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Introduction/Aims: Multifocal motor neuropathy (MMN) is a rare disease for which epidemiological and clinical data are limited. We conducted a nationwide survey to determine disease prevalence, incidence, clinical profile, and current treatment status in Japan. Methods: A nationwide survey was conducted in 2021 using an established epidemiological method. Questionnaires were sent to all neurology and pediatric neurology departments in Japan. An initial questionnaire was administered to determine the number of patients with and incidence of MMN. A second questionnaire was administered to collect detailed clinical information. The European Federation of Neurological Societies/Peripheral Nerve Society 2010 guidelines were used as diagnostic criteria. Results: The estimated number of patients with MMN was 507. The estimated prevalence was 0.40 per 100,000 individuals. Detailed clinical profiles were available for 120 patients. The male‐to‐female ratio was 2.3:1 and the median onset age was 42 years. The median disease duration at diagnosis was 25 months. Most patients presented with upper limb‐dominant muscle weakness. Motor nerve conduction blocks were found in 62% of patients and positive anti‐GM1 IgM antibody results in 54%. A total of 117 (98%) patients received immunoglobulin therapy, and 91% of them showed improvement. At the time of the last visit (median, 82 months from treatment initiation), 89 (74%) patients were receiving maintenance immunoglobulin therapy. A slight progression of neurological deficits was observed during follow‐up. Discussion: Most patients with MMN in Japan received induction and maintenance immunoglobulin therapies, which appear to suppress long‐term disease progression. [ABSTRACT FROM AUTHOR]

In this study, we analysed the regional distribution status, species composition differences, seasonal occurrence and habitat types of invasive alien insects that are distirbuted in natural ecosystems nationwide, targeting 3,802 locations in eight regions between 2019 and 2021. A total of 95,017 invasive alien insects belonging to nine orders, 48 families and 77 species were identified. Amongst the taxonomic groups, Hemiptera (35.1%) was dominant, followed by Coleoptera (18.2%) and Lepidoptera (14.3%). Gyeongsangnam-do had the highest percentage of invasive alien insects, with 55 species, while Gyeonggi-do had the highest number of invasive alien insects at 890 sites. We used Non-metric multidimensional scaling (NMDS) to analyse differences in invasive alien insect species composition by region, occurrence by season and habitat type. To compare the differences in invasive alien insect species composition by region, we divided them into four groups (Group 1: Jeollanam-do, Jeollabuk-do; Group 2: Chungcheongnam-do, Chungcheongbuk-do; Group 3: Gyeongsangnam-do, Gyeongsangbuk-do; and Group 4: Gyeonggi-do, Gangwon-do). We found an extensive overlap in invasive alien insects composition by region. Additionally, species composition exhibited seasonal differences, with the highest number of invasive alien insects occurring between July and September. Species occurring in spring (April to May) included Dryocosmus kuriphilus, Hypera postica and Brachypera zoilus, whereas those occurring in autumn (September to October) included Vespa velutina nigrithorax, Thecodiplosis japonensis and Hermetia illucens. Habitat type analysis showed that invasive alien insects lived along roadsides (31.9%), farmlands (27.9%) and parks (19.4%), exhibiting high densities in anthropogenic and disturbed sites, such as parks, residences and farmlands. Ecological statistical analysis showed that the dominance index was 0.6 in Chungcheongbuk-do, the diversity index was 2.7 in Gyeongsangbuk-do, the abundance index was 5.4 in Gyeongsnagnam-do and the equality index was 0.6–0.7 in all regions. Therefore, we aimed to identify the habitat status of introduced and settled invasive insects to provide a basis for selecting primary management target species. [ABSTRACT FROM AUTHOR]

Background: This study aimed to evaluate the outcomes and complications of secondary hepatolithiasis following choledochoenterostomy to guide suitable management. Methods: The study analyzed 127 patients from a 2017 national survey conducted by the Ministry of Health, Labor, and Welfare. The 2023 cohort study assessed residual stones, recurrences, cholangitis, cholangiocarcinoma, and prognosis. Results: The median follow‐up duration was 48 months. Balloon endoscopy‐assisted endoscopic retrograde cholangiography (BE‐ERC) was the most common treatment, achieving complete stone clearance in 84.4% of patients. Anatomical hepatectomy was the most common surgery. Predictors of residual stones were stone number ≥10 (odds ratio [OR], 7.480; p =.028) and stone diameter ≥10 mm (OR, 5.280; p =.020). Predictors of stone recurrence during follow‐up were biliary strictures (hazard ratio [HR], 3.580; p =.005) and cholangitis (HR, 2.700; p =.037). Predictors of cholangitis during follow‐up were biliary stricture (HR, 5.016; p =.006) and dilatation (HR, 3.560; p =.029). Any treatment for hepatolithiasis reduced cholangitis occurrence (HR, 0.168; p =.042). Balloon dilation combined with stenting for ≥3 months improved biliary strictures in 57.1% of patients. Conclusion: This study recommends BE‐ERC as the first‐choice treatment for secondary hepatolithiasis. Stone removal and relief of biliary strictures and dilatation are crucial to prevent stone recurrence and cholangitis after treatment. [ABSTRACT FROM AUTHOR]

Background: Prehabilitation during neoadjuvant therapy has the potential to improve clinical outcomes. However, information on its global dissemination status is limited. This Japanese nationwide survey investigated the implementation status of and barriers to prehabilitation during neoadjuvant chemotherapy (NAC) for patients with locally advanced esophageal cancer in hospitals. Methods: This multicenter nationwide survey was conducted by post. The eligible facilities were 155 Japanese hospitals that had been certified within the last 10 years as authorized institutes for board-certified esophageal surgeons by the Japan Esophageal Society. We administered an original questionnaire to investigate the current status of prehabilitation during NAC. Results: The response rate was 75% (117/155 facilities). Forty-six facilities (39%) provided prehabilitation during NAC. The most frequently selected reasons for not providing or providing insufficient prehabilitation were lack of human resources, issues with the reimbursement of medical fees, difficulty in providing continuous prehabilitation during repeated inpatient and outpatient care, the lack of established standard prehabilitation programs, challenges in providing multidisciplinary prehabilitation, and difficulty in managing physical symptoms. Conclusion: We observed that the implementation rate of prehabilitation during NAC was low. Critical reasons were not only the lack of medical resources but also the lack of evidence-based standard prehabilitation programs during NAC and the lack of evidence for how to continuously deliver prehabilitation during NAC to patients with physical symptoms. [ABSTRACT FROM AUTHOR]

Summary: Idiopathic hypereosinophilic syndrome (iHES) is a condition wherein persistent hypereosinophilia associated with end‐organ damage occurs without any known causes. Due to the rarity of the disease, insufficient knowledge has been accumulated. We therefore conducted a retrospective, multicentre, nationwide survey on iHES in Japan. A total of 57 patients were identified. For 43 patients who received any treatment, all cases were first treated with corticosteroids. An eosinophil percentage of less than 30% in the bone marrow and the absence of oedema were identified as factors associated with steroid dependency. The 5‐year overall survival was 88.2%, and five patients died during follow‐up; factors associated with worse overall survival were age >50, haemoglobin <12 g/dL, activated partial thromboplastin time >34 s, the presence of dyspnoea, the presence of thrombotic tendency and the presence of renal failure. Given the rarity of fatalities in our cohort, time‐to‐next‐treatment (TTNT) was further analysed; the presence of renal failure, splenomegaly and lung abnormalities were associated with worse TTNT. Our nationwide study not only demonstrated clinical characteristics and the outcome of patients with iHES but also for the first time revealed clinical factors associated with steroid dependency and duration of first‐line corticosteroid efficacy. [ABSTRACT FROM AUTHOR]

