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Objective: The quality of life (QOL) and psychological states of patients with pectus excavatum (PE) have yet to be well understood. This study aimed to evaluate the health-related QOL (HRQOL), psychological states, and personality traits of patients with PE, alongside the associations of these factors with the severity of PE. Methods: A cross-sectional evaluation was prospectively performed in patients scheduled to undergo PE repair surgery between July 2019 and April 2021. The primary outcome was the patients’ HRQOL, and the secondary outcomes were depression, social anxiety, self-efficacy, and personality traits. Results: In total, 129 patients were subjected to analyses. Patients' HRQOL had a lower role component summary score (mean ± standard deviation: 41.8 ± 12.8, P

IntroductionAnxiety disorder is one of the most prevalent mental disorders. Mindfulness-based cognitive therapy (MBCT) is effective for treating anxiety disorders. However, no studies have investigated the cost-effectiveness of MBCT for anxiety disorders. We aimed to conduct a cost-effectiveness analysis alongside a randomized controlled trial (RCT) to clarify the cost-effectiveness of MBCT for anxiety disorders.MethodsA cost-effectiveness analysis alongside an RCT was conducted for 8 weeks in 40 patients with anxiety disorders at a university hospital. Patients (1) aged 20–75 years; (2) who were diagnosed with panic disorder/agoraphobia or social anxiety disorder based on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria; and (3) who provided written consent were analyzed. The participants were allocated randomly (1:1 ratio) to the augmented MBCT group (i.e., MBCT plus treatment as usual [TAU]) or TAU (waitlist control) group. The cost-effectiveness was assessed using the incremental cost-effectiveness ratio (ICER), which is the ratio of the incremental costs divided by the incremental state-trait anxiety inventory- state (STAI-S), state-trait anxiety inventory- trait (STAI-T), and quality-adjusted life years (QALYs). The QALYs were estimated using The Japanese version of EuroQoL five-dimensional 3-level questionnaire. The unit cost data were derived from the government-regulated fees. This study was conducted from a public healthcare insurance perspective. No discount rates were considered.ResultsA total of 38 participants with complete data were included in the analysis. The MBCT was JPY 13,885 more than the cost of TAU and was associated with a STAI-S, STAI-T, and QALY increase of 10.13, 12.00, 0.009 respectively. The ICER were JPY 1,371 (USD13) per STAI-S, JPY 1,157 (USD 11) per STAI-T, and JPY 1,566,357 (USD 14,940) per QALY respectively. MBCT had an 77.5% probability of being cost-effective at a willingness to pay threshold in Japan (JPY 5,000,000 per QALY). The results of the four one-way sensitivity analyses supported the robustness of the base-case analysis findings.DiscussionAugmented MBCT for anxiety disorders is cost-effective compared with TAU post-treatment from a public healthcare insurance perspective. Future studies should include long-term observations, and analysis from a societal perspective.

Abstract Objective Comorbid psychiatric disorders negatively affect the survival rate of patients with some physical disorders. In liver transplant recipients, various psychiatric disorders have been identified as worsening prognosis. However, little is known about how the presence of any comorbid (overall) disorders affect the survival rate of transplant recipients. In this study, we examined the effect of overall comorbid psychiatric disorders on survival rate in liver transplant recipients. Methods A total of 1006 recipients who underwent liver transplantation between September 1997 and July 2017 across eight transplant facilities with a psychiatric consultation-liaison team were identified consecutively. Recipients were categorized into those with comorbid psychiatric disorders and those without comorbid psychiatric disorders. In the comorbid psychiatric disorder group, psychiatric disorder diagnosis and time of diagnosis were investigated retrospectively. Results Of the 1006 recipients, 294 (29.2%) had comorbid psychiatric disorders. Comorbid psychiatric disorders in the 1006 recipients were insomnia (N = 107, 10.6%), delirium (N = 103, 10.2%), major depressive disorder (N = 41, 4.1%), adjustment disorder (N = 19, 1.9%), anxiety disorder (N = 17, 1.7%), intellectual disability (N = 11, 1.1%), autism spectrum disorder (N = 7, 0.7%), somatic symptom disorder (N = 4, 0.4%) schizophrenia (N = 4, 0.4%), substance use disorder (N = 24, 2.4%) and personality disorder (N = 2, 0.2%). The most common time of psychiatric disorder diagnosis was within the first 3 months after liver transplantation (51.6%). The final mortality in patients with comorbid psychiatric disorder diagnosis during the five periods (pretransplant, transplant to 3 months, months to 1 year, 1 to 3 years, and over 3 years posttransplant) was 16.2%, 18.8%, 39.1%, 28.6%, and 16.2% respectively, and there were no significant differences between the five periods (χ2 = 8.05, df = 4, p = 0.09). Overall comorbid psychiatric disorders were significantly associated with shorter survival time (log-rank test: p = 0.01, hazard ratio: 1.59 [95% confidence interval: 1.14–2.21], survival rate at the endpoint [%]: 62.0 vs. 83.3). However, after adjusting for confounding variables using Cox proportional hazards regression, there was no significant effect of overall comorbid psychiatric disorders on prognosis. Conclusion Comorbid psychiatric disorders did not affect the survival rate of liver transplant recipients in this study.

