 1.29, 95% CI 1.25-1.33). The study findings suggest that anti-bullying interventions should include mental health components and target both traditional and cyberbullying. Due to the overlap between these, targeting bullying should primarily focus on how to reduce bullying behavior rather than just focusing on where bullying takes place., (© 2021. The Author(s).)

Introduction: Despite the high proportion of children and adolescents living in low- and middle-income countries, 95% of all specialized child and adolescent mental health resources are located in high-income countries. To strengthen child and adolescent mental health services (CAMHS), first it is necessary to complete an assessment of the available services and training programs to determine what is needed, particularly in regions with young populations, such as Southeast Europe, the Far East, and the Middle East. The aim of this article is to compare the status of child and adolescent psychiatry (CAP) training programs and the workforce in CAMHS in three geographical regions, to identify similar problems, highlight success stories, and to make recommendations for future studies., Methods: This study compared CAP training programs and CAMHS workforce using the World Psychiatric Association, CAP Section's regional studies data., Results: This study included data from 44 countries: 18 countries in the Far East, 15 countries in the Middle East, and 11 countries in Southeast Europe. There were significant differences both within, and between, the three included regions with regards to availability and infrastructure of CAP training programs. Besides Greece, all included countries reported the need for more child and adolescent psychiatrists and allied child and adolescent mental health professionals., Discussion: There is an urgent need for more qualified child and adolescent psychiatrists and allied professionals in a very large group of countries in three different geographic regions with great differences in religion, culture, and economy., (© 2021 The Authors. Asia-Pacific Psychiatry published by John Wiley & Sons Australia, Ltd.)

Background: Research on perceived school safety has been largely limited to studies conducted in Western countries and there has been a lack of large-scale cross-national studies on the topic., Methods: The present study examined the occurrence of adolescents who felt unsafe at school and the associated factors of perceived school safety in 13 Asian and European countries. The data were based on 21,688 adolescents aged 13-15 (11,028 girls, 10,660 boys) who completed self-administered surveys between 2011 and 2017. Logistic regression analyses were used to estimate odds ratios and 95% confidence intervals., Findings: The number of adolescents who felt unsafe at school varied widely across countries, with a mean occurrence of 31.4% for the total sample: 31.3% for girls, and 31.1% for boys. The findings revealed strong independent associations between feeling unsafe and individual and school-related factors, such as being bullied, emotional and behavioral problems and feeling that teachers did not care. The study also found large variations in perceived school safety between schools in many countries., Conclusion: The findings emphasize the need to create safe educational environments for all students, based on positive relationships with teachers and peers. School-based interventions to prevent bullying and promote mental health should be a natural part of school safety promotion., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Mori, Tiiri, Lempinen, Klomek, Kolaitis, Slobodskaya, Kaneko, Srabstein, Li, Huong, Praharaj, Ong, Lesinskiene, Kyrrestad, Wiguna, Zamani, Sillanmäki and Sourander.)

Aim: To assess heat stroke and heat exhaustion occurrence and response during the coronavirus disease 2019 pandemic in Japan., Methods: This retrospective, multicenter, registry-based study describes and compares the characteristics of patients between the months of July and September in 2019 and 2020. Factors affecting heat stroke and heat exhaustion were statistically analyzed. Cramér's V was calculated to determine the effect size for group comparisons. We also investigated the prevalence of mask wearing and details of different cooling methods., Results: No significant differences were observed between 2019 and 2020. In both years, in-hospital mortality rates just exceeded 8%. Individuals >65 years old comprised 50% of cases and non-exertional onset (office work and everyday life) comprised 60%-70%, respectively. The recommendations from the Working Group on Heat Stroke Medicine given during the coronavirus disease pandemic in 2019 had a significant impact on the choice of cooling methods. The percentage of cases, for which intravascular temperature management was performed and cooling blankets were used increased, whereas the percentage of cases in which evaporative plus convective cooling was performed decreased. A total of 49 cases of heat stroke in mask wearing were reported., Conclusion: Epidemiological assessments of heat stroke and heat exhaustion did not reveal significant changes between 2019 and 2020. The findings suggest that awareness campaigns regarding heat stroke prevention among the elderly in daily life should be continued in the coronavirus disease 2019 pandemic. In the future, it is also necessary to validate the recommendations of the Working Group on Heatstroke Medicine., (© 2022 The Authors. Acute Medicine & Surgery published by John Wiley & Sons Australia, Ltd on behalf of Japanese Association for Acute Medicine.)

