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This paper describes how the patriarchal structure of Japanese society and its notions of women, femininity, and gendered stereotypes produced strong cultural barriers to increasing the participation of females in science education. Baseline data on attitudes toward science and the perceptions of gender issues in science education, academic major and career choice were collected from 175 university students (124 female, 51 male). Students responded to a Likert scale that included the option "I don't understand the question". All respondents took advantage of the option for items related to gender issues. On some items up to 67% of the males responded that they did not understand the question. Females in science choosing this option did not exceed 19%. In Japan, gender is an invisible, pervasive construct that impacts females' participation in science and science education. In other ways, attitudes toward science among Japanese students mirrored those found in the United States and in other countries. Respondents held the most favorable views of science when they were in elementary school and females preferred biology while males preferred the physical sciences. The exception to the Western pattern of liking science and science teachers is that male non-science majors rather than female non-science majors reported poor academic performance in elementary school, declining attitudes in middle school, and they held the most negative attitudes toward their science teacher and science subjects.

Investigates the effects of learning material construction on concept learning while aiming for students to acquire the basic concepts of electricity and magnetism. Reports that concept learning of electricity and magnetism is influenced by the hierarchical structure of learning materials, not by sequence. (Contains 14 references.) (Author/YDS)

Background: As many local municipality and medical workers were involved in disaster recovery duties following the Great East Japan Earthquake (GEJE) on March 11, 2011, the aim of this work was to elucidate the distinct trajectories for post-traumatic stress disorder (PTSD) symptoms and associated factors among these personnel. They confronted a diverse range of stressors both as survivors and as relief workers; however, little is known about their longitudinal PTSD symptoms.Methods: The participants were 745 local municipality and hospital medical workers [average age: 43.6 ± 9.5 years, range: 20 - 66 years; 306 (59%) women] involved in disaster recovery duties following the GEJE. PTSD symptoms were measured using the Japanese version of the PTSD Checklist Specific Version (PCL-S) at four time points: 14, 30, 43, and 54 months after the GEJE. Using group-based trajectory modeling, distinct trajectories were elucidated.Results: We identified five distinct PTSD symptoms profiles: resistance (n = 467, 62.7%), subsyndromal (n = 181, 24.3%), recovery (n = 47, 6.3%), fluctuating (n = 26, 3.5%), and chronic (n = 24, 3.2%). The trajectories differed according to the post-disaster working conditions and personal disaster experiences.Limitations: Potential selection bias resulting from the limited number of participants who completed all waves. The survey was conducted in one region of the disaster area.Conclusions: The majority of participants remained stable, with a relatively small group classified as chronic and fluctuating. Our results highlight the importance of improved working conditions and sustained monitoring of workers responding to natural disasters. [ABSTRACT FROM AUTHOR]

On March 11, 2011 ("3/11"), a magnitude 9.0 earthquake in Northeastern Japan triggered a tsunami and nuclear power plant meltdown that killed 16,000 people and displaced more than 470,000 people. Since 2012, a group of volunteer docents from the September 11th Families Association in New York City has traveled throughout Northeastern Japan and held organized meetings where 9/11 and 3/11 survivors share their experiences and stories of trauma as part of an intercultural exchange to promote posttraumatic recovery. We sought to elucidate whether participating 9/11 docents developed a sense of increased resiliency by participating in this international outreach. This study employed photo-taking as well as framing questions, which were developed by 9/11 docents from the August 2016 trip. These questions guided photo-taking and resulting photographs informed discussion in individual and group sharing sessions. This process helped identify codes that guided analysis. Participants acquired a deeper appreciation of their own ability to overcome adversity and experienced a gratifying desire to help 3/11 survivors better cope with their experiences. This narrative photo-taking and group sharing experience demonstrates that a cross-cultural exchange between survivors of different disasters can instill feelings of resilience among participants. It additionally provides early evidence of the efficacy of such an exchange in benefitting disaster survivors in the long term. [ABSTRACT FROM AUTHOR]

Elucidation of the structure of human sexual networks is not only an interesting topic in the area of social networks but also an important clue for understanding the spreading risk of sexually transmitted infections (STIs). Some previous studies have indicated that sexual networks are scale free, while others have suggested that they are not. We conducted a Web-based survey on sexual contact in Japan to collect data on cumulative (total) heterosexual partners and the number of recent (in the last three or previous three months) heterosexual partners. To determine whether the number of heterosexual contacts in Japan has a power-law tail, we used maximum likelihood fitting methods and Kolmogorov-Smirnov tests. For confirmation, we also used the Akaike information criterion (AIC) and the Bayesian information criterion (BIC). Our results indicate that the distributions of the number of sexual partners in Japan have power-law tails. [ABSTRACT FROM AUTHOR]