In this study, we analysed the regional distribution status, species composition differences, seasonal occurrence and habitat types of invasive alien insects that are distirbuted in natural ecosystems nationwide, targeting 3,802 locations in eight regions between 2019 and 2021. A total of 95,017 invasive alien insects belonging to nine orders, 48 families and 77 species were identified. Amongst the taxonomic groups, Hemiptera (35.1%) was dominant, followed by Coleoptera (18.2%) and Lepidoptera (14.3%). Gyeongsangnam-do had the highest percentage of invasive alien insects, with 55 species, while Gyeonggi-do had the highest number of invasive alien insects at 890 sites. We used Non-metric multidimensional scaling (NMDS) to analyse differences in invasive alien insect species composition by region, occurrence by season and habitat type. To compare the differences in invasive alien insect species composition by region, we divided them into four groups (Group 1: Jeollanam-do, Jeollabuk-do; Group 2: Chungcheongnam-do, Chungcheongbuk-do; Group 3: Gyeongsangnam-do, Gyeongsangbuk-do; and Group 4: Gyeonggi-do, Gangwon-do). We found an extensive overlap in invasive alien insects composition by region. Additionally, species composition exhibited seasonal differences, with the highest number of invasive alien insects occurring between July and September. Species occurring in spring (April to May) included Dryocosmus kuriphilus, Hypera postica and Brachypera zoilus, whereas those occurring in autumn (September to October) included Vespa velutina nigrithorax, Thecodiplosis japonensis and Hermetia illucens. Habitat type analysis showed that invasive alien insects lived along roadsides (31.9%), farmlands (27.9%) and parks (19.4%), exhibiting high densities in anthropogenic and disturbed sites, such as parks, residences and farmlands. Ecological statistical analysis showed that the dominance index was 0.6 in Chungcheongbuk-do, the diversity index was 2.7 in Gyeongsangbuk-do, the abundance index was 5.4 in Gyeongsnagnam-do and the equality index was 0.6–0.7 in all regions. Therefore, we aimed to identify the habitat status of introduced and settled invasive insects to provide a basis for selecting primary management target species.

Objective: The objective of this study was to determine the implementation, clinical barriers, and unmet needs of repetitive transcranial magnetic stimulation (rTMS) and neuro-navigation systems for stroke rehabilitation. Design: We employed a nationwide survey via Google Forms (web and mobile) consisting of 36 questions across rTMS and neuro-navigation systems, focusing on their implementation, perceptions, and unmet needs in stroke recovery. The survey targeted physiatrists registered in the Korean Society for Neuro-rehabilitation and in rehabilitation hospitals in South Korea. Results: Of 1,129 surveys distributed, 122 responses were analyzed. Most respondents acknowledged the effectiveness of rTMS in treating poststroke impairments; however, they highlighted significant unmet needs in standardized treatment protocols, guidelines, education, device usability, and insurance coverage. Unmet needs for neuro-navigation were also identified; only 7.4% of respondents currently used such systems, despite acknowledging their potential to enhance treatment accuracy. Seventy percent of respondents identified lack of prescription coverage, time and errors in preparation, and device cost as barriers to clinical adoption of neuro-navigation systems. Conclusion: Despite recognition of the potential of rTMS in stroke rehabilitation, there is a considerable gap between research evidence and clinical practice. Addressing these challenges, establishing standardized protocols, and advancing accessible neuro-navigation systems could significantly enhance the clinical application of rTMS, offering a more personalized, effective treatment modality for stroke recovery. [ABSTRACT FROM AUTHOR]

Aim: A nationwide survey in 2018 showed decreasing involvement of viral hepatitis and increasing involvement of nonviral liver diseases in the etiology of liver cirrhosis (LC) in Japan. An updated nationwide survey was undertaken in 2023. Methods: Cases of LC diagnosed between 2018 and 2021 were collected from 75 institutions, and the etiologies of LC were investigated. In addition, the data obtained were compared with the results of previous studies. Results: Among the 15 517 cases, alcohol‐related liver disease (ALD)‐associated LC was the most frequent cause (n = 5,487, 35.4%). Hepatitis C virus‐associated LC, nonalcoholic steatohepatitis (NASH)‐associated LC, and hepatitis B virus‐associated LC were ranked as second, third, and fourth, respectively. In comparison to the previous survey, the ratios of viral hepatitis‐associated LC decreased (HBV: from 11.5% to 8.1%; HCV: from 48.2% to 23.4%), while the ratios of ALD‐associated LC and NASH‐associated LC increased (from 19.9% to 35.4% and from 6.3% to 14.6%, respectively). Regarding cases of LC with hepatocellular carcinoma (n = 5906), HCV‐associated LC (1986 cases, 33.6%) was the most frequent cause. Alcohol‐related liver disease‐associated LC, NASH‐associated LC, and HBV‐associated LC were the second‐, third‐, and fourth‐ranked causes, respectively. In comparison to the previous survey, as the cause of hepatocellular carcinoma‐complicated LC, HCV‐associated LC decreased from 60.3% to 33.6%, while the ratios of ALD‐associated LC and NASH‐associated LC increased from 14.2% to 28.6% and from 4.2% to 14.0%, respectively. Conclusions: The major causes of LC in Japan are suggested to have been shifting from viral hepatitis to nonviral chronic liver diseases. [ABSTRACT FROM AUTHOR]

Background and aims: Hepatitis B virus (HBV) vaccination programs in Taiwan are one of the earliest programs in the world and have largely reduced the prevalence of HBV infection. We aimed to demonstrate the vaccination efficacy after 35 years and identify gaps toward HBV elimination. Methods: A total of 4717 individuals aged 1–60 years were recruited from four administrative regions based on the proportion of population distribution. Serum levels of hepatitis B surface antigen (HBsAg), hepatitis B surface antibody (anti‐HBs), and hepatitis B core antibody (anti‐HBc) levels were assessed. HBV viral load, genotypes and HBsAg 'ɑ' determinant variants were evaluated if indicated. Results: After 35 years of vaccination, the overall seropositivity rates for HBsAg and anti‐HBc in Taiwan were 4.05% and 21.3%, respectively. The vaccinated birth cohorts exhibited significantly lower seropositivity rates for both markers compared to the unvaccinated birth cohorts (HBsAg: 0.64% vs. 9.78%; anti‐HBc: 2.1% vs. 53.55%, respectively; p < 0.0001). Maternal transmission was identified as the main route of HBV infection in breakthrough cases. Additionally, increased prevalences of genotype C and HBsAg escape mutants were observed. Conclusion: The 35‐year universal HBV vaccination program effectively reduced the burden of HBV infection, but complete eradication of HBV infection has not yet been achieved. In addition to immunization, comprehensive screening and antiviral therapy for infected individuals, especially for pregnant women, are crucial strategies to eliminate HBV. [ABSTRACT FROM AUTHOR]

Introduction: Acute stroke rehabilitation is crucial for achieving good functional recovery, even during the coronavirus disease 2019 (COVID-19) pandemic. This study aimed to clarify the impact of the COVID-19 pandemic on acute stroke rehabilitation and identify which components in the acute stroke rehabilitation provision system were susceptible to the pandemic. Methods: A web-based questionnaire survey was conducted in all primary stroke centers (PSCs) in Japan between February 7 and April 21, 2022. The survey included questions about the current status of acute stroke rehabilitation and the influence of the pandemic. We classified the influences and investigated the relationship between the influence of the pandemic and the provision of rehabilitation. Additionally, we investigated a group of prefectures divided according to the grade of the pandemic. Results: The survey response rate was 67% (639 of 959 PSCs). Among them, 387 PSCs (61%) reported that the COVID-19 pandemic affected acute stroke rehabilitation. In PSCs affected by the pandemic, more rehabilitation-related staff were working, and the proportion of weekend/holiday rehabilitation implementation was higher compared to those unaffected. In PSCs from highly infected prefectures, no significant relationship was observed between the influence of the pandemic and the rehabilitation provision system. Conclusions: PSCs that provide denser acute stroke rehabilitation may be affected to a greater extent by the pandemic. We conclude that stroke hospitals should formulate infection control procedures for acute stroke rehabilitation in advance, depending on the conditions of the region and facility. [ABSTRACT FROM AUTHOR]