Abstract Aim The aim of this research was to create a scale to assess the competency of therapists who conduct group cognitive behavioral therapy (G‐CBT). The scale is intended to serve as a tool to aid the training of therapists. Methods Three stepped studies were conducted. Process 1: Through literature review and experts' consensus process, essential skills for G‐CBT were articulated and categorized according to the criteria of the Cognitive Therapy Scale, a well‐established rating scale for evaluating clinicians' skills in individual cognitive behavioral therapy. The list of those skills was organized into a rating scale. Process 2: Behavioral anchors were added to each skill and were classified by the levels of difficulty (beginner, intermediate, and advanced levels), based on the rating by G‐CBT experts. Process 3: Inter‐rater reliability and validity of the rating scale were examined in a sample of 41 videotaped G‐CBT sessions of actual clinical sessions and educational role‐plays. Results The 12‐item Group Cognitive Therapy Scale (G‐CTS) was developed. It consists of 11 items that are adapted from the original Cognitive Therapy Scale, and a new 12th item called “Intervention using relationships with other participants,” which describes therapists' skills to address group dynamics. The G‐CTS showed excellent internal consistency (Cronbach's α: 0.95), satisfactory inter‐rater reliability (interclass correlation coefficients: 0.65–0.88), and high predictive validity. Conclusion A novel rating scale to evaluate therapists' competency in G‐CBT was developed and successfully validated. The G‐CTS behavioral checklist created in this study provides concrete guidelines that can be used by therapists to hone their skills in G‐CBT.

Abstract Aim The coronavirus disease 2019 (COVID‐19) pandemic has caused unprecedented stress. Mindfulness‐based interventions (MBIs) are known to be effective in reducing stress. However, it is unclear how long‐term outcomes differ between those who continue mindfulness practice after MBIs and those who do not. In this study, we hypothesized that those who continued mindfulness practice would have higher stress tolerance, and we examined this hypothesis through a survey of MBI graduates. In this study, we examined the association between the continuation of mindfulness practice among MBI completers and individual stress during the COVID‐19 epidemic. Methods A cross‐sectional survey of MBI graduates was conducted. The physical and mental health states were compared between those who established a habit of mindfulness practice (practice group) and those who did not (no practice group). Results The data were collected from 95 participants (response rate: 53.7%). Of the total respondents, 66 (69.5%) practiced mindfulness. Although the degree of perceived stress due to the COVID‐19 pandemic was not statistically different between the practice and no practice groups, the practice group showed significantly lower levels of depression (p = 0.007), higher levels of resilience (p = 0.006), higher levels of overall health (p = 0.006), and higher levels of mental health (p = 0.039). The effect of mindfulness practice on reducing depression was fully mediated by resilience. Conclusion Among MBI graduates, those who regularly practiced mindfulness had lower levels of depression and higher levels of physical and mental health. Thus, the continuation of mindfulness practice increases resilience, buffers against new stressors such as the COVID‐19 pandemic, and has the potential to prevent depression.

Abstract Aim An assertive case management intervention program, ACTION‐J, proved effective for preventing suicide attempters from reattempting suicide within 6 months. The ACTION‐J randomized trial was conducted as part of the “National Strategic Research Projects.” The program has been covered by the national medical payment system of Japan since 2016. The aim of the Post‐ACTION‐J Study (PACS) was to examine the current implementation status of assertive case management in a real‐world clinical setting. Methods PACS was a prospective, multicenter registry cohort study. The participants were suicide attempters admitted to the emergency departments of 10 participating medical facilities from October 2016 to September 2018. The assertive case management intervention developed by the ACTION‐J Study was offered to all patients, and the primary outcome was the duration and frequency of use of the intervention at 6 months. Results A total of 1159 patients were admitted to emergency departments after a suicide attempt during the study period, 144 of whom were included in our analysis. The proportion of participants who received the intervention for 6 months was 72.2% (104/144), and 63.9% (92/144) of the patients completed ≥7 case management interviews within 6 months. Conclusion The findings of this study indicate successful implementation of an assertive case management intervention program based on the ACTION‐J Study in a real‐world clinical setting, following its integration with the national medical payment scheme in Japan. The study provided the useful information that could improve the implementation of assertive case management interventions in future.

Abstract Aims Transcatheter aortic valvular replacement (TAVR) is increasingly being performed for elderly patients with aortic stenosis (AS), and current guidelines acknowledge the importance of shared decision‐making in their management. This study aimed to evaluate elderly symptomatic severe AS patients' perspectives on their treatment goals and identify factors that influence their treatment choice. Methods and Results We performed a pre‐procedural cross‐sectional survey using a questionnaire at a single university hospital. The questionnaire included three primary domains: (i) symptom burden, (ii) goals and important factors related to treatment, and (iii) preferred place of residence after treatment. We investigated 98 symptomatic severe AS patients who underwent TAVR (median age 86 years, 26% men). None of the patients died during hospitalization, and most of them (94%) were discharged home. Prior to TAVR, the three most common symptom burdens were poor mobility (52%), shortness of breath (52%), and weakness (44%). The reported preferred treatment goals were symptom burden reduction (78%), independence maintenance (68%), ability to perform a specific activity/hobby (62%), and improvement in prognosis (58%). In total, 54% of the patients rated ‘in alignment with my values’ as the factor that affected their decision to undergo TAVR. Nearly all patients (95%) stated that they preferred to live at home after TAVR. Conclusions Among elderly AS patients with varying symptoms who underwent TAVR, symptom burden reduction was the most cited patient‐reported goal. Nearly all the patients preferred to live at home after the procedure. Encouraging patients to define their specific goals may improve the quality of shared decision‐making in such settings.

Abstract The usefulness of depression scales for patients with cancer based on item response theory (IRT) and computer adaptive testing (CAT) has not yet been fully explored. This study thus aimed to develop an IRT-based tool for measuring depression in patients with cancer. We analyzed data from 393 patients with cancer from four tertiary centers in Japan who had not received psychiatric treatment. They answered 62 questions across five categories regarding their psychiatric status over the previous week. We selected 28 items that satisfied the assumptions of IRT, fitted a graded response model to these items, and performed CAT simulations. The CAT simulation used an average of 6.96 items and showed a Pearson’s correlation coefficient of 0.916 (95% confidence interval, 0.899–0.931) between the degree of depression estimated by simulation and that estimated using all 28 items. The measurement precision of CAT with only four items was superior to that of the estimation using the calibrated Patient Health Questionnaire-9. These results imply that this scale is useful and accurate for measuring depression in patients with cancer.