In Japan, a range of patients with traumatic brain injury (TBI) has been recorded in a nationwide database (Japan Neurotrauma Data Bank; JNTDB). This study aimed to externally validate three international prediction models using JNTDB data: Trauma and Injury Severity Score (TRISS), Corticosteroid Randomization After Significant Head Injury (CRASH), and International Mission for Prognosis and Analysis of Clinical Trials in TBI (IMPACT). We also aimed to validate the applicability of these models in the Japanese population. Of 1,091 patients registered in the JNTDB from July 2009 to June 2011, we analyzed data for 635 patients. We examined factors associated with mortality in-hospital and unfavorable outcomes 6 months after TBI by applying the TRISS, CRASH, and IMPACT models. We also conducted an external validation of these models based on these data. The patients’ mean age was 60.1 ±21.1 years, and 342 were alive at the time of discharge (53.9%). Univariate analysis revealed eight major risk factors for mortality in-hospital: age, Glasgow Coma Scale (GCS), Injury Severity Score (ISS), systolic blood pressure, heart rate, mydriasis, acute epidural hematoma (AEDH), and traumatic subarachnoid hemorrhage. A similar analysis identified five risk factors for unfavorable outcomes at 6 months: age, GCS, ISS, mydriasis, and AEDH. For mortality in-hospital, the TRISS had a satisfactory area under the curve value (0.75). For unfavorable outcomes at 6 months, the CRASH (basic and computed tomography) and IMPACT (core and core extended) models had satisfactory area under the curve values (0.86, 0.86, 0.81, and 0.85, respectively). The TRISS, CRASH, and IMPACT models were suitable for application to the JNTDB population, indicating these models had high value in Japanese patients with neurotrauma. [ABSTRACT FROM AUTHOR]

In this study, we assessed the factor structure and construct validity of the parent-reported Inventory of Callous-Unemotional Traits (ICU) among school-aged children and adolescents, aged 6 to 15 years, in a community setting in Japan (n = 10,936). We investigated 15 models that have been reported in previous studies and used confirmatory factor analyses to determine a model that might actually be the best-fit among these. We then examined the correlations between the score of ICU and the Strengths and Difficulties Questionnaire (SDQ) in the best fit model and the three-factor bifactor (3FBF) model with the original ICU through cross-sectional and longitudinal analysis to determine the concurrent and predictive validity of the ICU. The results showed that the best-fit model was the two-factor bifactor (2FBF) model with a revised version of the ICU with 12 items, excluding all but one item of unemotional factors. The cross-sectional and longitudinal analysis showed that higher general callous-unemotional factor scores, callousness and uncaring specific factor scores were significantly associated with a higher level of conduct problems and a lower level of prosocial behaviors in the SDQ. These tendencies were shown both in the 2FBF model with the revised version of the ICU and the 3FBF model with the original ICU. We conclude that the 2FBF model was useful for school-aged community samples, as it predicts increases in conduct problems and decreases in prosocial behavior with fewer items than the 3FBF model. [ABSTRACT FROM AUTHOR]

Background and purpose: Moyamoya disease (MMD) is a progressive cerebrovascular disease with unknown etiology. Growing evidence suggest its involvement of autoimmune and genetic mechanisms in the pathogenesis of MMD. This study aims to clarify the association between HLA allele and MMD. Methods: Case-control study: the DNA of 136 MMD patients in Japan was extracted and the genotype of human leukocyte antigen (HLA) from this DNA was determined by super-high-resolution single-molecule sequence-based typing using next-generation sequencing. Next, the frequency of each HLA allele (HLA-A, HLA-B, HLA-C, HLA-DRB1, HLA-DQB1, and HLA-DPB1) was compared with those in the Japanese control database. In addition, haplotype estimation was performed using the expectation maximization algorithm. Results: The frequencies of the HLA-DRB1*04:10 allele (4.77% vs. 1.47% in the control group; P = 1.7 × 10−3; odds ratio [OR] = 3.35) and of the HLA-DRB1*04:10–HLA-DQB1*04:02 haplotype (haplotype frequency 4.41% vs. 1.35% in the control group; P = 2.0 × 10−3; OR = 3.37) significantly increased. The frequency of thyroid diseases, such as Graves’ disease and Hashimoto thyroiditis, increased in HLA-DRB1*04:10-positive MMD patients compared with that in HLA-DRB1*04:10-negative MMD patients. Conclusions: HLA-DRB1*04:10 is a risk allele and HLA-DRB1*04:10–HLA-DQB1*04:02 a risk haplotype for MMD. In addition, HLA-DRB1*04:10 is associated with thyroid disease in MMD patients. [ABSTRACT FROM AUTHOR]

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), severe drug reactions, are often misdiagnosed due to their rarity and lack of information on differential diagnosis. The objective of the study was to develop an electronic medical record (EMR)-based algorithm to identify patients with SJS/TEN for future application in database studies. From the EMRs of a university hospital, two dermatologists identified all 13 patients with SJS/TEN seen at the Department of Dermatology as the case group. Another 1472 patients who visited the Department of Dermatology were identified using the ICD-10 codes for diseases requiring differentiation from SJS/TEN. One hundred of these patients were then randomly sampled as controls. Based on clinical guidelines for SJS/TEN and the experience of the dermatologists, we tested 128 algorithms based on the use of ICD-10 codes, clinical courses for SJS/TEN, medical encounters for mucocutaneous lesions from SJS/TEN, and items to exclude paraneoplastic pemphigus. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic odds ratio (DOR) of each algorithm were calculated, and the optimal algorithm was defined as that with high PPV and maximal sensitivity and specificity. One algorithm, consisting of a combination of clinical course for SJS/TEN, medical encounters for mucocutaneous lesions from SJS/TEN, and items to exclude paraneoplastic pemphigus, but not ICD-10 codes, showed a sensitivity of 76.9%, specificity of 99.0%, PPV of 40.5%, NPV of 99.8%, and DOR of 330.00. We developed a potentially optimized algorithm for identifying SJS/TEN based on clinical practice records. The almost perfect specificity of this algorithm will prevent bias in estimating relative risks of SJS/TEN in database studies. Considering the small sample size, this algorithm should be further tested in different settings. [ABSTRACT FROM AUTHOR]