Background: Frailty has been associated with a risk of adverse outcomes, and mortality in patients with various conditions. However, there have been few studies on whether or not frailty is associated with mortality in patients with accidental hypothermia (AH). In this study, we aim to determine this association in patients with AH using Japan's nationwide registry data., Methods: The data from the Hypothermia STUDY 2018&19, which included patients of ≥18 years of age with a body temperature of ≤35 °C, were obtained from a multicenter registry for AH conducted at 120 institutions throughout Japan, collected from December 2018 to February 2019 and December 2019 to February 2020. The clinical frailty scale (CFS) score was used to determine the presence and degree of frailty. The primary outcome was the comparison of mortality between the frail and non-frail patient groups., Results: In total, 1363 patients were included in the study, of which 920 were eligible for the analysis. The 920 patients were divided into the frail patient group (N = 221) and non-frail patient group (N = 699). After 30-days of hospitalization, 32.6% of frail patients and 20.6% of non-frail patients had died (p < 0.001). Frail patients had a significantly higher risk of 90-day mortality (Hazard ratio [HR], 1.64; 95% confidence interval [CI], 1.25-2.17; p < 0.001). Based on the Cox proportional hazards analysis using multiple imputation, after adjustment for age, potassium level, lactate level, pH value, sex, CPK level, heart rate, platelet count, location of hypothermia incidence, and rate of tracheal intubation, the HR was 1.69 (95% CI, 1.25-2.29; p < 0.001)., Conclusions: This study showed that frailty was associated with mortality in patients with AH. Preventive interventions for frailty may help to avoid death caused by AH., (© 2021. The Author(s).)

Aim: This study describes the clinical characteristics and outcomes as well as the prognostic factors of patients with accidental hypothermia (AH) using Japan's nationwide registry data., Methods: The Hypothermia study 2018 and 2019, which included patients aged 18 years or older with a body temperature of 35°C or less, was a multicenter registry conducted at 87 and 89 institutions throughout Japan, with data collected from December 2018 to February 2019 and December 2019 to February 2020, respectively., Results: In total, 1363 patients were enrolled in the registry, of which 1194 were analyzed in this study. The median (interquartile range) age was 79 (68-87) years, and the median (interquartile range) body temperature at the emergency department was 30.8°C (28.4-33.6°C). Forty-three percent of patients with AH had a mild condition, 35.2% moderate, and 21.9% severe. AH occurred in an indoor setting in 73.4% and was caused by acute medical illness in 49.3% of patients. A total of 101 (8.5%) patients suffered from cardiopulmonary arrest on arrival at the hospital. The overall 30-day mortality rate was 24.5%, the median (interquartile range) intensive care unit stay was 4 (2-7) days, and the median (interquartile range) hospital stay was 13 (4-27) days. In the multivariable logistic analysis, the prognostic factors were age (≥75 years old), male, activities of daily living (needing total assistance), cause of AH (trauma, alcohol), Glasgow Coma Scale score, and potassium level (>5.5 mEq/L)., Conclusion: The mortality rate of AH was 24.5% in Japan. The prognostic factors developed in this study may be useful for the early prediction, prevention, and awareness of severe AH., Competing Interests: Approval of the research protocol with approval No. and committee Name: The study was approved by the Ethics Review Board of Teikyo University Hospital in Japan (Approval No: 17‐090‐2). The requirement for informed consent was waived by the Ethics Review Board of Teikyo University Hospital because of the observational nature of this study. In addition, the institutional review boards of each of the hospitals listed in Appendix S1 approved this study. Registry and the Registration No. of the study/Trial: N/A. Animal Studies: N/A. Conflict of Interest: None declared., (© 2021 The Authors. Acute Medicine & Surgery published by John Wiley & Sons Australia, Ltd on behalf of Japanese Association for Acute Medicine.)