BackgroundsHikikomori, pathological social withdrawal, is becoming a crucial mental health issue in Japan and worldwide. We have developed a 3-day family intervention program for hikikomori sufferers based on Mental Health First Aid (MHFA) and Community Reinforcement and Family Training (CRAFT). This study aims to confirm the effectiveness of the 3-day program by a randomized controlled trial.MethodsThis study was registered on the UMIN Clinical Trials Registry (UMIN000037289). Fifteen parents were assigned to the treat as usual (TAU) group (TAU only; Age Mean, 65.6; SD, 7.8), and 14 to the Program group (program + TAU; Age Mean, 67.9; SD, 8.6). This study was discontinued due to the COVID-19 pandemic; the recruitment rate was 36.3% of our target sample size of 80.ResultsPerceived skills improved temporally and stigma temporally worsened in the TAU group. Confidence decreased and attitude showed no change in both groups. Aggressive behaviors of hikikomori sufferers were significantly worsened in the Program group; however, no serious domestic violence was reported. In the TAU group, Avoidance and irregular life patterns were improved. Activity levels were worsened in both groups. Two participants (16.7%) in the Program group and one participant (7.7%) in the TAU group reported actual behavioral changes (e.g., utilizing support).ConclusionWe could not draw general conclusions on the effectiveness of the program due to the study discontinuation. Nevertheless, this study indicates the necessity for revision of the program to improve family members’ confidence in engaging with hikikomori sufferers, with safer approaching by families.

Abstract Aims Early engagement in advance care planning (ACP) is recommended in heart failure (HF) management. We investigated the preferences of patients with HF regarding ACP and end‐of‐life (EOL) care, including their desired timing of ACP initiation. Methods and results Data were collected using a 92‐item questionnaire survey, which was directly distributed to hospitalized patients by dedicated physicians and nurses in a university hospital setting. One‐hundred eighty‐seven patients agreed to participate (response rate: 92.6%), and 171 completed the survey [valid response rate: 84.7%; men: 67.3%; median age: 73.0 (63.0–81.0) years]. Logistic regression analyses were conducted to identify the predictors of positive attitudes towards ACP. Most recognized ACP as important for their care (n = 127, 74.3%), 48.1% stated that ACP should be initiated after repeated HF hospitalizations in the past year, and 29.0% preferred ACP to begin during the first or second HF hospitalization. Only 21.7% of patients had previously engaged in ACP conversations during HF management. Positive attitudes towards ACP were associated with lower depressive symptoms [two‐item Patient Health Questionnaire; odds ratio (OR): 0.75, 95% confidence interval (CI): 0.61–0.92, P‐value: 0.006], marriage (OR: 2.53, 95% CI: 1.25–5.12, P‐value: 0.010), and a high educational level (OR: 2.66, 95% CI: 1.28–5.56, P‐value: 0.009), but not with severity of HF (represented by Seattle Heart Failure Model risk score). Regarding EOL care, while ‘Saying what one wants to tell loved ones’ (83.4%), ‘Dying a natural death’ (81.8%), and ‘Being able to stay at one's favorite place’ (75.6%) were the three most important factors for patients, preferences for ‘Receiving sufficient treatment’ (56.5%) and ‘Knowing what to expect about future condition’ (50.3%) were divergent. Conclusions Despite patients' preferences for ACP conversations, there was a discrepancy between preference and engagement in ACP among patients hospitalized for HF. Patients' preferences regarding EOL care may differ; physicians need to consider the appropriate ACP approach to align with patients' care goals.

Introduction An easy-to-access and effective psychotherapy for bereaved informal caregivers has not been established. People with higher self-compassion status tend to have lower bereavement related grief, psychotherapy focused on self-compassion can be promising for this population. This study aimed to examine the feasibility of online self-compassion focused psychotherapy for bereaved informal caregivers.Method and analysis A total of 60 study participants will undergo an intervention programme comprising online sessions of 2 hours per week for five consecutive weeks and undertake postsession work. The intervention personnel will comprise psychologists who have received more than 10 hours of structured training. The primary endpoint will be assessed on the intervention completion rate, with secondary endpoints consisting of the Complicated Grief Questionnaire, Patient Health Questionnaire-9, Generalised Anxiety Disorder-7, Brief Resilience Scale and Self-Compassion Scale. Evaluations will be conducted preintervention, immediately after intervention, and 4 and 12 weeks after intervention.Ethics and dissemination This study has been reviewed and approved by the Ethics Committee of the Kyoto University Graduate School and Faculty of Medicine, Kyoto University Hospital, Japan (Approved ID: C1565). The results of this study will be disseminated through publication in a peer-reviewed journal and conference presentations.Trial registration number UMIN000048554.

Background The implementation of advance care planning (ACP) in heart failure management is insufficient. Social isolation (SI) could be a barrier to ACP initiation, albeit the relationship between SI and patients' preference for ACP or end‐of‐life care remains unknown. Methods and Results We conducted a questionnaire survey, including assessments of SI using the 6‐item Lubben Social Network Scale as well as patients' perspectives on ACP and end‐of‐life care. Of the 160 patients approached by our multidisciplinary heart failure team during admission, 120 patients (75.0%) completed the survey (median age, 73.0 years; men, 74.2%). A Cox proportional hazard model was constructed to elucidate the short‐term (180‐day) prognostic impact of SI. Overall, 28.3% of participants were at high risk for SI (6‐item Lubben Social Network Scale score

Introduction Penile self‐mutilation is predominantly associated with psychiatric disorders and rarely occurs during suicide attempts by men with depressive mood disorders. Herein, we have reported a case of penile self‐mutilation by a patient with depression. Case presentation A 63‐year‐old man with a 20‐year treatment history of depression presented to our hospital an hour after cutting his penile shaft during a suicide attempt. Hemostasis was achieved by urologists, and his psychiatric condition was evaluated by psychiatrists. The patient and his family hoped for penile replantation. His mood disorders were controllable, and microscopic replantation was performed by plastic surgeons after multidisciplinary discussion. The patient recovered, urinated without any signs of urinary stricture, showed no progression of depression, and did not repeat the mutilation. Conclusion Penile self‐mutilation during suicide attempts is a rare urological emergency that requires multidisciplinary management involving urologists, psychiatrists, and plastic surgeons.