To obtain genetic information about the germplasm of tea (Camellia sinensis L.) in Japan, 167 accessions including 138 var. sinensis (96 Japanese var. sinensis and 42 exotic var. sinensis) and 29 Assam hybrids were analyzed using single nucleotide polymorphisms (SNPs) markers identified by double-digest restriction-site-associated DNA sequencing (ddRAD-seq) analysis. Approximately 10,000 SNPs were identified by ddRAD-seq and were mapped across the whole genome. The 167 tea accessions were classified into three genetic subgroups: (1) Japanese var. sinensis; (2) Japanese and exotic var. sinensis; (3) Assam hybrids and exotic var. sinensis. Leaf morphology varied widely within each genetic subgroups. The 96 Japanese var. sinensis were classified into four genetic subgroups as follows; two subgroups of Shizuoka (the largest tea production region) landraces, Uji (most ancient tea production region) landraces, and the pedigree of ‘Yabukita’, the leading green tea cultivar in Japan. These results indicated that the SNP markers obtained from ddRAD-seq are a useful tool to investigate the geographical background and breeding history of Japanese tea. This genetic information revealed the ancestral admixture situation of the ‘Yabukita’ pedigree, and showed that the genome structure of ‘Yabukita’ is clearly different from those of other Japanese accessions. [ABSTRACT FROM AUTHOR]

Several external factors including lunar cycle and weather conditions might be associated with calving conditions. Our objective here was to determine the effects of lunar cycle and weather conditions on calving frequency and the occurrence of preterm calving in Japanese Black cows. Calving records were obtained from 905 farms in Miyazaki Prefecture, Japan. Data were collected from 41,116 calvings. We conducted two studies: Study 1 investigated the effects of lunar cycle and weather conditions on daily calving frequency (DCF) with the observational unit of each day and Study 2 investigated those effects on the occurrence of preterm calving with the observational unit for each calving. Preterm calving was defined by whether or not a cow calving before 280 days of gestation, lower 10th percentile of gestation length of the collected data, and by whether or not a cow calving before 289 days of gestation, median of the gestation length. For Study 1, lunar cycle was not associated with DCF in all cows, in only primiparous cows and in only multiparous cows. As well as lunar cycle, weather conditions such as temperature, diurnal temperature variation, the temperature-humidity index, precipitation amount, barometric pressure, relative humidity and solar radiation, were also not associated with DCF. For Study 2, lunar cycle phases were not associated with the occurrence of preterm calving. However, preterm calving was associated with all of the weather conditions (P < 0.05) except for precipitation amounts and solar radiation. Temperature, the temperature-humidity index and relative humidity were positively associated with the occurrence of preterm calving. In contrast, diurnal temperature variations and barometric pressure were negatively associated with the occurrence of preterm calving. In conclusion, the lunar cycle was not associated with DCF and preterm calving, but the weather conditions were associated with preterm calving. [ABSTRACT FROM AUTHOR]

The present study recorded the population of the goby fish (Perciformes: Gobiidae), Eutaeniichthys cf. gilli Jordan & Snyder, 1901, from the tunnel burrowed by the mud shrimp Austinogebia edulis Ngo-Ho and Chan, 1992 in a mudflat in Shengang and Wangong of Changhua County, western Taiwan. This finding is not only a new record of the genus in Taiwan, it is also the first record of this species in a mudflat near an industrial park. In total, 56 individuals of E. cf. gilli were collected from June 2016 to September 2018. Morphological traits of males and females were measured. The resin casting method trapped bodies of E. cf. gilli that were present in the tunnel burrow and proved that the fish inhabits burrows of the mud shrimp A. edulis. In addition, a species of snapping shrimp was also found in the same tunnel. Symbiotic interaction may occur between E. cf. gilli, A. eduli and the snapping shrimp. The China Coastal Current (CCC) runs along the coastlines of Japan, Korea, China, and reaches western Taiwan during the northeast monsoon period. The CCC, therefore, might play an important role in the biogeographic distribution of E. cf. gilli in the western Pacific Ocean. Since E. cf. gilli is listed in the Red List as an endangered species of Japan for many years, Taiwan waters may provide a refuge for this fish species warranting a broader investigation. Since Taiwan is some distance away from the previously recorded locations in Japan, Korea, the Yellow Sea, and the Bohai Sea, a phylogenic analysis is warranted for population and species differentiation in the future. [ABSTRACT FROM AUTHOR]

Objective: To investigate the cost differences between magnetic resonance-guided focussed ultrasound (MRgFUS) and unilateral deep brain stimulation (DBS) for the treatment of medication-refractory essential tremor (ET) in Japan using a cost-minimisation model. Methods: A cost-minimisation model estimated total costs for MRgFUS and unilateral DBS by summing the pre-procedure, procedure, and post-procedure costs over a 12-month time horizon, using data from published sources and expert clinical opinion. The model base case considered medical costs from fee-for-service tariffs. Scenario analyses investigated the use of Diagnosis Procedure Combination tariffs, a diagnosis-related group-based fixed-payment system, and the addition of healthcare professional labour costs healthcare professionals using tariffs from the Japanese Health Insurance Federation for Surgery. One-way sensitivity analyses altered costs associated with tremor recurrence after MRgFUS, the extraction rate following unilateral DBS, the length of hospitalisation for unilateral DBS and the procedure duration for MRgFUS. The impact of uncertainty in model parameters on the model results was further explored using probabilistic sensitivity analysis. Results: Compared to unilateral DBS, MRgFUS was cost saving in the base case and Diagnosis Procedure Combination cost scenario, with total savings of JPY400,380 and JPY414,691, respectively. The majority of savings were accrued at the procedural stage. Including labour costs further increased the cost differences between MRgFUS and unilateral DBS. Cost savings were maintained in each sensitivity analysis and the probabilistic sensitivity analysis, demonstrating that the model results are highly robust. Conclusions: In the Japanese healthcare setting, MRgFUS could be a cost saving option versus unilateral DBS for treating medication-refractory ET. The model results may even be conservative, as the cost of multiple follow-ups for unilateral DBS and treatment costs for adverse events associated with each procedure were not included. This model is also consistent with the results of other economic analyses of MRgFUS versus DBS in various settings worldwide. [ABSTRACT FROM AUTHOR]