The association was investigated between healthcare practitioners' actions of routinely identifying children of adults with mental illness by asking whether they have children under the age of 18 and practitioners' perspectives and practices regarding supporting parents and their children. The factors that contribute to practitioners' such routine identification were also determined. A cross-sectional nationwide survey was conducted using an anonymous self-report questionnaire among Japanese healthcare practitioners. The responses (84.7% were nurses) from 1138 participants were analysed. More than half of the participants (73.7%) routinely identified whether adults with mental illness had children. Participants who routinely identified children also provided more support to children and to the client regarding his or her parenting. Three factors were found to contribute to the participants' routine identification of children: (1) recognising 'difficulty with parenting' as a reason why support for children is necessary; (2) 'assessing parenting status when supporting a parent with a mental illness' and (3) realising that participants 'do not know how to provide support' as a reason why support for children is difficult. Providing education to practitioners regarding supporting children whose parents have a mental illness will help increase the routine identification of children in mental health services. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to show the results of radical radiation therapy (RT) and concurrent chemoradiotherapy (CCRT) for vulvar cancer (VC) based on data from a Japanese nationwide survey. Materials and methods: We collected data from 108 institutions on cases of VC diagnosed between January 2001 and December 2010. Patients with histologically proven squamous cell carcinoma and adenocarcinoma with curative intent were selected, and 172 patients with VC were included in this study. The collected data were analyzed for overall survival (OS) using the Kaplan–Meier method. Univariate and multivariate analyses were performed to examine the prognostic factors for patients with VC. Results: The median follow-up period was 16.8 (range; 3.2–154.8) months. Fifty-five patients received CCRT, and 117 patients received RT alone. The 2-year OS rates (95% confidence interval [CI]) for stages I, II, III, and IV were 77.9% (55.8–100.0), 71.9% (53.8–89.9), 55.4% (42.5–68.3), and 41.5% (27.3–55.7) respectively. Univariate analyses showed that the FIGO stage (p = 0.001), tumor diameter (p = 0.005), and lymph node (LN) status (p = 0.001) were associated with OS. The concurrent use of chemotherapy resulted in a significantly longer OS in Stage III (p = 0.013). Multivariate analysis showed that the hazard ratios (95% CI) for tumor diameter, positivity for LN metastasis, and RT alone (no concurrent chemotherapy) were 1.502 (1.116–2.021), 1.801 (1.287–2.521), and 1.936 (1.187–3.159), respectively. Conclusions: Our analysis revealed that CCRT should be recommended, especially for Stage III VC patients. Further studies are warranted to determine who benefits from CCRT, considering primary tumor size and LN status. The study was registered at the University Hospital Medical Information Network (protocol number: UMIN000017080) on April 8th, 2015. [ABSTRACT FROM AUTHOR]

Simple Summary: This study compared postoperative complication rates between pylorus-preserving gastrectomy (PPG) and distal gastrectomy (DG) using Korean nationwide survey data with propensity score weighting (PSW). PPG preserves gastric function but may lead to more complications than DG. Before PSW, 87.8% of DG and 87.1% of PPG patients had no complications (p = 0.053). Severe complications were more frequent in PPG (6.6%) than in DG (3.8%) (p = 0.039). After PSW, overall and severe complication rates were similar (p = 0.960 and p = 0.574). Anastomotic stricture and leakage rates were higher in PPG (2.9% and 1.7%) than in DG (0.6% and 0.5%) before PSW, but not after (p = 0.999 and 0.123). The PSW-adjusted analysis indicates no significant difference in complication rates between PPG and DG. Background/Objective. This study aimed to compare complication rates between pylorus-preserving gastrectomy (PPG) and distal gastrectomy (DG) using Korean nationwide survey data and propensity score weighting (PSW). PPG preserves gastric function but may lead to more postoperative complications than DG. Methods and Results. We analyzed 9424 gastric cancer patients who underwent either DG (n = 9183) or PPG (n = 241). PSW balanced variables such as age, sex, TNM stage, comorbidities, ASA score, and surgical approach. Before PSW, 87.8% of DG patients and 87.1% of PPG patients had no complications (p = 0.053). Severe complications (Clavien–Dindo IIIa or higher) were more frequent in PPG (6.6%) than in DG (3.8%) (p = 0.039). After PSW, overall complication rates (p = 0.960) and severe complication rates (p = 0.574) were similar between groups. Incidence rates of anastomotic stricture and leakage were higher in PPG (2.9% and 1.7%) compared to DG (0.6% and 0.5%) (p = 0.001 and 0.036) before PSW, but these differences were not significant after PSW (p = 0.999 and 0.123). Conclusion. The PSW-adjusted analysis indicates no significant difference in overall and severe complication rates between PPG and DG in gastric cancer patients. [ABSTRACT FROM AUTHOR]

Background: Active transport– for example walking and bicycling to travel from place to place– may improve physical fitness and health and mitigate climate change if it replaces motorised transport. The aim of this study is to analyse the active transport behaviour of adults living in Germany, to investigate differences among population groups and to determine whether climate protection is a frequent motive for this behaviour. Methods: This study uses self-reported data of 4,971 adults who participated in a national health survey (German Health Update 2021), which was conducted as a telephone survey from July to December 2021. Associations between active transport behaviour and corresponding motives with sociodemographic and health-related variables were analysed using logistic regression models. Results: Of the adult population, 83% use active transport at least once a week. The frequency and duration of walking per week are significantly higher than those for bicycling (walking 214 min/week; bicycling 57 min/week). Those with a lower education level are less likely to practise active transport than those with a higher education level. Furthermore, women are less likely to use a bicycle for transport than men. Among those practising active transport, the most frequently mentioned motive is "is good for health" (84%) followed by "to be physically active" (74%) and "is good for the climate/environment" (68%). Women and frequent bicyclists (at least 4 days/week) mention climate protection as a motive more often than men and those bicycling occasionally. Conclusions: The improvement of active transport, especially among people with lower education and women (for bicycling), may benefit from better insights into motives and barriers. Climate protection is an important motivator for practising active transport within the adult population living in Germany and should therefore have greater emphasis in behavioural change programmes. [ABSTRACT FROM AUTHOR]

Historical and contemporary scholarship paint a picture of women in media as under-represented, misrepresented and lacking the opportunity to influence what happens in media and their own status in media. This is despite years of interventions – including pushing for affirmative action – targeted at improving their status and working conditions. In this study, we argue that part of the solution lies in conscientizing women in media to become more aware of the inequalities they face. Through a nationwide survey of women in the Ghanaian media and premised on feminist media theory, we show that though progress is visible in the status of women, inequalities persist. Respondents were ambivalent about status parity with males, pointing to the possibility that they acquiesce to unfair practices because they are unaware of the embedded inequality. We discuss these findings and their implications for scholarship and practice. [ABSTRACT FROM AUTHOR]

• We conducted a nationwide semi-standardized interview with 1072 drivers in Germany. • Almost 88% of all drivers performed a non-driving-related task. • Passenger presence decreases engagement in other secondary tasks, especially on the phone. • Mobile phone addiction is an indicator for predicting secondary tasks on the phone. • Drivers are more engaged in secondary tasks while leisure than shopping and business trips. One of the leading causes of crashes is the distraction of drivers caused by performing secondary tasks. This study investigated the impact of sociodemographic, contextual factors, and driver characteristics on secondary task engagement while driving in Germany. We conducted a nationwide face-to-face semi-standardized interview study with car drivers in Germany. In total, 1,072 drivers were interviewed. The data of 949 drivers were included in the analysis. Overall, they reported 2,146 secondary tasks. Drivers performed, on average, 2.3 non-driving-related activities (SD = 1.7) during the last 30 min of their trip. Consistent with previous findings, the presence of passengers was associated with a decrease in the amount of other secondary tasks, especially on the mobile phone. Young drivers (<25 years), in particular, were twice as likely to undertake secondary activities on the phone compared to older ones. Among drivers with a high mobile phone addiction score, tasks on the mobile phone were significantly more likely to be performed while driving. During longer trips, more secondary activities are performed within the last 30 min than during short trips (<30 min). Surprisingly, the purpose of the trip also has a significant influence insofar as trips for leisure activities, in particular, are more frequently associated with secondary activities than shopping and business trips. The results of this study help to determine better crash probabilities based on influencing factors, which in turn should form the basis for specific customised information and educational campaigns. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to investigate the current status of progestogen treatment for pregnant women at a high risk for preterm birth (PTB) in childbirth healthcare facilities in Japan. Methods: A web‐based nationwide questionnaire survey regarding progestogen use for prevention of PTB was conducted among childbirth healthcare facilities from 2019 to 2021. Results: Valid responses were obtained from 528 facilities (25.2% of those surveyed), including 155 tertiary perinatal facilities (making up 92.3% of all tertiary perinatal care facilities). In the survey period, progestogen treatment was implemented in 207 facilities (39.2%) for PTB prevention. Regarding types of progestogens, 17α‐hydroxyprogesterone caproate was used in 170 facilities (82.1%), with a low dose (125 mg/week) administered in 62.9% of the facilities to comply with the regulations of the national health insurance system, although 250 mg/week is considered the best dose. Vaginal progesterone was used in 36 facilities (17.4%), although the cost of vaginal progesterone was not covered by health insurance. Of the facilities not administering progestogen treatment, approximately 40% expressed that vaginal progesterone would be their first choice for PTB prevention in daily practice if it would be covered by health insurance in the future. Conclusions: Due to the current regulations of the Japanese health insurance system, 17α‐hydroxyprogesterone caproate, rather than vaginal progesterone, was mainly used for PTB prevention. Despite global evidence supporting vaginal progesterone as the approach with the highest efficacy, only a limited number of facilities have utilized it due to the current drug use regulations in Japan. [ABSTRACT FROM AUTHOR]