Aim: An early tracheostomy is often considered for patients with veno-venous extracorporeal membrane oxygenation (VV-ECMO). However, there is no consensus on the timing of a tracheostomy in patients on VV-ECMO for coronavirus disease 2019 (COVID-19). The present report described the optimal timing of tracheostomy for these patients., Method: The present study was a single-center case series. We retrospectively reviewed the medical records of nine consecutive patients who underwent tracheostomy either during or after VV-ECMO treatment in our center between January 1, 2020 and December 31, 2020., Results: All the patients received a percutaneous dilatational tracheostomy, which was performed during VV-ECMO in four patients. Three of these patients experienced hemorrhagic complications, and the remaining patient required a circuit change on the day after the operation. Heparin was discontinued 8 h preoperatively and resumed 1-14 h later. The platelet count was below normal in two patients, but no transfusion was performed. APTT was almost normal, and D-dimer was elevated postoperatively. The remaining five patients received a tracheostomy after weaning off VV-ECMO, and no complication was observed. Eight patients were deeply sedated during VV-ECMO to prioritize lung rest and prevent infecting the healthcare workers., Conclusion: In the present study, patients who underwent a tracheostomy during VV-ECMO tended to have more hemorrhagic complications. Because an early tracheostomy during ECMO has little benefit for patients with COVID-19, it should be performed after weaning off VV-ECMO to protect the safety of the healthcare workers concerned., Competing Interests: Approval of the Research Protocol: This study was approved by the hospital’s institutional review board. Informed Consent: Written informed consent was obtained from the patients or their family. Registry of the study/trial: N/A. Animal Studies: N/A. Conflict of Interest: None declared., (© 2021 The Authors. Acute Medicine & Surgery published by John Wiley & Sons Australia, Ltd on behalf of Japanese Association for Acute Medicine.)

In this study, we aimed to develop and validate a machine learning-based mortality prediction model for hospitalized heat-related illness patients. After 2393 hospitalized patients were extracted from a multicentered heat-related illness registry in Japan, subjects were divided into the training set for development (n = 1516, data from 2014, 2017-2019) and the test set (n = 877, data from 2020) for validation. Twenty-four variables including characteristics of patients, vital signs, and laboratory test data at hospital arrival were trained as predictor features for machine learning. The outcome was death during hospital stay. In validation, the developed machine learning models (logistic regression, support vector machine, random forest, XGBoost) demonstrated favorable performance for outcome prediction with significantly increased values of the area under the precision-recall curve (AUPR) of 0.415 [95% confidence interval (CI) 0.336-0.494], 0.395 [CI 0.318-0.472], 0.426 [CI 0.346-0.506], and 0.528 [CI 0.442-0.614], respectively, compared to that of the conventional acute physiology and chronic health evaluation (APACHE)-II score of 0.287 [CI 0.222-0.351] as a reference standard. The area under the receiver operating characteristic curve (AUROC) values were also high over 0.92 in all models, although there were no statistical differences compared to APACHE-II. This is the first demonstration of the potential of machine learning-based mortality prediction models for heat-related illnesses.

Background: Postpartum depression (PPD) negatively impacts maternal health, parenting and development of children. Most previous studies on PPD risk factors are based on Western populations. Additionally, little is known about the association between psychosocial factors during early pregnancy period and PPD. We aimed to identify early risk factors for PPD until three months after delivery using a longitudinal population-based sample from Japan., Methods: The data was collected from 1050 mothers at four time points: first trimester, after the birth, and one and three months post-delivery. Mothers who had a Japanese Edinburgh Postnatal Depression Scale (EPDS) cutoff score above 9 at one or 3 months after delivery were recognized as having PPD (n = 91/8.7%)., Results: Negative feelings about pregnancy, combined breast and bottle feeding, first-time motherhood, motherhood 24 or less years old, perceived maternal mental illness before pregnancy, and lack of social support were all significantly associated with PPD at three months after delivery., Limitations: The data was collected from one city in Japan, which limits the generalization of the findings. Additionally, PPD was assessed by an EPDS questionnaire, and not by a clinical interview., Conclusions: Even after controlling for the perceived mental illness before pregnancy, several risk factors as early as in the first trimester were associated with PPD. These risk factors should be identified and the mothers should be offered a suitable intervention, in order to prevent the development of PPD., Competing Interests: Declaration of Competing Interest On behalf of all authors, the corresponding author states that there is no conflict of interest., (Copyright © 2020 Elsevier B.V. All rights reserved.)