Background: The clinical component of medical education for students and resident doctors in Japan occurs almost entirely in the hospital setting. Because of this inpatient focus, graduate medical education clinical training often fails to expose physicians-in-training to the challenges that patients may face in the outpatient or home setting. This is a descriptive study in which we explore what participating students and resident doctors learned through our brief home-based teaching experience. Methods: From June 2016 to December 2017, attending physicians on the internal medicine service had medical students and resident doctors accompany them on home care visits. Participants were selected by convenience sampling based on their rotation availability. After the home visit and the interactive discussion, the participants were expected to prepare a reflective journal on their experience and learning. Thematic analysis was applied, and key themes were developed based on Kolb’s ELT (Experiential learning theory). Three months after completion of the experience, semi-structured interviews were individually conducted assessing participants’ self-perceived changes. Results: Thirty-two medical students(10) or residents(22)participated in a home visit. Thirty of these learners were able to complete a reflective journal. Using thematic analysis, we identified 2 domains and 6 key themes from the participants’ perceptions. Participants recognized the importance of patient-centered care, inter-professional collaboration of the home care team, and reconceptualized the meaning of medical practice and their professional identity as a doctor. Three month post-experience interviews were completed on 12 of the original 30 participants who completed the reflective journal. 2 domains and 6 key themes from the residents’ experiences and perceptions were generated. The participants reported an increased attention to the daily lives and social situations of their hospitalized patients, and an extension of their focus beyond the clinical medical treatment of the patient. Conclusion: The experience of a brief visit to a patient’s home is a novel educational approach that may potentially provide medical students and resident doctors with opportunities to learn about out-of-hospital, patient-centered, home-based medical care. [ABSTRACT FROM AUTHOR]

Background: In summer 2014, an autochthonous outbreak of dengue occurred in Tokyo, Japan, in which Yoyogi Park acted as the focal area of transmission. Recognizing the outbreak, concerted efforts were made to control viral spread, which included mosquito control, public announcement of the outbreak, and a total ban on entering the park. We sought to assess the effectiveness of these control measures. Methodology/Principal findings: We used a mathematical model to describe the transmission dynamics. Using dates of exposure and illness onset, we categorized cases into three groups according to the availability of these datasets. The infection process was parametrically modeled by generation, and convolution of the infection process and the incubation period was fitted to the data. By estimating the effective reproduction number, we determined that the effect of dengue risk communication together with mosquito control from 28 August 2014 was insufficiently large to lower the reproduction number to below 1. However, once Yoyogi Park was closed on 4 September, the value of the effective reproduction number began to fall below 1, and the associated relative reduction in the effective reproduction number was estimated to be 20%–60%. The mean incubation period was an estimated 5.8 days. Conclusions/Significance: Regardless of the assumed number of generations of cases, the combined effect of mosquito control, risk communication, and park closure appeared to be successful in interrupting the chain of dengue transmission in Tokyo. [ABSTRACT FROM AUTHOR]

The Bitcoin market becomes the focus of the economic market since its birth, and it has attracted wide attention from both academia and industry. Due to the absence of regulations in the Bitcoin market, it may be easier to bring some kinds of illegal behaviors. Thus, it raises an interesting question: Is there abnormity or illegal behavior in Bitcoin platforms? To answer this question, we investigate the abnormity in five leading Bitcoin platforms. By analyzing the financial index, i.e. the normalized logarithmic price return, we find that the properties of price return in bitFlyer are completely different from others. To find the possible reasons, we find that the abnormal ask price and bid price appear simultaneously in bitFlyer, which may be potentially linked to either price manipulation or money laundering. It verifies our conjecture that there may be abnormity or price manipulation in Bitcoin platforms. Furthermore, our findings in price return could also provide an innovative and effective method to detect the abnormity in Bitcoin platforms. [ABSTRACT FROM AUTHOR]

The dosage of pharmaceuticals is determined through the process of clinical development and approval review based on clinical trial results; however, the information obtained from clinical trials before approval is limited. Some pharmaceutical products are used at doses lower than those approved for post-marketing use. The aim of this study was to reveal the actual state of lower-dose prescriptions for post-marketing clinical use of pharmaceuticals. We investigated the factors related to the deviation based on therapeutic area, detailed statement of the approved dosage, clinical data package, and post-marketing requirement. Among the new molecular entities approved in Japan between January 2005 and December 2014, we identified products that are orally administered and have the same daily dose for different indications, if any. For these products, we collected information on the actual daily dose from the medical information databases of Medical Data Vision Co., LTD. and JammNet Co., LTD. Products whose dose was lower than the approved dose (maintenance dose excluding the initial dose) in ≥ 30% prescriptions in 2015 were defined here as “lower-dose prescription drugs.” We identified 27 lower-dose prescription drugs out of 113 products investigated. The results of the multivariate analysis revealed that factors related to the Anatomical Therapeutic Chemical classification and the detailed statement of the approved dosage significantly influenced the occurrence of lower-dose prescription, whereas the factors related to clinical data package and post-marketing requirements did not. These results suggest the limitation in determining an optimal dosage for the actual clinical use of a drug based on the information obtained from clinical trials conducted before approval, emphasizing the importance of reexamining the optimal dosage that is applicable to a greater number of patients after marketing, if necessary. We believe that the utilization of real-world data could be of help in this regard. [ABSTRACT FROM AUTHOR]