Abstract Background Patient participation is a key foundation of advance care planning (ACP). However, a patient himself/herself may be left out from sensitive conversations such as end-of-life (EOL) care discussions. The objectives of this study were to investigate patients’ participation rate in the discussion of Cardiopulmonary Resuscitation (CPR) / Do-Not-Attempt-Resuscitation (DNAR) order, and in the discussion that the patient is at his/her EOL stage (EOL disclosure), and to explore their associated factors. Methods This is a retrospective chart review study. The participants were all the patients who were hospitalized and died in a university-affiliated teaching hospital (tertiary medical facility) in central Tokyo, Japan during the period from April 2018 to March 2019. The following patients were excluded: (1) cardiopulmonary arrest on arrival; (2) stillbirth; (3) under 18 years old at the time of death; and (4) refusal by their bereaved family. Presence or absence of CPR/DNAR discussion and EOL disclosure, patients’ involvement in those discussions, and their associated factors were investigated. Results CPR/DNAR discussions were observed in 336 out of the 358 patients (93.9%). However, 224 of these discussions were carried out without a patient (patient participation rate 33.3%). Male gender (odds ratio (OR) = 2.37 [95% confidence interval (CI) 1.32–4.25]), living alone (OR = 2.51 [1.34–4.71]), and 1 year or more from the date of diagnosis (OR = 1.78 [1.03–3.10]) were associated with higher patient’s participation in CPR/DNAR discussions. The EOL disclosure was observed in 341 out of the 358 patients (95.3%). However, 170 of the discussions were carried out without the patient (patient participation rate 50.1%). Patients who died of cancer (OR = 2.41[1.45–4.03]) and patients without mental illness (OR=2.41 [1.11–5.25]) were more likely to participate in EOL disclosure. Conclusions In this clinical sample, only up to half of the patients participated in CPR/DNAR discussions and EOL disclosure. Female, living with family, a shorter period from the diagnosis, non-cancer, and mental illness presence are risk factors for lack of patients’ participation in CPR/DNAR or EOL discussions. Further attempts to facilitate patients’ participation, based on their preference, are warranted.

In this report, we present a case in which good results were achieved by treatment using a free jejunal patch graft with virtual endoscopy (VE) assistance in a patient whose swallowing had failed to improve for 40 years after he mistakenly swallowed sulfuric acid, despite pectoralis major myocutaneous flap grafting and frequent balloon dilatation surgery. During the last 20 years, virtual computed tomography imaging has improved remarkably and continues to be used to address new challenges. For reconstructive surgeons, the greatest advantage of VE is that it is a noninvasive modality capable of visualizing areas inaccessible to a flexible endoscope. Using VE findings, we were able to visualize the 3-dimensional shape beyond the stenosis. VE can also help predict the area of the defect after contracture release.

BackgroundAugmented mindfulness-based cognitive therapy (MBCT) with treatment as usual (mainly pharmacotherapy) is reported to be effective after treatment for anxiety disorders. However, whether its effectiveness persists in the long term is unclear. ObjectiveThis study aims to examine the feasibility, acceptability, and effectiveness of a follow-up program by conducting a feasibility randomized controlled trial (RCT) that compares augmented MBCT with follow-up sessions and that without follow-up sessions in preparation for a definitive RCT. MethodsThe study involves an 8-week MBCT with a 10-month follow-up. Patients aged 20 to 65 years who meet the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) criteria for panic disorder, agoraphobia, or social anxiety disorder, which is not remitted with usual treatment for at least 4 weeks, will be included in the study and randomly allocated to receive augmented MBCT with follow-up sessions or augmented MBCT without follow-up sessions. For this feasibility RCT, the primary outcomes are (1) study inclusion rate, (2) dropout rate, (3) attendance rate, and (4) mean and standard deviation of several clinical measures at 8 weeks and 5, 8, and 12 months. ResultsWe started recruiting participants in January 2020, and 43 participants have been enrolled up to January 2021. The study is ongoing, and data collection will be completed by May 2022. ConclusionsThis study is novel in terms of its design, which compares augmented MBCT with and without follow-up sessions. The limitations of the trial are as follows: (1) mixed participants in terms of the delivery mode of the intervention, and (2) lack of a pharmacotherapy-alone arm. Owing to its novelty and significance, this study will provide fruitful knowledge for future definitive RCTs. Trial RegistrationUMIN Clinical Trials Registry UMIN000038626; https://tinyurl.com/2p9dtxzh International Registered Report Identifier (IRRID)DERR1-10.2196/33776

Background. The biopsychosocial mechanism by which exercise leads to improvement in chronic low back pain (CLBP) remains unstudied. This prospective cohort study was performed to examine the effectiveness of exercise on pain, disability, and psychological status for CLBP. We also tested path analytic models in which changes in these variables were included. Methods. CLBP patients who visited the Interdisciplinary Pain Center of Keio University Hospital from July 2018 to April 2020 were included. The propensity score matching was performed between patients who underwent exercise (the exercise group) and those who did not (the control group). At the first visit and at the 3-month follow-up, pain (Numerical Rating Scale (NRS)), disability (Pain Disability Assessment Scale (PDAS)), and psychological status (Pain Self-Efficacy Questionnaire (PSEQ), and Pain Catastrophizing Scale (PCS)) were assessed. Changes in pain and disability at the follow-up were compared between the groups. The relationships between changes in pain, disability, and psychological variables were examined using Pearson’s correlation and mediation analysis. Results. A significantly larger decrease in the PDAS was observed in the exercise group (N = 49) than in the control (N = 49) (p