A 71-year-old woman presented to our hospital with fever and dyspnea. Computed tomography showed shadows of bilateral pneumonia and anterior vertebral mass. She was admitted to our hospital for respiratory failure. Despite treatment with antibiotics, she developed right thoracic empyema. A high level of inflammation and fever persisted, despite chest tube drainage and continued treatment with antibiotics. Therefore, thoracoscopic curettage was conducted. The histopathological findings of the curetted anterior vertebral body lesion revealed the diagnosis of chordoma. After confirming that all the culture results and inflammation findings had turned negative, the patient was discharged from the hospital. Thoracic vertebral chordoma is being treated at the department of orthopedics.

This nationwide population-based register study examined the family and parental risk factors associated with offspring reactive attachment disorder (RAD). We identified 614 children diagnosed with RAD from the Finnish Care Register for Health Care and each case was matched with four controls. Univariate and multivariate models examined the associations between risk factors and RAD. In the multivariate model, offspring RAD was associated with only mother, only father and both parents having psychiatric diagnoses. Increased odds were observed for maternal smoking during pregnancy, single motherhood and paternal age ≥ 45 years. This study provides information on several parental adversities and offspring RAD that have important implications for public health, when planning early prevention and interventions in infant mental health.

Background: Impaired maternal bonding has been associated with antenatal and postnatal factors, especially postpartum depression. Only a few population-based, longitudinal studies have examined the association between maternal depression and bonding in outside western countries. In addition, little is known about the association between psychosocial factors during pregnancy and impaired maternal bonding. The aim of this study was to investigate risk factors associated with impaired maternal bonding 3 months after delivery using Japanese population-based, longitudinal study from pregnancy period to 3 months after delivery., Methods: This study was performed at the public health care center in Hekinan city, Aichi prefecture, Japan. Mothers who participated the infant's health check-up 3 months after delivery from July 2013 to Jun 2015 completed the Postpartum Bonding Questionnaire (PBQ) and the Edinburgh Postnatal Depression Scale (EPDS) 1 month after delivery. Information was also provided from home visit at 1 month after delivery, birth registration form, and pregnancy notification form. The study included 1060 mothers with a mean age of 29.90 years, who had given birth at a mean of 38.95 weeks., Results: Bivariate and multivariate logistic regression analyses were conducted to identify the association between antenatal and postnatal factors and impaired maternal bonding. The main findings were that maternal negative feelings about pregnancy (OR = 2.16, 95% CI = 1.02-4.56) and postpartum depression at 1 month after delivery (OR = 7.85, 95% CI = 3.44-17.90) were associated with higher levels of impaired maternal bonding 1 months after delivery. Mothers who had delivered their first child had increased odds of a moderate level of impaired maternal bonding 3 months after delivery (OR = 1.85, 95% CI = 1.22-2.81)., Conclusions: The findings emphasize the importance of identifying mothers with depression and those with maternal negative feelings towards pregnancy to assess possible impaired maternal bonding.

This cross-sectional population-based survey compares the prevalence of self-reported body image and eating distress symptoms among adolescents in Japan and Finland, and associations between emotional/behavioral problems, body image and eating distress from a cross-cultural perspective. The study included 1,840 Japanese and 1,135 Finnish 8th grade students. The self-reported questionnaire included the Body Image and Eating Distress Scale and Strengths and Difficulties Questionnaire (SDQ). The female adolescents from both Finland and Japan reported much greater dissatisfaction with, and concern about, their bodies than the males and Japanese females expressed even higher distress than Finnish females. High levels of body image and eating distress were associated with psychiatric problems measured with the SDQ. There was a significant three-way interaction effect of body image and eating distress, gender and country with SDQ peer problems and prosocial behavior., (© 2018 The Authors. Scandinavian Journal of Psychology published by Scandinavian Psychological Associations and John Wiley & Sons Ltd.)