Background and purpose: The aim of this study was to determine the prevalence of anti‐myelin‐associated glycoprotein (MAG) neuropathy and the current status of such patients in Japan. Methods: We conducted a nationwide survey in 2021 using established epidemiological methods. Questionnaires were sent to all neurology and pediatric neurology departments throughout Japan to identify patients with anti‐MAG neuropathy. An initial questionnaire was used to determine the number of patients, with a second one used to collect detailed clinical information. Results: The estimated number of patients with anti‐MAG neuropathy was 353, with a prevalence of 0.28 per 100,000 and an incidence of 0.05 per 100,000. The detailed clinical profiles of 133 patients were available. The median (range) age of onset was 67 (30–87) years, with a prominent peak in the age range 66–70 years, and the male‐to‐female ratio was 3.6. Most patients had distal sensory‐predominant polyneuropathy, and neuropathic pain (50%), or sensory ataxia (42%), while 18% had Waldenström's macroglobulinemia or multiple myeloma. Intravenous immunoglobulin was the most frequently used treatment (65%), but the response rate was <50%, whereas rituximab was given in 32% of patients, and 64% of these showed improvement. At the last visit, 27% of patients could not walk independently. Conclusions: This study on anti‐MAG neuropathy provides updated insights into the epidemiology of this disease, clinical profiles, and treatment approaches in Japan. Rituximab therapy, used for only one‐third of the patients, demonstrated efficacy. During the final visit, a quarter of the patients were unable to walk independently. Further studies are warranted to determine the optimal management of this rare and intractable disorder. [ABSTRACT FROM AUTHOR]

What qualities and abilities are appropriate for a person who plans to become a doctor? To answer this question, it is meaningful to understand the opinions of the general public, since they are important stakeholders in the training of doctors. As part of a national door-to-door questionnaire survey, participants were asked about 16 qualities and abilities they considered suitable for becoming a doctor. Of the 1200 people interviewed, 1190 responded. The ratio of affirmative answers was the highest (92.2%) for the "Accurately judges situations" element, followed by "Cares about others' feelings" (87.4%), "Understands the reality of medical care and welfare" (87.2%), and "Resistant to mental stress" (86.2%). "High academic ability", which is currently the most important factor in the actual selection of students, ranked ninth among the sixteen elements (71.8%). Aside from academic ability, the general public places importance on other factors in selecting students for admission to medical schools. This study provides a valuable reference for medical schools regarding admission policies and applicant selection processes. [ABSTRACT FROM AUTHOR]

Objective: To identify patients with biliary atresia (BA) with extremely poor outcomes of bile drainage surgery using the infant BA liver fibrosis (iBALF) score, a liver fibrosis marker based on standard blood analysis. Background: Although primary liver transplantation is beginning to be considered as an alternative to bile drainage surgery in patients with BA, those most likely to benefit from this procedure have not yet been identified. Methods: The medical records of 380 patients with BA with bile drainage surgery between 2015 and 2019 were collected for retrospective analysis from 60 participating hospitals. To predict native liver survival at age 1 year, a receiver operating characteristic curve was drawn for the iBALF score. The cutoff value was determined as the point indicating >99% sensitivity. Results: The median age at surgery was 56 days (range: 4–183 days), and native liver survival at age 1 year was achieved in 258 (67.9%) patients. An iBALF score of 5.27 was chosen as the cutoff, and 18 patients (4.7%) were found to have an iBALF score >5.27; of these, only 2 (95% CI: 1.4%–34.7%) had native liver survival at age 1 year, indicating a significantly poorer outcome than in the other patients (95% CI: 65.7%–75.4%). Moreover, patients with an iBALF score >5.27 had significantly higher mortality and younger age at salvage liver transplantation. Conclusions: Patients with BA having a preoperative iBALF score >5.27 had extremely poor outcomes of bile drainage surgery and may be considered candidates for primary LTx. [ABSTRACT FROM AUTHOR]

Introduction: Many guidelines now recommend early rehabilitation for acute stroke patients. However, evidence remains lacking regarding the specific timings for initiation of various rehabilitation steps and management when complications are encountered in acute stroke rehabilitation. This survey aimed to investigate actual clinical situations in acute stroke rehabilitation in Japan and to improve the medical systems for rehabilitation and plan further studies. Methods: This nationwide, cross-sectional, web-based questionnaire survey was administered between February 7, 2022, and April 21, 2022, targeting all primary stroke centers (PSCs) in Japan. Among several components of the survey, this paper focused on the timing of the initiation of three rehabilitation steps (passive bed exercise; head elevation; and out-of-bed mobilization), along with the management of rehabilitation (continued or suspended) in the event of complications during acute stroke rehabilitation. We also investigated the influence of facility features on these contents. Results: Responses were obtained from 639 of the 959 PSCs surveyed (response rate: 66.6%). In cases of ischemic stroke and intracerebral hemorrhage, most PSCs initiated passive bed exercise on day 1, head elevation on day 1, and out-of-bed mobilization on day 2 (with day of admission defined as day 1). In cases with subarachnoid hemorrhage, rehabilitation steps were delayed compared to other stroke subtypes or showed wide variation depending on the facility. Passive bed exercise was accelerated by the presence of protocols for rehabilitation and weekend rehabilitation. Out-of-bed mobilization was accelerated by the presence of a stroke care unit. Facilities with board-certified rehabilitation doctors were cautious regarding the initiation of head elevation. Most PSCs suspended rehabilitation training in the event of symptomatic systemic/neurological complications. Conclusion: Our survey revealed the actual situation of acute stroke rehabilitation in Japan and indicated that some facility features appear to influence early increases in physical activity levels and early mobilization. Our survey provides fundamental data to improve the medical systems for acute stroke rehabilitation in the future. [ABSTRACT FROM AUTHOR]

This article attempts to describe Poles' attitudes towards AI in the development of Christian prayer as a technology supporting prayer practices. Four research questions were formulated: 1. Do the frequency of prayer and engagement in religious practices influence the attitudes of Poles towards prayer programs/applications based on AI technology? 2. Does believers' age affect Poles' attitudes towards prayer programs/applications based on AI? 3. Does believers' place of residence affect the attitude of Poles towards AI-based prayer programs/applications? 4. Do current users of the prayer-supporting applications plan to continue using it, and are new believers considering using it in the future? Research hypotheses were adopted to verify the research problem, with the first, second, and third being positively verified. H1: The higher the level of prayer frequency and engagement in religious practices of respondents, the more conservative the attitude towards prayer programs/applications based on AI; H2: The age of respondents differentiates the attitudes of Poles towards prayer programs/applications. H3: The respondents' place of residence differentiates Poles' attitudes towards prayer programs/applications. H4: Most AI users plan to continue such usage in the future, while new practitioners will appear. [ABSTRACT FROM AUTHOR]