Aim: Sorafenib is used as a first-line treatment for advanced hepatocellular carcinoma (HCC). However, hepatic arterial infusion chemotherapy (HAIC) has also gained acceptance, but only in Japan. We explored the role of body composition as a factor affecting the survival benefit of HAIC compared to sorafenib for the treatment of advanced HCC. Methods: We conducted a retrospective study using the clinical records of 133 patients with advanced HCC treated either with HAIC or sorafenib. Prior to treatment induction, skeletal muscle index and visceral fat area (VFA) were measured at the third lumbar vertebral and umbilical levels, respectively, using computed tomography. Muscle depletion and high-VFA (H-VFA) were defined using published cut-offs. We analyzed clinical parameters, including body composition as prognostic factors. Results: In the HAIC group, multivariate analysis identified a positive response to HAIC (hazard ratio [HR], 0.438; p = 0.022), and conversion from HAIC to sorafenib (HR, 0.374; p = 0.008) as favorable prognostic factors for survival. In contrast, tumor number < 7 (HR, 0.475; p = 0.008), absence of extra-hepatic spread (HR, 0.511; p = 0.015), absence of muscle depletion (HR, 0.555; p = 0.044), and H-VFA (HR, 0.483; p = 0.015) were studied in the sorafenib group. Conclusions: Body composition was identified as a prognostic factor for patient survival after treatment with sorafenib, but not for HAIC, and may be used as a biomarker when selecting between HAIC or sorafenib treatment of patients with advanced HCC. Additionally, conversion to sorafenib in patients receiving HAIC could improve survival regardless of response status. [ABSTRACT FROM AUTHOR]

Whether higher serum uric acid (UA) values comprise a risk factor for death and whether treatment for high UA is effective in patients undergoing hemodialysis (HD) are essentially unknown. To determine associations between UA and all-cause or cardiovascular (CV) mortality, interactions between UA or medication and effects on mortality, and significance of treatment for hyperuricemia in patients undergoing hemodialysis (HD). We collected the baseline data of 222,434 patients undergoing three HD sessions per week, extracted from a nationwide dialysis registry at the end of 2011 in Japan. Then we evaluated the interaction between serum uric acid level and all-cause and cardiovascular (CV) mortality by the end of 2012. Univariate and multivariate logistic regression and Cox regression analyses found higher all-cause and CV mortality rates among patients with lower, than higher UA values. Hazard ratios (HR) for all-cause and CV mortality were significantly lower in a group with, than without medication for hyperuricemia (HR, 0.837; 95% confidence interval (CI), 0.789–0.889 and HR, 0.830; 95%CI 0.758–0.909, respectively). Lower UA values remained associated with all-cause and CV mortality rates even when in patients taking medication for hyperuricemia. The chief interacting factors for higher mortality rates due to lower UA were higher BMI and diabetes mellitus. In conclusion, lower UA levels were independently associated with higher all-cause and CV mortality among Japanese patients undergoing HD. Intervention for hyperuricemia is considered to improve patient outcomes. [ABSTRACT FROM AUTHOR]

The Nankai Trough in Japan has been identified as a geological feature that could cause extensive damage in the event of a major earthquake. In this study, we investigated the impact of effective guidance signs for hearing-impaired individuals requiring special care when escaping to a tsunami evacuation building (emergency evacuation location) using geographical information system (GIS) and viewshed analysis. We selected an area we considered would suffer severe damage following a major earthquake and tsunami; we identified difficulties in the provision of escape routes. Using GIS, we determined the time required for escape and tsunami arrival time if effective signs were installed; we undertook such analysis using the height data of buildings in the target area. With effectively installed guidance signs, the average required evacuation time was 36.88 minutes; without such signs (which is currently the case in the target area), the average time was 47.10 minutes: that would result in citizens getting caught by the tsunami. Installing effective guidance signs would allow hearing-impaired individuals to escape to an evacuation building before being hit by the tsunami. [ABSTRACT FROM AUTHOR]

Introduction: Only a few, large population-based studies, have reported on whiplash-associated disorder (WAD). However, none of them have investigated the influence of crash severity on WAD outcome. In the present study, we aimed to determine whether crash severity predicts outcomes among patients with no-fault government insurance for acute WAD. Methods: We utilized data from a compulsory, no-fault government automobile liability insurance agency in Japan. Individuals involved in a car accident between April 2001 and June 2015 with residual disabilities reported at the end of the treatment between October 2014 and September 2015 were included. Crash severity was assessed based on property damage costs, size of the other vehicle (large car, medium car, small car, or two-wheeled vehicles), and collision types (rear-end collision, contact with vehicle moving in the same direction, or in the opposite direction). Outcomes included the time to claim closure and the number of treatment visits. Results: We analyzed data for a total of 52,251 individuals (28,571 male and 23,680 female) with a median age of 44 years (range: 2–95 years). The median time to claim closure was 220 days (range: 1–4,938 days), and the median number of treatment visits was 102 (range: 1–2,492). There was no significant association between outcomes and property damage costs or size of the other vehicle. Collision types exhibited no consistent association with outcomes. However, older age and affected body parts, in addition to the neck, were independent risk factors for delayed claim closure and a large number of visits, although, all odds ratios were low (often less than 2.0). Conclusions: There was no obvious association of outcomes with property damage costs, size of the other vehicle, or collision types in acute WAD patients. Further studies should investigate the influence of psychological factors, compensation systems, and cultural conditions. [ABSTRACT FROM AUTHOR]