Aim: Data pertaining to child and adolescent psychiatry (CAP) training systems are limited as extant research has mostly been derived from one-time data collection. This 5-year follow-up survey collects updated information on CAP training systems in the Far East, allowing for the tracking of system changes over the past 5 years., Methods: Data were obtained from 18 countries, or functionally self-governing areas, in the Far East, 17 of which were also included in the original study. An online questionnaire was completed by leading CAP professionals in each country. Questions were expanded in the present study to capture the contents of CAP training., Results: When compared to data from the original study, there has been progress in CAP training systems in the last 5 years. Specifically, there has been an increase in the number of countries with CAP training programs and national guidelines for the training. In addition, the number of CAP departments/divisions affiliated with academic institutions/universities has increased. Findings from 12 of 18 countries in the present study provide data on clinical contents. All informants of the present study reported the need for more child and adolescent psychiatrists and allied professionals., Conclusion: Despite progress in CAP training systems over the last 5 years, the need for more professionals in child and adolescent mental health care in all the relevant areas in this region have yet to be adequately addressed. Continued national efforts and international collaborations are imperative to developing and sustaining new CAP training systems while facilitating improvements in existing programs., (© 2018 The Authors. Psychiatry and Clinical Neurosciences © 2018 Japanese Society of Psychiatry and Neurology.)

Background: No previous population-based studies have examined associations between self-cutting, perceived school safety, and bullying behavior among East Asian adolescents., Method: We examined whether bullying, victimization, and perceived school safety were associated with self-cutting by getting 1865 students with a mean age of 13.9 years (standard deviation 0.2 years) to complete questions on these variables. Psychiatric problems were assessed with the Strengths and Difficulties Questionnaire., Results: About 5.6% of males and 11.9% females had practiced self-cutting and when we controlled these results for psychiatric symptoms, self-cutting was associated with being both a bully and a victim among males and females. In addition, self-cutting was independently associated with perceived school safety among females. Those who felt unsafe at school and were victimized were much more likely to engage in self-cutting., Conclusions: Self-cutting among Japanese adolescents was linked with bullying behavior and feeling unsafe at school. Secure school environments and school-based antibullying programs could help to prevent adolescent self-injurious behavior., (© 2016 Association for Child and Adolescent Mental Health.)

Background and Objectives: An increased prevalence of low maternal weight and insufficient pregnancy weight gain may be responsible for an increase in low birthweight infants in Japan. We aimed to examine the effects of individualised dietary education at medical check-ups on maternal/fetal outcomes in Japanese women., Methods and Study Design: Four hundred and six underweight and normal weight singleton pregnant women, who attended check-ups at an obstetric facility until ≥30 weeks gestation and delivered at 36-41 weeks gestation, were selected for analyses. Weight gain was assessed at each check-up based on the official "Dietary Guidelines for Pregnant and Lactating Women". Individual dietary advice was provided by dieticians to those with insufficient or excess weight gain status around 28 weeks gestation. The medical records from uncomplicated singleton deliveries (36-41 weeks gestation) at the same facility from 2008-2010 were used (n=792) to examine the effect of dietary education on maternal/fetal outcomes., Results: Pre-pregnancy underweight was present in >24% of women in both the intervention and non-intervention groups. Adequate weight gain occurred more frequently in the intervention group (p<0.01). There were no significant differences in mean birthweight or the proportion of low birthweight infants. However, the proportion of extremely small for gestational age infants (birthweight <3rd percentile) was lower in the intervention group (p=0.011). There were no differences in the frequency of caesarean delivery, pregnancy induced hypertension, or infant Apgar scores <7., Conclusions: Dietary education during pregnancy check-ups promotes adequate maternal weight gain and helps prevent extreme fetal growth restraint.

Aim: Despite the general consensus on the importance of youth mental health, the scarcity of child and adolescent mental health services is prominent all over the world. Child and adolescent psychiatry (CAP) postgraduate training can play a pivotal role in increasing access to youth mental health services. In comparison to Europe and North America, however, little is reported regarding CAP training in the Far East, one of the most dynamic and rapidly developing world regions with a very young population. This paper presents an original study on the current status of academic child and adolescent psychiatry training across the Far East., Methods: We collected data from 17 countries in the Far East using an internally distributed questionnaire to the Consortium members invited for this study, consisting of leading academic child and adolescent psychiatrists in each country., Results: Based on informants' input, we found an overall underdevelopment of CAP postgraduate training systems despite CAP's recognition as a subspecialty in 12 of 17 of the nations or functionally self-governing areas in the Far East. Paucity of official guidelines for CAP training was also evident. All informants reported a need for additional child and adolescent mental health professionals., Conclusion: There seems to be several obstacles to the development of CAP postgraduate training in the Far East, including stigma towards mental health issues and lack of funding. International collaboration is desired to develop evidence-based and culture-tailored CAP training systems., (© 2014 The Authors. Psychiatry and Clinical Neurosciences © 2014 Japanese Society of Psychiatry and Neurology.)