BackgroundThe COVID-19 pandemic underscored the critical importance of biosafety in microbiology laboratories worldwide. In response, China has ramped up its efforts to enhance biosafety measures within its Centers for Disease Control and Prevention (CDC) laboratories. This study provides the first comprehensive assessment of biosafety practices across provincial, city, and county levels of CDC microbiology laboratories in China.MethodsWe conducted a nationwide cross-sectional survey from 2021 to 2023, targeting staff from microbiology laboratories within CDCs at all administrative levels in China. Stratified sampling was employed to select respondents, ensuring a representative mix across different CDC hierarchies, job titles, and academic qualifications. The survey encompassed questions on biosafety training, the presence of BSL-2 and BSL-3 laboratories, adherence to general biosafety guidelines, and management practices regarding specimens, reagents, and consumables. Statistical analysis was performed to identify significant differences in biosafety practices among different CDC levels.ResultsA total of 990 valid responses were received, highlighting a nearly universal presence (98.69%) of BSL-2 laboratories and a significant yet varied presence of BSL-3 laboratories across the CDC network. The survey revealed high levels of biosafety training (98.69%) and adherence to biosafety protocols. However, challenges remain in the consistent application of certain safety practices, especially at lower administrative levels. Notable differences in the management of specimens, reagents, and consumables point to areas for improvement in ensuring biosecurity.ConclusionOur findings indicate a robust foundation of biosafety practices within CDC microbiology laboratories in China, reflecting significant advancements in the wake of the Biosecurity Law's implementation. Nevertheless, the variability in adherence to specific protocols underscores the need for ongoing training, resources allocation, and policy refinement to enhance biosafety standards uniformly across all levels. This study's insights are crucial for guiding future improvements in laboratory biosafety, not just in China but potentially in other countries enhancing their public health infrastructures.

Abstract Background Internet addiction (IA) has been drawing attention to mental health. However, few reports have been found on the related factors of at‐risk IA among regular workers by a nationwide survey. The study aimed to evaluate the characteristics of at‐risk IA and identify related factors among senior high school teachers in Japan. Methods This survey was a cross‐sectional survey of high schools across Japan in 2017. There were 3189 teachers (2088 males and 1098 female) who participated in this survey. The questionnaire asked about their devices, both the time and the activities of using their internet, and sociodemographic factors. IA was measured by the internet addiction test (IAT) by which 40–79 points were classified as at‐risk IA, and more as IA. We compared the related factors of at‐risk IA and non‐IA using descriptive analysis and multivariable regression analysis. Results The rates of IA and at‐risk IA were 0.09% (n = 3) and 6.91% (n = 220), respectively. At‐risk IA was positively associated with activities on the internet for gaming, entertainment, net‐surfing, and younger ages. In addition, the at‐risk IA group had a longer time spent on the internet than the non‐IA group. Conclusions Around 7% of high school teachers are at‐risk IA in this survey, though they have regular work. Our results suggest that at‐risk IA may be reinforced not only by the active internet use such as gaming, but also by purposeless behaviors, such as net‐surfing. Managing time on the internet may support preventing at‐risk IA among senior high school teachers.

Objectives: This study aimed to investigate the performance of oral assessment and health care education at nursing schools across Japan to identify problems and the need for oral health professional support. Methods: The participants were the academic staff in charge of oral health care education in the basic, adult, gerontological, and home nursing fields of 295 schools in Japan that offered a bachelor's degree in nursing. A questionnaire was sent to 1180 heads of the nursing fields of these schools. They were requested to have oral health care educators complete the survey; data on the performance of oral assessment and health care education and human resources allocated were collected through a questionnaire. Results: A total of 311 (26%) questionnaires were returned, 196 (63%) of which were completed by oral health care educators. Regarding the performance of oral assessment education, the majority (71%) of them spent less than 2 hours in teaching, and only 24.5% taught the usage of oral assessment tools. Regarding the performance of oral health care education, more than 90% spent less than 2 hours in lecture-based and practical oral health care education, respectively. Less than half taught the association of periodontal diseases with diabetes and cardiovascular diseases and use of fluoride for caries prevention in the lectures, and only approximately 30% taught the usage of an interspace brush or dental floss. Moreover, less than 10% of oral health professionals taught oral health care in lectures or practical oral health care. Conclusions: This study revealed problems associated with oral assessment and health care education in Japanese nursing schools. To address these, support from oral health care professionals is required. Further studies are also required to reveal problems in oral assessment and health care education in other nursing schools that do not offer a bachelor's degree programme in Japan and other countries.

Introduction: We aimed to evaluate the safety and short‐term outcomes of robotic‐assisted transabdominal preperitoneal repair for inguinal hernia in 12 pioneering hospitals in Japan. Methods: Clinical data of patients who underwent robotic‐assisted transabdominal preperitoneal repair between September 1, 2016, and December 31, 2021 were collected. Primary outcome measures were intra‐operative adverse events and post‐operative complications, whereas secondary outcomes were surgical outcomes, including chronic pain, recurrence, and learning curve. Results: In total, 307 patients were included. One case of inferior epigastric arterial injury was reported; no cases of bowel or bladder injury were reported. Thirty‐five seromas were observed, including four (1.3%) cases that required aspiration. The median operative time of a unilateral case was 108 minutes (interquartile range: 89.8–125.5), and post‐operative pain was rated 1 (interquartile range: 0–2) on the numerical rating scale. In complicated cases, such as recurrent inguinal hernias and robotic‐assisted radical prostatectomy‐associated hernias, dissection and suture were safely achieved, and no complications were observed, except for non‐symptomatic seroma. All patients underwent robotic procedures, and there was no chronic post‐operative inguinal pain, although one case of hernia recurrence was reported. Regarding the learning curve, plateau performance was achieved after 7–10 cases in terms of operative time (P <.001). Conclusion: Robotic‐assisted transabdominal preperitoneal repair can be safely introduced in Japan. Regardless of the involvement of many surgeons, the mastery of robotic techniques was achieved relatively quickly. The advantage of robotic technology such as wristed instruments may expand the application of minimally invasive hernia repair for complicated cases. [ABSTRACT FROM AUTHOR]

Reintroducing apex predators is an important approach in ecosystem restoration; however, it is challenging. Wolves (Canis lupus) were exterminated in Japan around 1900, and since then, there has been a lack of top predators throughout the country. Currently, the wild ungulate population is increasing, causing agricultural and forest damage. This has triggered an ongoing debate among researchers and nongovernmental organizations on whether wolves should be reintroduced to promote self‐regulating biodiverse ecosystems. We conducted a nationwide survey to examine public attitudes toward wolf reintroduction (WR) in Japan. We sent online questionnaires to 88,318 citizens across the country. Among the 12,028 respondents, excluding those with invalid or incomplete answers and unqualified respondents, we obtained and analyzed 7500 responses that were representative of Japanese citizens in terms of some key sociodemographic attributes. More respondents disagreed with WR (39.9%) than agreed (17.1%), and many respondents (43.0%) were undecided. Structural equation modeling revealed that risk perceptions affected public attitudes, implying that the greater the perceived threat of wolf attacks, the less likely people are to support WR. In contrast, attitudes toward wolves (e.g., "I like wolves.") influenced by wildlife value orientation and beliefs about the ecological role of wolves (e.g., controlling deer populations) positively affected public attitudes toward WR. Those who had a positive attitude toward WR showed intentions to engage in behaviors that support WR. Our results suggest that the dissemination of information related to the ecological role of wolves and the development of a more mutualistic mindset in people could positively influence public support for WR in Japan. [ABSTRACT FROM AUTHOR]