Objectives: Better subjective and eudaimonic well-being fosters better health conditions. Several studies have confirmed that mindfulness-based interventions are effective for improving well-being; however, the samples examined in these studies have been limited to specific populations, and the studies only measured certain aspects of well-being rather than the entire construct. Additionally, few studies have examined the effect of mindfulness-based cognitive therapy on well-being. The present study examines the feasibility of mindfulness-based cognitive therapy and its effectiveness for improving subjective and eudaimonic well-being among community residents.Methods: The study design featured an 8-week randomized, waiting-list controlled, parallel-group study. 8 weekly mindfulness classes, followed by 2 monthly classes, were provided for healthy individuals aged 20–65 years who had a Satisfaction with Life Scale score of ≤ 24 indicating average to low cognitive aspect of subjective well-being. This trial was registered with the University Hospital Medical Information Network Clinical Trials Registry (ID: UMIN000031885, URL: https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000036376).Results: The results showed that cognitive aspect of subjective well-being and mindfulness skills were significantly improved at 8 weeks, and this effect was enhanced up to the end of the follow-up period. Positive affective aspect of subjective and eudaimonic well-being were significantly improved at 16 weeks.Conclusions: Eight weeks of mindfulness-based cognitive therapy with a 2-month follow-up period improves cognitive and affective aspects of subjective and eudaimonic well-being in healthy individuals. The order of improvement was cognitive, positive affective, and eudaimonic well-being. To verify these findings, multi-center randomized controlled trials with active control groups and longer follow-up periods are warranted.

Abstract Spitz nevus is an important differential diagnosis of malignant melanoma, especially in young adults. This case provides a significant information about unusual dermoscopic features of adult Spitz nevus, which may reflect changes over the years.

Objectives Work performance has been known to be influenced by both psychological stress (mind) and physical conditions (body). The aim of this study was to investigate the association between work performance and ‘body trusting’, which is a dimension of interoceptive awareness representing mind–body interactions.Methods A cross-sectional study was conducted among a sample of workers in an industrial manufacturing company in Japan. Participants were assessed with a self-reported questionnaire including evaluations of work performance, body trusting, psychological distress, pain persistence, workplace and home stressors, and workaholism. Participants’ sociodemographic, health and lifestyle characteristics were collected from their annual health check data. The association between work performance and body trusting was examined using multivariable regression analyses in the overall sample and in a subsample of people with pain.Results A total of 349 workers participated in the study. A significant association between work performance and body trusting was observed, with higher body trusting representing higher work performance. The association was significant after controlling for psychological distress, workplace and home stress, workaholism and participants’ characteristics (p

Backgrounds: Hikikomori, a severe form of social withdrawal, is increasingly a serious mental health issue worldwide. Hikikomori is comorbid with various psychiatric conditions including depression, social anxiety and suicidal behaviors. Family support is encouraged as a vital first step, however evidence-based programs have yet to be established. Mental Health First Aid (MHFA) is one of the most well-validated educational programs encouraging lay people such as family members, to support close persons suffering from various psychiatric conditions such as depression, anxiety and suicidal behaviors. Methods: We newly developed an educational program for family members of hikikomori sufferers mainly based on MHFA and ‘Community Reinforcement and Family Training (CRAFT)’ with role-play and homework. As a single-arm trial, 21 parents (7 fathers and 14 mothers) living with hikikomori sufferers participated in our program with five once-a-week sessions (2 h per session) and six monthly follow-ups, and its effectiveness was evaluated using various self-rated questionnaires. Results: Perceived skills toward a depressed hikikomori case vignette, stigma held by participants, and subscales of two problematic and one adaptive behaviors of hikikomori sufferers were improved throughout the sessions and follow-ups. In addition, positive behavioral changes of hikikomori sufferers such as improved social participation were reported by participants. Limitations: Single-arm design and evaluation using self-rated questionnaires are the main limitations of the present study. Conclusions: Our newly developed program has positive effects on family members in their contact and support of hikikomori sufferers. Future trials with control groups are required to validate the effectiveness of this program.

Abstract Objective Mindfulness-based cognitive therapy (MBCT) could be a treatment option for anxiety disorders. Although its effectiveness under conditions of low pharmacotherapy rates has been demonstrated, its effectiveness under condition of high pharmacotherapy rate is still unknown. The aim of the study was to evaluate effectiveness of MBCT under the context of high pharmacotherapy rates. Results A single arm with pre-post comparison design was adopted. Those who had any diagnosis of anxiety disorders, between the ages of 20 and 74, were included. Participants attended 8 weekly 2-hour-long sessions followed by 2 monthly boosters. Evaluation was conducted at baseline, in the middle, at end of the intervention, and at follow-up. The State-Trait Anxiety Inventory (STAI)-state was set as the primary outcome. Pre-post analyses with mixed-effect models repeated measures were conducted. Fourteen patients were involved. The mean age was 45.0, and 71.4% were female. The mean change in the STAI-state at every point showed statistically significant improvement. The STAI-trait also showed improvement at a high significance level from the very early stages. The participants showed significant improvement at least one point in some other secondary outcomes. Trial registration Retrospectively registered at the University Hospital Medical Information Network on 1st August 2013 (ID: UMIN000011347)

Background:. This report describes the authors' novel preferred method of nipple reconstruction over 10 years. Methods:. The procedure was used in 39 patients (unilateral 38, bilateral 1). The circle is designed as the new nipple cap. Then, 4 fan-shapes (one-quarter of the circle) are drawn so that the base portion is in contact with the circumference. These fanshapes are deepithelialized, and their linear portions are cut with full thickness of skin and elevated as dermal flaps. Then, the cross-type flap is elevated with sufficient subcutaneous fat. The two pairs of dermal flaps are sutured to each other on a diagonal line. Double-layer dermal bridge flaps sustain the base of the pocket. As a result, the cross flap becomes a birdcage-like tower. The rolled auricular cartilage is placed into the pocket. Results:. In one early case, the cartilage was exposed. Early postoperatively, the other three cases underwent reoperation during other procedures because the reconstructed nipple was too large or too small. The projection of the flap was designed to be 7–15 mm (average, 9.3 mm). The average follow-up period was 25.7 ± 22.0 months. The reconstructed nipple projection was maintained at 4.4 ± 2.4 mm (maintenance rate, 48.4% ± 27.0%). Conclusions:. All scars were contained within the periareolar region and thus could be completely camouflaged by tattooing. The perfusion of the skin flap is stable because of sufficient circulation from quadruped pedicle. The cartilage supported by the double-layered dermal bridge flaps contributes to nipple projection. We recommend it for patients seeking nipple reconstruction.