To study the mechanism underlying the influence of psychological pressure on task performance, we investigated the relationship between prefrontal activation, autonomic arousal, and performance in an n-back working memory task with 3 load levels (l-, 2-, and 3-back tasks) under evaluative pressure. The tasks were performed by 32 university students with or without evaluative observation by experimenters. The error rate and prefrontal activation were found to increase with pressure only in the highest load task (3-back). In contrast, autonomic arousal increased with pressure regardless of the task condition. Correlation analysis showed a positive correlation of the error rate with prefrontal activation in the 3-back task and no consistent correlation with autonomic arousal. We concluded that the inhibitory effect of evaluative pressure on task performance is mediated by prefrontal overactivation rather than autonomic arousal., (Copyright © 2011 Society for Psychophysiological Research.)

Background/aims: In this study, we examined changes in the concentrations of oxygenated and deoxygenated hemoglobin (oxy- and deoxy-Hb, respectively) in the prefrontal cortex (PFC) during the digit span task by using near-infrared spectroscopy (NIRS)., Methods: The digit span task consists of the digit span forward and backward tasks. The tasks were performed by 22 healthy undergraduate students who participated in this study. Differences in the mean concentrations of oxy-Hb and deoxy-Hb between the baseline and task intervals were evaluated., Results: In digit span backward, oxy-Hb was significantly higher during the task interval than during the baseline. Further, deoxy-Hb was significantly lower during the task interval than during the baseline in both digit span forward and digit span backward. Digit span forward performance was significantly higher for the right-PFC-dominant group than for the left-PFC-dominant group., Conclusion: These results suggest that the digit span backward task is more demanding and requires greater activation of the prefrontal cortex than the digit span forward task. Our NIRS findings suggest that the digit span backward task involves executive functioning., (© 2010 S. Karger AG, Basel.)

The immediate premotor signals for saccades are created at the level of medium-lead burst neurons (MLBNs). During fixations, MLBNs receive tonic inhibition from omnipause neurons (OPNs), which use glycine as a neurotransmitter. To elucidate the role of this inhibition, we studied discharge patterns of horizontal MLBNs following iontophoretic application of strychnine, a glycine-receptor antagonist, in alert cats. Three-barrel micropipettes were used for extracellular recording and iontophoresis. After application of strychnine, MLBNs exhibited spontaneous discharge and visual responses during intersaccadic intervals. Spikes were evoked by single-pulse stimulation of the contralateral superior colliculus (SC). These results show that MLBNs receive substantial excitatory input during intersaccadic intervals and that inhibitory action of OPNs is indeed necessary to prevent MLBNs from firing. Strychnine also affected saccade-related activity of MLBNs. The burst of activity, as in normal conditions, declined rapidly before the end of saccades but was followed by low rate spike activity, which continued beyond the end of saccades. This suggests that in normal conditions, the termination of saccades is determined by resumed inhibitory action of OPNs and not by termination of excitatory input to MLBNs. In addition, the firing rate and the number of spikes during saccades increased after strychnine application, suggesting that MLBNs receive glycinergic inhibition of non-OPN origin as well. We conclude that glycinergic inhibition plays essential roles in the maintenance of stable fixation, the termination of saccades, and the regulation of saccade size and velocity.