Purpose: This study was performed to clarify the clinical features of cloacal exstrophy (CE) patients who underwent anoplasty and their functional outcomes based on a nationwide survey in Japan. Methods: A questionnaire survey was conducted and data were obtained from 229 CE patients. After the exclusion of non-surviving patients and unknown data, 195 patients were enrolled. We compared the patient characteristics of the no anoplasty group (NAP group) to the anoplasty group (AP group). The defecation function of patients who underwent anoplasty was evaluated. Results: The AP group had significantly lower rates of omphalocele (p = 0.045) and spinal defects (p = 0.003) than the NAP group. Of the 195 patients enrolled in this study, only 17 (8.7%) underwent anoplasty. Of the 17 patients who underwent anoplasty, 7 (41.1%) eventually had a permanent stoma after anoplasty [after ileostomy: n = 3 (60.0%), after colostomy: n = 4 (44.4%)]. Regarding soiling, 4 patients (66.7%) showed the absence of soiling, 2 (33.3%) showed accidental soiling, and no patients showed frequent soiling. Conclusion: In our study, spinal defects may have affected the determination of anoplasty. Anoplasty may improve the quality of life, because defecation can be kept clean, but indications, including colon function, may be carefully considered. [ABSTRACT FROM AUTHOR]

Background: Internet addiction (IA) has been drawing attention to mental health. However, few reports have been found on the related factors of at‐risk IA among regular workers by a nationwide survey. The study aimed to evaluate the characteristics of at‐risk IA and identify related factors among senior high school teachers in Japan. Methods: This survey was a cross‐sectional survey of high schools across Japan in 2017. There were 3189 teachers (2088 males and 1098 female) who participated in this survey. The questionnaire asked about their devices, both the time and the activities of using their internet, and sociodemographic factors. IA was measured by the internet addiction test (IAT) by which 40–79 points were classified as at‐risk IA, and more as IA. We compared the related factors of at‐risk IA and non‐IA using descriptive analysis and multivariable regression analysis. Results: The rates of IA and at‐risk IA were 0.09% (n = 3) and 6.91% (n = 220), respectively. At‐risk IA was positively associated with activities on the internet for gaming, entertainment, net‐surfing, and younger ages. In addition, the at‐risk IA group had a longer time spent on the internet than the non‐IA group. Conclusions: Around 7% of high school teachers are at‐risk IA in this survey, though they have regular work. Our results suggest that at‐risk IA may be reinforced not only by the active internet use such as gaming, but also by purposeless behaviors, such as net‐surfing. Managing time on the internet may support preventing at‐risk IA among senior high school teachers. [ABSTRACT FROM AUTHOR]

Background: Pseudohypoparathyroidism (PHP) and nonsurgical hypoparathyroidism (NS-HypoPT) are rare diseases with hypocalcemia, hyperphosphatemia, and high and low parathyroid hormone levels, respectively. In Japan, over 20 years have passed since the last survey on these diseases. We carried out a nationwide cross-sectional survey to estimate the prevalence of these diseases in 2018. Methods: We conducted a nationwide mail-based survey targeting hospitals in 2018. >From a total of 13,156 departments throughout Japan, including internal medicine, pediatrics, neurology, and psychiatry, 3,501 (27%) departments were selected using a stratified random sampling method. We asked each included department to report the number of patients with PHP and NS-HypoPT in 2017. Results: The overall survey response rate was 52.0% (1,807 departments). The estimated number of patients with PHP and NS-HypoPT was 1,484 (95% confidence interval [CI], 1,143–1,825) and 2,304 (95% CI, 1,189–3,419), respectively; the prevalence per 100,000 population was 1.2 and 1.8, respectively. Conclusion: In this study, we generated estimates of the national prevalence of PHP and NS-HypoPT in Japan during 2017, which were found to be higher than those previously reported.

Peripheral blood stem cell harvesting (PBSCH) is an established general practice; however, recent medical advances have led to diversification in hematopoietic stem cell transplantation and collection. A questionnaire survey on cell therapy and blood cell apheresis was conducted to understand the current situation and identify issues in Japan. A total of 159 facilities/departments responded to the survey. The annual number of autologous PBSCH was "11-25" in 48% and "1-10" in 37% of the centers, while the annual number of allogeneic PBSCH for related transplantation was "1-10" in 60% of the centers and "1-10" in 50% for unrelated transplantation. Collection sites were in the wards (40%), transfusion department (36%), and dialysis unit (26%). The apheresis system was staffed mainly by clinical engineers (67%) and doctors (23%). Primarily, doctors (96%) performed peripheral vascular punctures and were present at all times during collection in 37% of the centers. The Spectra Optia was the equipment most commonly used for apheresis. To freeze the product, 89% of the centers used "CP-1" without a controlled rate freezer. This survey revealed the diversification of collection methods in Japan, with "task shift" emerging as a significant concern. [ABSTRACT FROM AUTHOR]

For the 23rd Nationwide Follow‐up Survey of Primary Liver Cancer in Japan, data from 20 889 newly registered patients and 42 274 previously registered follow‐up patients were compiled from 516 institutions over a 2‐year period from January 1, 2014 to December 31, 2015. Basic statistics compiled for patients newly registered in the 23rd survey were cause of death, past medical history, clinical diagnosis, imaging diagnosis, treatment‐related factors, pathological diagnosis, recurrence status, and autopsy findings. Compared with the previous 22nd survey, the population of patients with hepatocellular carcinoma (HCC) was older at the time of clinical diagnosis, had more female patients, had more patients with non‐B non‐C HCC, had smaller tumor diameter, and was more frequently treated with hepatectomy. Cumulative survival rates were calculated for HCC, intrahepatic cholangiocarcinoma, and combined hepatocellular cholangiocarcinoma (combined HCC and intrahepatic cholangiocarcinoma) by treatment type and background characteristics for patients newly registered between 2004 and 2015 whose final outcome was survival or death. The median overall survival and cumulative survival rates for HCC were calculated by dividing patients by combinations of background factors (number of tumors, tumor diameter, Child–Pugh grade, or albumin‐bilirubin grade) and by treatment type (hepatectomy, radiofrequency ablation therapy, transcatheter arterial chemoembolization, hepatic arterial infusion chemotherapy, and systemic therapy). The same values were also calculated according to registration date by dividing patients newly registered between 1978 and 2015 into five time period groups. The data obtained from this nationwide follow‐up survey are expected to contribute to advancing clinical research and treatment of primary liver cancer in the world. [ABSTRACT FROM AUTHOR]

Langerhans cell histiocytosis (LCH) is a rare disease characterized by clonal expansion of CD1a+CD207+ myeloid dendritic cells. The features of LCH are mainly described in children and remain poorly defined in adults; therefore, we conducted a nationwide survey to collect clinical data from 148 adult patients with LCH. The median age at diagnosis was 46.5 (range: 20–87) years with male predominance (60.8%). Among the 86 patients with detailed treatment information, 40 (46.5%) had single system LCH, whereas 46 (53.5%) had multisystem LCH. Moreover, 19 patients (22.1%) had an additional malignancy. BRAF V600E in plasma cell‐free DNA was associated with a low overall survival (OS) rate and the risk of the pituitary gland and central nervous system involvement. At a median follow‐up of 55 months from diagnosis, six patients (7.0%) had died, and the four patients with LCH‐related death did not respond to initial chemotherapy. The OS probability at 5 years post‐diagnosis was 90.6% (95% confidence interval: 79.8–95.8). Multivariate analysis showed that patients aged ≥60 years at diagnosis had a relatively poor prognosis. The probability of event‐free survival at 5 years was 52.1% (95% confidence interval: 36.6–65.5), with 57 patients requiring chemotherapy. In this study, we first revealed the high rate of relapse after chemotherapy and mortality of poor responders in adults as well as children. Therefore, prospective therapeutic studies of adults with LCH using targeted therapies are needed to improve outcomes in adults with LCH. [ABSTRACT FROM AUTHOR]

This correlational study aimed to identify factors that contribute to changes in perceptions of digital technology among older adults during the COVID-19 pandemic. This study utilized raw data from "The 2021 Report on the Digital Divide," a nationwide survey conducted in South Korea. Data were collected from 1171 older adults (aged ≥ 65 years) from September to December 2021. Multiple regression analyses were performed to examine the factors influencing changes in the perception of digital technology. Over one-third of the participants reported positive changes in their perceptions of digital technology during the pandemic. Key factors included self-efficacy for digital devices (β = 0.35, p < 0.001), digital networking (β = 0.11, p < 0.001), accessibility to digital devices (β = 0.10, p = 0.002), and perceived health (β = 0.08, p = 0.003). The expansion of digital technology owing to the pandemic has served as a catalyst for changes in older adults' perceptions. Healthcare providers and caregivers should consider digital technology perceptions and influencing factors when providing digital healthcare services. The results can be utilized to identify vulnerable older adults with negative perceptions of digital technology, thus minimizing disparities in access to digital healthcare services. [ABSTRACT FROM AUTHOR]