ObjectiveIn the workplace depression and suicide are serious mental health problems. A lack of knowledge and mental health skills along with the stigma toward mental health problems often results in delays in seeking professional help. Interventions targeting not only persons with mental health problems but also people around the individual are warranted in order to encourage supporting behavior within entire workplace. In the present study, we investigated the efficacy of our newly developed educational training program in the management with depression and suicidal risk in the workplace as a single-arm pilot trial.MethodsThe program is a two-hour (2-h) training course for employees based on the Mental Health First Aid (MHFA) program which aims to increase public mental health literacy. We conducted this program at a company workplace among 91 employees, and ultimately 83 participants completed the self-rated questionnaires. Changes in confidence and practical skills in early intervention of depression and suicide-prevention, and stigma toward mental health problems were evaluated using self-rated questionnaires at 3 time-points; pre-program, immediately post-program, and 1 month after the program.ResultsConfidence and practical skills were significantly improved even 1 month after the program, and stigma reduced just after the program.ConclusionsOur pilot study suggests that the program has a positive impact on encouraging employees to support their co-workers with mental health problems, and is applicable for busy workers due to its short duration. A single-arm design, evaluation using self-rated questionnaire and short-term follow up period are the main limitations of the present study. Hence, future research is required to validate the effects of this program with control groups, and also to assess long-term effectiveness and objective changes such as absenteeism and sick leave.Trial registrationUMIN Clinical Trials Registry (UMIN-CTR) R000023258.

Graphene is a promising new material for photodetectors due to its excellent optical properties and high-speed response. However, graphene-based phototransistors have low responsivity due to the weak light absorption of graphene. We have observed a giant Dirac point shift upon white light illumination in graphene-based phototransistors with n-doped Si substrates, but not those with p-doped substrates. The source-drain current and substrate current were investigated with and without illumination for both p-type and n-type Si substrates. The decay time of the drain-source current indicates that the Si substrate, SiO2 layer, and metal electrode comprise a metal-oxide-semiconductor (MOS) capacitor due to the presence of defects at the interface between the Si substrate and SiO2 layer. The difference in the diffusion time of the intrinsic major carriers (electrons) and the photogenerated electron-hole pairs to the depletion layer delays the application of the gate voltage to the graphene channel. Therefore, the giant Dirac point shift is attributed to the n-type Si substrate current. This phenomenon can be exploited to realize high-performance graphene-based phototransistors.

Significant enhancement of infrared transmittance by the presence of a graphene layer on a plasmonic metasurface (PLM) has been demonstrated. PLMs with different configurations were fabricated, and their transmittance with and without graphene was compared. Selective enhancement by graphene occurred at the plasmon resonance wavelength. The degree of enhancement was found to depend on the width of the gap between the periodic metal regions in the PLM. A maximum enhancement of ∼210% was achieved at a wavelength of 10 μm. The ability to achieve such a drastic increase in transmittance at the plasmon resonant wavelength is expected to lead to improvements in the performance of energy collecting devices and optical sensors.

BACKGROUND: Psychiatry has been consistently shown to be a profession characterised by 'high-burnout'; however, no nationwide surveys on this topic have been conducted in Japan. AIMS: The objective of this study was to estimate the prevalence of burnout and to ascertain the relationship between work environment satisfaction, work-life balance satisfaction and burnout among psychiatrists working in medical schools in Japan. METHOD: We mailed anonymous questionnaires to all 80 psychiatry departments in medical schools throughout Japan. Work-life satisfaction, work-environment satisfaction and social support assessments, as well as the Maslach Burnout Inventory (MBI), were used. RESULTS: Sixty psychiatric departments (75.0%) responded, and 704 psychiatrists provided answers to the assessments and MBI. Half of the respondents (n = 311, 46.0%) experienced difficulty with their work-life balance. Based on the responses to the MBI, 21.0% of the respondents had a high level of emotional exhaustion, 12.0% had a high level of depersonalisation, and 72.0% had a low level of personal accomplishment. Receiving little support, experiencing difficulty with work-life balance, and having less work-environment satisfaction were significantly associated with higher emotional exhaustion. A higher number of nights worked per month was significantly associated with higher depersonalisation. CONCLUSIONS: A low level of personal accomplishment was quite prevalent among Japanese psychiatrists compared with the results of previous studies. Poor work-life balance was related to burnout, and social support was noted to mitigate the impact of burnout.

Wavelength-selective infrared (IR) absorbers have attracted considerable interest due to their potential for a wide range of applications. In particular, they can be employed as advanced uncooled IR sensors that identify objects through their radiation spectra. Herein, we propose a mushroom plasmonic metamaterial absorber incorporating tube-shaped metal posts (MPMAT) for use in the long-wavelength IR (LWIR) region. The MPMAT design consists of a periodic array of thin metal micropatches connected to a thin metal plate via tube-shaped metal posts. Both the micropatches and posts can be constructed simultaneously as a result of the tube-shaped structure of the metal post structure; thus, the fabrication procedure is both simple and low cost. The absorption properties of these MPMATs were assessed both theoretically and experimentally, and the results of both investigations demonstrated that these devices exhibit suitable levels of LWIR absorption regardless of the specific tube-shaped structures employed. It was also found to be possible to tune the absorption wavelength by varying the micropatch width and the inner diameter of the tube-shaped metal posts, and to obtain absorbance values of over 90%. Focal plane array structures based on such MPMATs could potentially serve as high-performance, low-cost, multi-spectral uncooled IR image sensors.