Currently, individuals tend to encounter many unavoidable, painful events and hardships in the process of growth and development. To lead one's life adapting to these social conditions, it is necessary to maintain one's mental health even while experiencing challenging events; in other words, resilience is required. This study of 130 undergraduates focused on the Adolescent Resilience Scale which assesses capacity for successful adaptation despite challenging or threatening circumstances and examined correlations with scores on the Big Five Personality Inventory. A significant negative correlation of -.59 (p<.001) was noted for scores on the Adolescent Resilience Scale and the Neuroticism dimension of the Big Five Personality Inventory, accounting for 35% of the variance, and positive values with the Extraversion, Openness, and Conscientiousness dimensions (rs= .37, .40, .48, accounting for 14, 16, and 18% of the variance, respectively. Personalities of adolescents who have psychological traits leading to resilience may be partially predicted using these results.

The Japanese version of the Revised Infant Temperament Questionnaire (RITQ) was implemented to re-evaluate factor structure of the temperament scale with the objective of simplification. The questionnaire was conducted on 1099 mothers of Japanese infants visiting health centers for their children's health examinations at 6 or 7 months. As a result, a 57-item abridged version was constructed consisting of the seven subscales: 'fear of strangers and strange situations', 'insensitivity to food', 'regularity of rhythm', 'manageability', 'activity level', 'persistence of attention', and 'insensitivity to touch'. Although the items did not break down into the traditional nine temperament dimensions extracted by Carey et al., a certain commonality was seen in factor structure compared with the results of factor analysis using the RITQ in studies in Japan and abroad.

Although children in infancy present eating problems of multifarious nature, the diagnostic classification of infant eating disorders remains markedly deficient. The authors present a case exhibiting transient eating disorder in early childhood, alongside discussion of some considerations relevant to this age group. The subject was a boy aged 5 years 6 months at first presentation. Starting with an inability to swallow "sushi" at dinner, he was brought to the clinic for inability to ingest food or liquids. Treatment was planned as play therapy for the patient, and psychological interviews for the mother. The child's symptoms were improved in five sessions, but interviews of the mother revealed eating disorders such as bulimia and vomiting, and sexual problems in the marital relationship, necessitating long-term therapy.

Objective: Hallucinatory experiences in children are often thought to indicate serious psychopathology. However, they have also been reported in normally developing children and in association with temporary psychological reactions to acute stress. The aim of this study was to investigate the prevalence of hallucinatory experiences in a nonclinical population of children and to examine the relationship between the modality and content of hallucinations and psychopathology., Method: Seven hundred sixty-one Japanese children, 11 to 12 years old, completed a battery of four measures: (1) a questionnaire about the type of hallucinatory experience, (2) the Children's Depression Inventory, (3) the State-Trait Anxiety Inventory for Children, and (4) the Adolescent Dissociative Experiences Scale., Results: Approximately 21% of the subjects had experienced hallucinations. Subjects who had experienced hallucinations, in particular, hallucinations characterized by combined modalities, closely self-related auditory content, or concrete visual content, had more significant psychopathology than did those who had never experienced hallucinations., Conclusions: Therapeutic intervention should be considered for children who experience hallucinations in association with depression, anxiety, or dissociation.

We are exposed to many external and internal stresses in this day and age. Stress weakens the function of immune systems in living organisms and disturbs homeostasis. As a result, stress induces various psychosomatic diseases. Thus, ways of reducing stress and thus protecting humans from disease must be developed. One such method is called "the prevention of Mibyou" in Kampo, the Chinese traditional medicine. Many studies have reported the direct effects of medical ginseng on damaged target organs and recovery from disease. It also increases immune potential and may maintain homeostasis of living organisms through the autonomic-endocrine systems. It is also thought to prevent the development of disease. We studied and considered the action of medical ginseng on living organisms that were exposed to various stresses such as cold environment and industrial work. Furthermore, we confirmed the preventive effects of medical ginseng on the common cold symptom complex, including flu, by clinical observation. Here, we report our experiences.

A rising tendency has been reported for child abuse in our country in recent years, and the need to provide support for child-care capabilities in the home has been raised. In this context, attention has turned to the mother-child relationship and the mother's mental health from early on, in pregnancy and the antenatal period. In particular, it has become clear that the incidence of post-partum maternity blues and puerperal depression is higher than hitherto believed, drawing focus upon the effects of the mother's depression on the mother-child relationship. This report outlines the research and clinical intervention we have been undertaking for the mother's depression in pregnancy and the puerperium in relation to maternal attachment. 1) Results from studies in the puerperium on a group of mothers with children admitted to the NICU and a control group of mothers, and a 1-year follow-up study on the control group of mothers have revealed a relationship between a mother's depression and maternal attachment in the puerperium with depression and maternal attachment after 1 year, indicating the importance of focusing on the mother's depression and maternal attachment from the puerperium in thinking about maternal mental health and the mother-child relationship. 2) We have been attempting clinical intervention for the mother's psychological problems through the obstetric clinic, obstetric ward, and NICU, since 1998. The number of subjects, interviews, interview content, and other such data are reported. 3) A borderline personality disorder case we have been involved with clinically from age 19 is presented, for discussion of problems arising in the mother-child relationship from pregnancy through the child-rearing years.