(1) Background: Medical disputes have long been resolved via lawsuits. Alternative dispute resolutions have been promoted for their benefits and win–win results. This study aims to investigate Taiwanese hospital medical dispute capacities and burdens. (2) Methods: This study used 2015 nationwide questionnaire data. The number and value of medical disputes that occurred in 2014 was examined to evaluate hospitals' capabilities. Poisson regressions were used to determine the impact of coping abilities on the incidence of disputes and the associated compensation. (3) Results: The response rate of the questionnaire was 90%. Hospital features associated with higher medical disputes incidence included those of a scale ≤ 100 or 200–499 and having a dispute–inform process of over 4 h. In contrast, hospitals whose compensation fund was solely based on medical liability insurance reported less medical dispute incidence. The features associated with higher compensation were lack of continuing training and having a dispute–inform process over 4 h. In contrast, hospitals with standard operating procedures for in-hospital mediation and solicitude paid lower compensation. (4) Conclusions: Hospitals with quicker response times experienced fewer medical disputes and paid lower compensation. Dispute coping skills, other than reaction time, were more visible in compensation bargaining, but were not significantly correlated with incidence. [ABSTRACT FROM AUTHOR]

Purpose: After conducting a nationwide survey of persistent cloaca (PC), we assessed whether or not the timing of definitive anorectoplasty affects the long-term bowel function of patients with PC. Methods: Patient information was obtained via questionnaire, and a total of 169 PC patients who underwent posterior sagittal anorectourethrovaginoplasty (PSARUVP) were enrolled in this study. Patients were classified into 2 groups based on their operative period, which was analyzed by the area under the receiver operating characteristic curve: the early group (EG) underwent anorectoplasty at ≤ 18 months old (n = 106), and the late group (LG) underwent anorectoplasty at > 18 months old (n = 63). The bowel function was evaluated using the evacuation score of the Japan Society of Anorectal Malformation Study Group. We also examined the postoperative results of vaginoplasty. Results: The total evacuation score was significantly higher in the EG than in the LG (5.2 ± 1.7 vs. 4.2 ± 1.8, p = 0.003). The frequency of bowel movement and the constipation scores were significantly higher in the EG than in the LG (1.4 ± 0.6 vs. 1.2 ± 0.7, p < 0.05, 2.4 ± 1.0 vs. 2.1 ± 1.0, p < 0.05, respectively). Postoperative vaginal stenosis was observed in 18 cases (10.7%), of which 16 could be reconstructed transperineally. Conclusion: PSARUVP should be performed in early infancy and facilitate vaginal reconstruction. [ABSTRACT FROM AUTHOR]

Purpose: Cloacal exstrophy (CE) patients may need bladder reconstruction after initially undergoing surgery to obtain continence and improve their quality of life. This study attempts to clarify the clinical features of CE patients who underwent bladder augmentation (BA) and their urinary functional outcomes based on a nationwide survey in Japan. Methods: A questionnaire survey was conducted, and 150 CE patients were enrolled. Their clinical characteristics and urinary outcomes were reviewed. Results: BA was performed in 52 patients (34.7%). Most cases underwent early bladder closure at initial surgery in neonate period. The age at the BA was performed 6.4 [6–9.0] years. Among them, the most used organ for BA was ileum (n = 30, 57.7%). Regarding the outcomes, the age when the renal function was evaluated was 14.0 [10.0–20.5] years and the serum creatinine level was 0.44 [0.36–0.60] (mg/dl). Clean intermittent catheterization was required in 37 (71.2%) patients. On the other hand, no dialysis or kidney transplantation was necessary in any of these patients. Conclusion: The renal function and conditions of patients who underwent BA were relatively well preserved. Individualized management with a stepwise surgical approach for CE patients should thus be considered in the future. [ABSTRACT FROM AUTHOR]

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Intracranial carotid artery dissection causing cerebral ischemia is a rare but important cause of cerebral infarction in children and adolescents. Although endovascular therapy has been reported to be effective, questions regarding the indications for intervention are yet to be addressed. Therefore, this study aimed to evaluate factors related to clinical outcomes through a nationwide survey. Overall, 35 neurosurgical centers reported patients within 2 weeks after ischemic onset due to intracranial carotid artery dissection causing cerebral ischemia treated between January 2015 and December 2020. Data on clinical and radiological findings were statistically analyzed. Twenty-eight patients met the inclusion criteria. The median age was 36 years (range, 7-59 years), without sex differences. Headache at onset was documented in 60.7% of the patients. Dissection findings were categorized into stenosis (71.4%) or occlusion (28.6%). Initial treatments, including various antithrombotic agent combinations in 23 (82.1%) patients, effectively improved or prevented aggravation in half of the patients. The patients with stenotic dissection were significantly more likely to experience aggravation during the initial treatment than did those with occlusive dissection (P = 0.03). In addition, the patients with moderate to severe neurological deficits on admission had poorer outcomes at discharge more frequently than did those with mild neurological deficits on admission. Eight patients undergoing endovascular therapy had no procedural complications or further aggravation after intervention. In conclusion, patients with intracranial carotid dissection causing cerebral ischemia who had a stenotic dissection were at risk of further aggravation, and endovascular therapy effectively improved or prevented aggravation.

Background: Holistic multimodal interventions have not been established for cancer cachexia. The beliefs and perceptions of health care professionals (HCPs) based on their experiences influence the interventions. Objectives: HCPs' knowledge, perceptions, and practices in cancer cachexia management were evaluated. Design/Setting/Subjects/Measurements: A nationwide questionnaire survey was conducted that focused on the perspectives of HCPs on interventions in 451 designated cancer hospitals across Japan. Descriptive statistics were applied. Results: Among 2255 participants, 1320 responded (58.5%), and 1188 in 258 institutes were included in the analysis. The current international definition of cancer cachexia is not commonly known and recent clinical practice guidelines have not been widely adopted. More than 50% of participants considered ?5% weight loss in six months and ECOG PS (Eastern Cooperative Oncology Group Performance Status) 2?4 to be cancer cachexia, whereas 50% answered that there was no relationship between life expectancy and cancer cachexia. Participants tended to consider it important to initiate nutritional and exercise interventions before cancer cachexia becomes apparent. The majority of participants recognized the importance of holistic multimodal interventions, particularly for the management of physical and psychological symptoms; however, only 20% reported that they educated patients and families. Furthermore, 33% of participants considered themselves to have provided patients and families with sufficient nutritional and exercise interventions and evidence-based information. Conclusion: The results reveal that HCPs are not regularly providing education and emotional support to patients and families suffering from cancer cachexia. The results also show the need for education for HCPs to enhance implementation of holistic multimodal interventions for cancer cachexia.

Abstract The residential environment clearly affects health. For example, a previous study has established relationships between specific environmental factors and the health status of residents in detached houses. However, studies focused on apartment buildings are still insufficient. Therefore, in this study, a large nationwide questionnaire survey of residents of apartments was conducted. The residential environment was subjectively evaluated using a Japanese Comprehensive Assessment System for Built Environment Efficiency (CASBEE) tool: the CASBEE Health Checklist. The results showed that residents living in apartments who score higher on the checklist tend to have a lower prevalence of various diseases, indicating that residential environment may be an important determinant of health. Furthermore, the odds ratios for residents living in apartment buildings were lower for diabetes mellitus, hypertensive diseases, heart diseases, cerebrovascular diseases, chronic lower respiratory diseases, and inflammatory polyarthropathies compared with residents living in detached houses. These findings support the general link between the residential environment and residents' health and suggest that housing typology is an important factor.