BACKGROUND: Complicated grief, which is often under-recognized and under-treated, can lead to substantial impairment in functioning. The Brief Grief Questionnaire (BGQ) is a 5-item self-report or interview instrument for screening complicated grief. Although investigations with help-seeking samples suggest that the BGQ is valid and reliable, it has not been validated in a broader population. METHODOLOGY/PRINCIPAL FINDINGS: A questionnaire was mailed to a randomly selected sample (n = 5000) residing in one of 4 areas of Japan. The BCQ was examined for responders who were bereaved more than 6 months and less than 10 years (n = 915). Non-specific psychological distress was assessed with the K6 screening scale. Multiple group confirmatory factor analysis supported a uni-dimensional factor structure and the invariance of parameters across gender and age. Cronbach's alpha was sufficiently high (alpha = .75) to confirm internal consistency. Average Variance Extracted (0.39) was higher than the shared covariance (0.14) between BGQ and K6, suggesting discriminant validity. CONCLUSIONS: The results of this study support the reliability and validity of the BGQ in the Japanese population. Future studies should examine predictive validity by using structured interviews or more detailed scales for complicated grief.

PURPOSE Patients' values and priorities in their lives should be appreciated from an early phase of incurable diseases such as advanced cancer. However, studies examining these characteristics have been lacking. This study attempted to determine what patients with advanced lung cancer valued most, once they had been diagnosed, and any associated factors. METHODS Patients with newly diagnosed advanced lung cancer (N = 248) were enrolled in a questionnaire survey conducted at 16 hospitals in Japan. Their priorities were assessed using a free-text response to the question what is the most important thing to you now? at the time of diagnosis and 3 months after diagnosis. The free-text responses were classified into 10 categories for quantification. The clinical characteristics associated with the category describing daily life were further examined. RESULTS Free-text comments were obtained from 103 (44.0%) and 66 (42.6%) patients at the time of diagnosis and at 3 months, respectively. Themost frequent categories were family (at diagnosis: 50.5%; at 3months: 50.0%) and daily life (at diagnosis: 33.0%; at 3 months: 36.4%), followed by health (at diagnosis: 32.0%; at 3 months: 27.3%) at both time points. The patients mentioning daily life, the issues related to how to spend daily life, showed significantly higher total scores and functional well-being subscale scores on the Functional Assessment of Cancer Therapy-Lung scale at both time points and lower depression scores at diagnosis and lower anxiety scores at 3 months on the Hospital Anxiety and Depression Scale. CONCLUSION Family and daily life were highly valued by patients with advanced lung cancer at diagnosis. A better quality of life and better mood were associated with mentioning daily life, which should be taken into account in care planning to maintain patients' involvement in daily life even with incurable diseases. [ABSTRACT FROM AUTHOR]

Depressive symptoms are prevalent in cancer patients and are one of the most distressing symptoms in this population. Although mental health professionals such as psychiatrists and psychologists are now engaged in cancer care, the management of depressive symptoms in cancer patients needs further improvement. Peer support interventions (PSIs) in cancer care have attracted substantial attention and have several advantages over support by medical professionals, potentially improving depressive symptoms in cancer patients. However, there may be some potential risks. Several strategies using PSIs have been developed to improve depressive symptoms and have been evaluated in randomized controlled trials. The strategies include education on stress management skills, promoting emotional support, counseling on specific topics that are difficult to discuss with others, helping patients navigate the use of resources, and promoting health-related behaviors to decrease depressive symptoms. In this paper, we present recent findings on PSIs in cancer, focusing on randomized controlled trials. [ABSTRACT FROM AUTHOR]

Background. Accurate prognostic understanding in patients with advanced cancer is essential for shared decision making; however, patients may experience psychological burden through knowing the incurable nature of advanced cancer. It has been unclear how their prognostic understanding fluctuates and whether accurate prognostic understanding is associated with psychological distress from the time of diagnosis over time. Materials and Methods. We longitudinally investigated prognostic understanding in 225 patients with newly diagnosed advanced lung cancer at 16 hospitals in Japan until 24 months after diagnosis. We examined associated factors with being consistently accurate in prognostic understanding, especially focusing on its association with psychological well-being. Results. The proportion of patients with an inaccurate prognostic understanding remained approximately 20% over time with the presence of patients with inconsistent understanding. Patients with consistently accurate prognostic understanding showed a significantly lower Emotional Well-Being subscale score at both 3 and 6 months after diagnosis (p = .010 and p = .014, respectively). In multivariate analyses, being consistently accurate in prognostic understanding was significantly associated with female gender and higher lung cancer--specific symptom burden at 3 months (p = .008 and p = .005, respectively) and lower emotional well-being at 6 months (p = .006). Conclusion. Although substantial proportions of patients with advanced lung cancer had inaccurate prognostic understanding from the time of diagnosis over time, patients with consistently accurate prognostic understanding experienced greater psychological burden. Our findings highlight the importance of continuous psychological care and support for patients who understand their severe prognosis accurately. [ABSTRACT FROM AUTHOR]

High-performance wavelength-selective infrared (IR) sensors require small pixel structures, a lowthermal mass, and operation in the middle-wavelength infrared (MWIR) and long-wavelength infrared (LWIR) regions for multicolor IR imaging. All-metal-based mushroom plasmonic metamaterial absorbers (MPMAs) were investigated theoretically and were designed to enhance the performance of wavelength-selective uncooled IR sensors. All components of the MPMAs are based on thin layers of metals such as Au without oxide insulators for increased absorption. The absorption properties of the MPMAs were investigated by rigorous coupled-wave analysis. Strong wavelength-selective absorption is realized over a wide range of MWIR and LWIR wavelengths by the plasmonic resonance of the micropatch and the narrow-gap resonance, without disturbance from the intrinsic absorption of oxide insulators. The absorption wavelength is defined mainly by the micropatch size and is longer than its period. The metal post width has less impact on the absorption properties and can maintain single-mode operation. Through-holes can be formed on the plate area to reduce the thermal mass. A small pixel size with reduced thermal mass and wideband single-mode operation can be realized using all-metal-based MPMAs. [ABSTRACT FROM AUTHOR]