Long-term stock decline in the Japanese eel (Anguilla japonica) is a serious issue. To reduce natural resource utilization in Japan, artificial hormonal induction of maturation and fertilization in the Japanese eel has been intensively studied. Recent experiment on feminized (by feeding a commercial diet containing estradiol-17β for first half year) cultured female eels have shown ovulation problems, which is seldom observed in captured wild female eels. Therefore, the aim of this study is to try to investigate causes of ovulation problem frequently seen in cultured female eels by comparative trans-omics analyses. The omics data showed low growth hormone and luteinizing hormone transcription levels in the brain and low sex hormone–binding globulin transcription levels in the liver of the cultured female eels. In addition, it was found that high accumulation of glucose-6-phosphate and, maltose in the liver of the cultured female eel. It was also found that docosahexaenoic (DHA) acid, eicosapentaenoic acid (EPA) and arachidonic acid (ARA) ratios in cultured female eels were quite different from wild female eels. The data suggested that ovulation problem in cultured female eels was possibly resulted from prolonged intake of a high-carbohydrate diet and/or suboptimal DHA/EPA/ARA ratios in a diet. [ABSTRACT FROM AUTHOR]

Background: In the current meta-analysis, we aimed to systematically review and summarize the eligible studies evaluating the association between dietary acid load in terms of potential renal acid load (PRAL) and net-endogenous acid production (NEAP) with anthropometric parameters and serum lipids in adult population. Methods: In a systematic search from PubMed, Scopus, Web of Sciences and Cochrane electronic databases up to December 2018, relevant studies were included. Cross-sectional, case control or cohort studies evaluating the association between PRAL and NEAP with the mean values of body mass index (BMI), waist circumference (WC), low and high density lipoprotein cholesterol (LDL, HDL), triglyceride (TG), total cholesterol (TC) and the prevalence of obesity were included. Results: According to our results, having higher dietary acid load content in terms of high PRAL scores was associated with higher triglyceride concentrations (weighted mean difference (WMD): 3.468; confidence interval (CI): -0.231, 7.166, P = 0.04) and higher obesity prevalence (30% and 27% in highest versus lowest categories). Accordingly, being in the highest category of NEAP was associated with higher prevalence of obesity (25% and 22% in highest versus lowest category). In subgroup analysis, higher PRAL scores was associated with higher BMI in women (WMD: 0.122; CI: -0.001, 0.245; P = 0.049) and higher NEAP in men (WMD: 0.890; CI: 0.430, 1.350; P < 0.001). There was no association between dietary acid load and other studied parameters. Conclusions: In the current meta-analysis, high dietary acid load content was associated with higher serum triglyceride concentrations and higher obesity prevalence. Reducing dietary acid load content might be a useful preventive strategy against obesity and metabolic disorders. [ABSTRACT FROM AUTHOR]

Background: Clinical practice guidelines (CPGs) are representative methods for promoting the standardization of healthcare and improvement of its quality. Few studies have investigated changes in the quality of CPGs published in a country over time. Our aim was to investigate changes in the quality of CPGs over time in the context of the available infrastructure for CPG development, public interest in healthcare quality, and healthcare providers’ responses to this interest. Methods: All CPGs pertaining to evidence-based medicine (EBM) issued between 2000 and 2014 in Japan (n = 373) were evaluated using the Japanese version of the Appraisal of Guidelines for Research and Evaluation (AGREE) I. Additionally, time trends in quality were analyzed. Using a cut-off point based on the publication year of CPG development literature, the evaluated CPGs were classified into those published until 2008 (pre-2008) and those published since 2009 (post-2008). Subsequently, we compared these groups in terms of 1) first edition CPGs and its second editions, and 2) patients’ version of CPGs. Results: Scores on all six domains of AGREE I improved each year. A comparison of the first- and second-edition of CPGs (n = 64) showed that scores on all domains improved significantly after revision. Significant improvement was observed in three domains (#2 stakeholder involvement, #3 rigor of development, and #4 clarity of presentation) in the pre-2008 group and in all domains in the post-2008 group. The comparison between the pre- and post-2008 groups in terms of CPGs for patients showed that the score increased in only one domain (#1 scope and purpose). Conclusions: The number of published CPGs has been increasing and the quality of CPGs, as assessed using the AGREE I instrument, has been improving. These changes seem to be influenced by improvements in social infrastructure, such as the publication of CPG development procedures, availability of CPG preparation methodology training, and increase in CPG-related skills. [ABSTRACT FROM AUTHOR]