The aim of this study was to assess the construct validity of the Adolescent Resilience Scale which measures the psychological features of resilient individuals. Research involving this scale, the Negative Life Events Scale, and the General Health Questionnaire was conducted with a group of 207 Japanese undergraduate students (104 men and 103 women; M age=20.2 yr., SD=.9). A cluster analysis for the Negative Life Events Scale and General Health Questionnaire yielded three clusters: (1) mentally healthy with little experience of Negative Life Events, (2) poorer mental health with many experiences of Negative Life Events, (3) mentally healthy despite many experiences of Negative Life Events. These three groups were defined as (1) Well Adjusted, (2) Vulnerable, and (3) Resilient, respectively. Mean differences in scores on the Adolescent Resilience Scale among the three groups were subjected to one-way analysis of variance. The mean scores of both the Well Adjusted and Resilient groups were higher than that of the Vulnerable group, and therefore support the construct validity of the Adolescent Resilience Scale.

Background: In recent years, attention has been turned to maternal mental health in relation to the mother-child relationship accompanying a widening in focus, i.e. taking into account not only the puerperium, but also the stage of pregnancy. This applies to studies that have revealed a connection between depression and maternal attachment in the postpartum period and late pregnancy. This study, however, was designed to evaluate the maternal-fetal relationship in the first and second trimesters, being the first one to address this issue in these early stages., Sampling and Methods: Zung's Self-Rating Depression Scale (ZSDS), the original Antenatal Maternal Attachment Scale (AMAS), and a questionnaire addressing peripheral factors were given to 216 pregnant women (3-6 months of gestation) who visited the Nagoya University Hospital between September 1998 and June 2001., Results: Contrary to reports on the latter stages of pregnancy, no direct association was observed between depression in mothers and maternal-fetal attachment before fetal movement was perceived., Conclusion: However, education, form of employment, planning of pregnancy, and premenstrual mood changes were found to be associated with the ZSDS score (mean: 41.9), while form of employment, feelings regarding pregnancy, and sources of support were extracted as factors associated with the AMAS, which are of interest in terms of the subsequent association between depression and maternal-fetal attachment in the peri- and postnatal periods., (Copyright 2003 S. Karger AG, Basel)

School refusal is a phenomenon that first drew attention in Japan around 1960 and it remains one of the major issues in child psychiatry today. Moreover, it is now said that there exists a large group of latent school refusers currently attending school but harboring feelings of school avoidance. To address this issue, a questionnaire survey was conducted on students enrolled in a junior high and high school affiliated with the Nagoya University School of Education. The questionnaire consisted of the Children's Depression Inventory (CDI), a scale for evaluating feelings of school avoidance (School Avoidance Scale), and a scale for assessment of personality characteristics associated with school refusal (School Refusal Personality Scale). The subjects were 425 first-year junior high to second-year high school students. Factor analysis of each scale revealed the CDI to consist of three factors: 'core depression', 'feelings of interpersonal maladaptation', and 'self-revulsion', and the School Avoidance Scale to consist of two factors: 'school dislike', and 'school avoidance'. The School Refusal Personality Scale consisted of three factors: 'obsessive-compulsive', 'passive/unsocial', and 'socially introverted'. Mean CDI score and standard deviation (SD) was 19.44 +/- 7.49, and that for 'feelings of school avoidance' was 20.18 +/- 5.61. The two subordinate factors of the School Avoidance Scale were intimately associated with both 'feelings of interpersonal maladaptation' and 'core depression' of the CDI, and negatively correlated with the 'obsessive-compulsive' factor of the School Refusal Personality Scale.