Abstract Background Cancer pain may be refractory to standard pharmacological treatment. Interventional procedures are important for quality of analgesia. The aim of the present study was to clarify the availability of four interventional procedures (celiac plexus neurolysis/splanchnic nerve neurolysis, phenol saddle block, epidural analgesia, and intrathecal analgesia), the number of procedures performed by specialists, and their associated factors. In addition, we aimed to establish how familiar home hospice physicians and oncologists are with the different interventional procedures available to manage cancer pain. Methods A cross-sectional survey using a self-administered questionnaire was conducted. Subjects were certified pain specialists, interventional radiologists, home hospice physicians, and clinical oncologists. Results The numbers of valid responses/mails were 545/1,112 for pain specialists, 554/1,087 for interventional radiology specialists, 144/308 for home hospice physicians, and 412/800 for oncologists. Among pain specialists, depending on intervention, 40.9-75.2% indicated that they perform each procedure by themselves, and 47.5-79.8% had not performed any of the procedures in the past 3 years. Pain specialists had performed the four procedures 4,591 times in the past 3 years. Among interventional radiology specialists, 18.1% indicated that they conduct celiac plexus neurolysis/splanchnic nerve neurolysis by themselves. Interventional radiology specialists had performed celiac plexus neurolysis/splanchnic nerve neurolysis 202 times in the past 3 years. Multivariate analysis revealed that the number of patients seen for cancer pain and the perceived difficulty in gaining experience correlated with the implementation of procedures among pain specialists. Among home hospice physicians and oncologists, depending on intervention, 3.5-27.1% responded that they were unfamiliar with each procedure. Conclusions Although pain specialists responded that the implementation of each intervention was possible, the actual number of the interventions used was limited. As interventional procedures are well known, it is important to take measures to ensure that pain specialists and interventional radiology physicians are sufficiently utilized to manage refractory cancer pain.

Aim: The aim of this study was to investigate initial symptoms of early‐onset dementia (EOD) for each dementia subtype. Method: We conducted a nationwide, population‐based EOD prevalence study in Japan. Data were collected through service providers for people with EOD. Initial symptoms were assessed in six domains: loss of memory, difficulty in word generation, irritability, loss of motivation, increased mistakes in the workplace or domestically, and unusual behaviours or attitudes other than those listed. Results: Participants were 770 people with EOD. Characteristic initial symptoms were observed for each EOD subtype. Loss of memory was more common in early‐onset Alzheimer's disease (75.7%, P < 0.001), difficulty in word generation was more common in early‐onset vascular dementia (41.3%, P < 0.001), and loss of motivation, increased mistakes in the workplace or domestically, and unusual behaviours or attitudes other than those listed were more common in early‐onset frontotemporal dementia (34.9%, P < 0.001; 49.4%, P < 0.001; 34.9%, P < 0.001, respectively). In addition, we observed gender differences whereby loss of memory was more common among women and irritability was more common among men. More than half of the participants were employed at symptom onset, and 57.2% of those who were employed at the onset had initial symptoms of increased mistakes in the workplace or domestically. Conclusion: This report reveals differences in the frequency of initial symptoms by EOD subtype. The results contribute to increasing public awareness of the initial symptoms of EOD, which will facilitate early diagnosis and social support. [ABSTRACT FROM AUTHOR]

Objective: This study sought to investigate the current status and faculty members' perceptions of oral care education in Bachelor of Nursing curriculums in Japan. Method: Data were gathered through a questionnaire survey of 196 participants, who were faculty members in charge of oral care education in the basic, adult, gerontological, and home nursing fields, from 295 nursing schools that offered Bachelor degrees in nursing across Japan. Results: The quantitative data showed that 38.5% of the participants worked for less than 5 years as oral care educators, only 15.5% taught oral care in perioperative wards, only 62.2% used an oral care training simulator, and less than 30% believed that training in the prevention of oral diseases should be enhanced. From the descriptive responses, this study identified such problems as the inability of students to perform student‐on‐student and patient‐based oral care training owing to the risk of SARS‐CoV‐2 transmission, and the lack of teaching materials, time, and human resources, and cooperation with other nursing fields and health professionals. Conclusions: This study revealed several problems in oral care education in the Bachelor of Nursing curriculums in Japan. To tackle these challenges, this study suggests the development of an interdisciplinary course that unifies oral care education in nursing fields, in order to promote collaborative oral care education and to improve nursing students' knowledge and skills of oral care. [ABSTRACT FROM AUTHOR]

This article attempts to describe Poles’ attitudes towards AI in the development of Christian prayer as a technology supporting prayer practices. Four research questions were formulated: 1. Do the frequency of prayer and engagement in religious practices influence the attitudes of Poles towards prayer programs/applications based on AI technology? 2. Does believers’ age affect Poles’ attitudes towards prayer programs/applications based on AI? 3. Does believers’ place of residence affect the attitude of Poles towards AI-based prayer programs/applications? 4. Do current users of the prayer-supporting applications plan to continue using it, and are new believers considering using it in the future? Research hypotheses were adopted to verify the research problem, with the first, second, and third being positively verified. H1: The higher the level of prayer frequency and engagement in religious practices of respondents, the more conservative the attitude towards prayer programs/applications based on AI; H2: The age of respondents differentiates the attitudes of Poles towards prayer programs/applications. H3: The respondents’ place of residence differentiates Poles’ attitudes towards prayer programs/applications. H4: Most AI users plan to continue such usage in the future, while new practitioners will appear.

This study aimed to measure the impact of the COVID-19 pandemic on the volumes of annual stroke admissions compared with those before the pandemic in Japan. We conducted an observational, retrospective nationwide survey across 542 primary stroke centers in Japan. The annual admission volumes for acute stroke within 7 days from onset between 2019 as the pre-pandemic period and 2020 as the pandemic period were compared as a whole and separately by months during which the epidemic was serious and prefectures of high numbers of infected persons. The number of stroke patients declined from 182,660 in 2019 to 178,083 in 2020, with a reduction rate of 2.51% (95% confidence interval [CI], 2.58%-2.44%). The reduction rates were 1.92% (95% CI, 1.85%-2.00%; 127,979-125,522) for ischemic stroke, 3.88% (95% CI, 3.70%-4.07%, 41,906-40,278) for intracerebral hemorrhage, and 4.58% (95% CI, 4.23%-4.95%; 13,020-12,424) for subarachnoid hemorrhage. The admission volume declined by 5.60% (95% CI, 5.46%-5.74%) during the 7 months of 2020 when the epidemic was serious, whereas it increased in the remaining 5 months (2.01%; 95% CI, 1.91%-2.11%). The annual decline in the admission volume was predominant in the five prefectures with the largest numbers of infected people per million population (4.72%; 95% CI, 4.53%-4.92%). In conclusion, the acute stroke admission volume declined by 2.51% in 2020 relative to 2019 in Japan, especially during the months of high infection, and in highly infected prefectures. Overwhelmed healthcare systems and infection control practices may have been associated with the decline in the stroke admission volume during the COVID-19 pandemic.

We investigated the identity and distribution of the invasive alien insect species inhabiting Korean ecosystems, targeting 3,249 locations in nine regions between 2015 and 2018. In natural ecosystems, we identified 63 species in 43 families and nine orders of invasive alien insect species, respectively. We observed that the order Hemiptera exhibited the highest species diversity with 20 species. Gyeonggi-do was where the highest number of invasive alien insect species were identified (45 species). Species richness analysis revealed that Jeju-do showed the highest Dominance Index (0.8), whereas Gyeongsangnam-do had the highest Diversity Index (2.8). Corythucha marmorata (Hemiptera: Tingidae), Lycorma delicatula (Hemiptera: Fulgoridae), Ophraella communa (Coleoptera: Chrysomeridae), Metcalfa pruinosa (Say) (Hemiptera: Flatidae) and Pochazia shantungensis (Hemiptera: Ricaniidae) were distributed in more than 300 locations of the country. Invasive alien insect species inhabited the roadsides (31.3%), farmlands (18.3%) and parks (16.6%). In this study, we list the invasive alien insect species in Korean ecosystems and provide a basis for selecting primary management target species.