The diameter and vertical depth of sand crab tunnels in sandy beaches are usually restricted to a few centimeters scale and several tens of centimeters, respectively. We designed a study to determine what physical factors restrict tunnel diameter and predict the maximum attainable tunnel diameter and depth. We collected field data on the size and spatial distributions of ghost crab (Ocypode spp.) burrows on two sandy beaches (Kawage Beach in Tsu, Mie Prefecture, Japan and Sakieda Beach in Ishigaki, Okinawa Prefecture, Japan), where O. ceratophthalma dominants the ghost crab fauna. We measured burrow depths and distance from shoreline in concert with water content of sandy beaches. To explain our observed distributions of crab burrows in the field, we performed experiments in a lab microcosm, comprising a horizontal tunnel through wet sand. We measured the static stability of tunnel structures in relation to water content and two strengths computed from loading force exerted on the sand overlying the tunnels. By comparing field and experimental data, we found that crabs construct their burrows in appropriately wet zones (wet enough to provide sufficient cohesion of the sand grains in tunnel walls to prevent collapse) and that tunnel diameters and depths are sufficiently small to prevent deformation and collapse of their tunnels. [ABSTRACT FROM AUTHOR]

Background: Vitamin D has been reported to affect both innate, and acquired immunity with immune cells such as dendritic cells having the vitamin D receptors. The co-occurrence of the high prevalence of allergic diseases and vitamin D deficiency globally documented in recent decades, has prompted a hypothesis on whether there is a reasonable association between them. Objective: To investigate the association between serum vitamin D deficiency and allergic symptoms. Methods: Historical cohort. On a cohort study for the association between desert dust exposure and allergic symptoms in 3,327 pregnant women during spring and fall in 2011–2013 in Japan conducted as an adjunct study to the Japan Environment and Children’s Study, we promptly acquired subjects’ daily allergic symptom scores by sending a web-based questionnaire to each participant on some days. Of the 29,434 answers provided by 3,327 participating pregnant women, we extracted 13,356 answers from 1,475 pregnant women that were answered within a 3-month period after blood samplings. And we measured 25(OH)D levels on those samples to investigate the association between their vitamin D deficiency (serum 25(OH)D < 20ng/mL) and the occurrence of any allergic symptom (allergic symptom score> 0) within 3 months. Results: Serum 25(OH)D was less than 20ng/mL in 1,233 of 1,745 samples (70.7%). The adjusted odds ratio (aOR) for occurrence of any allergic symptom in deficient cases compared with non-deficient cases was 1.33 (95% CI: 1.07–1.64, p = 0.01). Further, vitamin D deficiency significantly enhanced the risk increase at desert dust events and at pollen exposure (p-values for interaction <0.1). Conclusion: We confirmed the association between serum vitamin D deficiency and allergic symptoms in Japanese pregnant women. [ABSTRACT FROM AUTHOR]

Purpose: To examine the foveal structure and vasculature in eyes with an idiopathic epiretinal membrane (ERM). Methods: Forty-nine eyes of 48 patients with an idiopathic ERM were studied. The superficial foveal avascular zone (FAZ) was measured by optical coherence tomography angiography (OCTA; RTVue XR Avanti, Optovue Inc., Fremont, CA), and the central foveal thickness (CFT) was measured by swept source OCT (DRI-OCT, Topcon, Japan). Twenty eyes underwent vitrectomy with internal limiting membrane (ILM) peeling, and the FAZ and CFT were evaluated pre- and postoperatively. Forty-nine eyes of 49 age-matched healthy subjects were also examined as control. Results: The FAZ in eyes with an ERM was significantly smaller than that of the control eyes (0.188±0.16 mm2 vs 0.328±0.14 mm2, P<0.01). The CFT in eyes with an ERM was significantly thicker than that of control eyes (315±0.14 μm vs 193±0.14 μm, P<0.01). The size of the FAZ was strongly correlated with the CFT (ERM, R = -0.753; control, R = -0.61, both P<0.01). The postoperative size of the FAZ was not significantly different from the preoperative size (0.115 mm2 vs 0.128 mm2, P = 0.17) but the CFT was significantly thinner (370 μm vs 288 μm, P<0.01) after the vitrectomy with ILM peeling in 20 eyes. Conclusions: The results indicate that an ERM might affect the morphology and vasculature of not only the inner but also the outer retina before and after vitrectomy with ILM peeling. The FAZ area might have been affected by the ILM peeling. [ABSTRACT FROM AUTHOR]

The complex nature of mental well-being is reflected in the great diversity of variables thought to represent aspects of mental flourishing. Discovering the underlying structure of mental well-being is important for a full understanding of this complex construct. Using data from 3 countries (the United States, Japan, and Iran), we performed multi-dimensional scaling to analyze the representation of 9 hedonic and eudaimonic well-being variables in a 2-dimensional psychological space. The analyses revealed 2 interpretable underlying dimensions across cultures and gender groups. The first dimension—eudaimonic well-being versus hedonic well-being—is well-known to well-being researchers. The second dimension—existential relatedness versus Epicurean independence—has not been recognized before. Existential relatedness is the characteristic of being meaningfully interconnected with things other than oneself, and is mainly based on the variables positive relations with others, personal growth, purpose in life, and life satisfaction. Epicurean independence is the characteristic of being relatively free of painful experiences and not feeling the need to have ones’ views accepted by anyone but oneself. Epicurean independence is mainly based on the variables autonomy and absence of negative affect. We explain these dimensions in detail and discuss the implications for well-being research and policy. [ABSTRACT FROM AUTHOR]