There has been a considerable amount of interest in the development of various types of electromagnetic wave absorbers for use in different wavelength ranges. In particular, infrared (IR) absorbers with wavelength selectivity can be applied to advanced uncooled IR sensors, which would be capable of identifying objects through their radiation spectrum. In the present study, mushroom plasmonic metamaterial absorbers (MPMAs) for the IR wavelength region were designed and fabricated. The MPMAs consist of a periodic array of thin metal micropatches connected to a thin metal plate with narrow silicon (Si) posts. A Si post height of 200 nm was achieved by isotropic XeF2 etching of a thin Si layer sandwiched between metal plates. This fabrication procedure is relatively simple and is consistent with complementary metal oxide semiconductor technology. The absorption spectra of the fabricated MPMAs were experimentally measured. In addition, theoretical calculations of their absorption properties were conducted using rigorous coupled wave analysis. Both the calculated and measured absorbance results demonstrated that these MPMAs can realize strong selective absorption at wavelengths beyond the period of the array by varying the micropatch width. Absorbance values greater than 90% were achieved. Dual- or single-mode absorption can also be selected by varying the width of the Si posts. Pixel structures using such MPMAs could be used as high responsivity, high resolution and fast uncooled IR sensors. [ABSTRACT FROM AUTHOR]

Introduction: Major depression is a serious mental disorder that causes substantial distress and impairment in individuals and places an enormous burden on society. Although antidepressant treatment is the most common therapy provided in routine practice, there is little evidence to guide second-line therapy for patients who have failed to respond to antidepressants. The aim of this paper is to describe the study protocol for a randomised controlled trial that measures the clinical effectiveness of cognitive behavioural therapy (CBT) as an augmentation strategy to treat patients with non-psychotic major depression identified as suboptimal responders to usual depression care. Methods and analysis: The current study is a 16-week assessor-blinded randomised, parallel-groups superiority trial with 12-month follow-up at an outpatient clinic as part of usual depression care. Patients aged 20-65 years with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) Major Depressive Disorder who have experienced at least one failed trial of antidepressants as part of usual depression care, will be randomly assigned to receive CBT plus treatment as usual, or treatment as usual alone. The primary outcome is the change in clinician-rated 17-item GRID-Hamilton Depression Rating Scale (GRID-HAMD) score at 16 weeks, and secondary outcomes include severity and change in scores of subjective depression symptoms, proportion of responders and remitters, safety and quality of life. The primary population will be the intention-to-treat patients. Ethics and dissemination: All protocols and the informed consent form comply with the Ethics Guideline for Clinical Research (Japanese Ministry of Health, Labour and Welfare). Ethics review committees at the Keio University School of Medicine and the Sakuragaoka Memorial Hospital approved the study protocol. The results of the study will be disseminated at several research conferences and as published articles in peer-reviewed journals. The study will be implemented and reported in line with the CONSORT statement. [ABSTRACT FROM AUTHOR]

VEGF (vascular endothelial growth factor) regulates neovascularization through binding to its receptor KDR (kinase insert domain-containing receptor; VEGF receptor-2). We recently identified a catalytically inactive PLA2 (phospholipase A2) homologue (KDR-bp) in the venom of eastern cottonmouth (Agkistrodon piscivorus piscivorus) as a third KDR-binding protein, in addition to VEGF165 and tissue inhibitor of metalloproteinase-3. KDR-bp binds to the extracellular domain of KDR with a Kd of 10−8 M, resulting in specific blockade of endothelial cell growth induced by VEGF165. Inactive PLA2 homologues are widely distributed in the venoms of Viperidae snakes and are known to act as myotoxins. In the present study, we demonstrated that KDR-binding ability is a common characteristic for inactive PLA2 homologues in snake venom, but not for active PLA2s such as neurotoxic and platelet aggregation-modulating PLA2s. To understand better the KDR and KDR-bp interaction, we resolved the binding region of KDR-bp using eight synthetic peptides designed based on the structure of KDR-bp. A synthetic peptide based on the structure of the C-terminal loop region of KDR-bp showed high affinity for KDR, but other peptides did not, suggesting that the C-terminal loop region of KDR-bp is involved in the interaction with KDR. The results of the present study provide insight into the binding of inactive PLA2 homologues to KDR, and may also assist in the design of novel anti-KDR molecules for anti-angiogenic therapy. [ABSTRACT FROM AUTHOR]

A p–n junction was developed in a graphene transistor by a simple photolithography process used in typical semiconductor processes. The p- and n-type regions were formed by coating photoresist on part of the graphene channel and immersion of the uncovered graphene region in alkali developer, respectively. A 3-fold enhancement of the photocurrent was observed at the maximum field effect mobility. It is therefore important to maximize the field effect mobility by doping to maximize the photocurrent. The results obtained here are an important step toward the production of high-sensitivity graphene-based phototransistors compatible with conventional industrial procedures. [ABSTRACT FROM AUTHOR]

The acoustic charge transportation induced by surface acoustic wave (SAW) propagation in graphene in solution was investigated. The sign of acoustic current (IA) was found to switch when crossing the Dirac point because the major carrier was transitioned from holes to electrons by the change in electrolyte-gate voltage. IA also exhibited a peak value under conditions of both hole and electron conduction. These results can be explained on the basis of a change in the type of major carrier in graphene, as well as a change in the carrier mobility of graphene. [ABSTRACT FROM AUTHOR]