The aim of this study was to investigate the running pace and step characteristics among various competitive-level 400-m hurdlers through inter-group and intra-athlete comparisons. We analysed spatiotemporal data involving the split time, mean step length (SL) and mean step frequency (SF) for 13 male world-class and 14 male national-level 400-m hurdlers. We analysed 16.5 ± 3.9 races for each world-class hurdler and 19.8 ± 6.0 races for each national-level hurdler (the total number of analysed runs was 491) using publicly available television and internet broadcasts. Inter-group comparisons showed that both first- and latter-halves split times of the world-class hurdlers were significantly shorter than those of the national-level hurdlers. In the latter-half phase, no significant differences of SL and SF were observed between the world-class and national level hurdlers. Intra-athlete comparisons showed that no athletes favoured only first-half phase in terms of running speed in short finish times. In contrast, finish times of all hurdlers were sensitive to running speed in the latter-half phase. In the latter half of the race, 18 of the 27 hurdlers were identified as being SF reliant during speed enhancements; running speed of the other 9 hurdlers were also sensitive to high SF. In conclusions, important findings regarding high performance in inter-group comparisons do not always corresponded with those in intra-athlete comparisons. All athletes and coaches should first prioritize maintaining high running speeds in the latter half of 400-m hurdles rather than in the first half of the race. [ABSTRACT FROM AUTHOR]

Background: Assessment of infection-related mortality remains inadequate in patients undergoing peritoneal dialysis. This study was performed to develop a risk model for predicting the 2-year infection-related mortality risk in patients undergoing peritoneal dialysis. Methods: The study cohort comprised 606 patients who started and continued peritoneal dialysis for 90 at least days and was drawn from the Fukuoka Peritoneal Dialysis Database Registry Study in Japan. The patients were registered from 1 January 2006 to 31 December 2016 and followed up until 31 December 2017. To generate a prediction rule, the score for each variable was weighted by the regression coefficients calculated using a Cox proportional hazard model adjusted by risk factors for infection-related mortality, including patient characteristics, comorbidities, and laboratory data. Results: During the follow-up period (median, 2.2 years), 138 patients died; 58 of them of infectious disease. The final model for infection-related mortality comprises six factors: age, sex, serum albumin, serum creatinine, total cholesterol, and weekly renal Kt/V. The incidence of infection-related mortality increased linearly with increasing total risk score (P for trend <0.001). Furthermore, the prediction model showed adequate discrimination (c-statistic = 0.79 [0.72–0.86]) and calibration (Hosmer–Lemeshow test, P = 0.47). Conclusion: In this study, we developed a new model using clinical measures for predicting infection-related mortality in patients undergoing peritoneal dialysis. [ABSTRACT FROM AUTHOR]

Background: Understanding seasonality of tuberculosis (TB) epidemics may lead to identify potentially modifiable risk factors. Studies conducted outside Japan have found seasonal variation among reported TB cases, with peaks in spring and summer and low prevalence in fall and winter. One hypothesis regarding spring or summer peaks in TB epidemics is that TB transmission likely increases in winter because of indoor crowding and poor ventilation, with development of primary TB among socially vulnerable people in spring and summer. Another plausible explanation is that vitamin D deficiency in winter depresses immunity, increasing the TB reactivation risk in these seasons. Previous studies suggest latitude-dependent factors, including reduced winter sunlight and its effect on vitamin D levels. Here, we investigated mechanisms of seasonality in TB epidemics in Japan, according to the effects of crowding and latitude. Methods: We used time-series analysis consisting of spectral analysis and least-squares method, to analyse geographically specific monthly number of newly registered cases of all forms of active TB in all 47 prefectures of Japan during 1998–2015. Results: In all power spectral densities for the 47 prefectures, spectral lines were observed at frequency positions corresponding to a 1-year cycle. The degree of this seasonality was associated with population density. We did not detect greater amplitude of seasonality at higher latitudes, suggesting that latitude-dependent factors, including reduced winter sunlight and its potential effect on vitamin D levels, do not contribute significantly to seasonality in Japan. Discussion and conclusion: In districts with high population density, measures are needed to address two specific types of active infection risk in adolescents and middle-aged adults: (i) public transport use, and (ii) irregular employment with no periodic medical examinations. To control active TB epidemics, investigating periodic structures in the temporal patterns of active TB in each district and each age group is important. [ABSTRACT FROM AUTHOR]

This study examines how negative shocks due to, for example, natural disasters propagate through supply chains. We apply a simulation technique to actual supply chain data covering most Japanese firms. To investigate the property of the propagation in the network, we test different types of artificial negative shocks. We find that, first, network structures severely affect the speed of propagation in the short run, and the total loss in the long run. The scale-free nature of the actual supply-chain network—that is, the power-law degree distribution—leads to faster propagation. Second, more intensive damages—that is, more damages suffered by fewer firms—result in faster propagation than extensive damages of the same total size. Third, the actual supply-chain network has innate robustness that comes from substitutability of supplies. If the supply-chain network has severe substitutability, the propagation of negative shocks becomes substantially large. Fourth, direct damages in urban regions promote faster propagation than those in rural regions. Fifth, different sectoral damages show significant differences in the speed of propagation. Finally, we check the indirect damage triggered by a single firm’s loss: 9.7% of all firms contribute to significant loss, and this loss accounts for more than 10% of the damage to the entire production. The simulations conspicuously show that different direct damages, even if they have the same total magnitude of damages, can generate considerably different damages because of the structure of the supply-chain network. [ABSTRACT FROM AUTHOR]

Purpose: Abnormal fundus autofluorescence (FAF) potentially precedes onset of late age-related macular degeneration (AMD) in Caucasian patients. Many differences exist between Asian and Caucasian patients regarding AMD types and severity, gender, and genetic backgrounds. We investigated the characteristics of abnormal FAF and retinal sensitivity in the fellow eyes of Japanese patients with unilateral neovascular AMD. Methods: Sixty-six patients with unilateral neovascular AMD and abnormal FAF in the fellow eye were enrolled in this multicenter, prospective, observational study. The best-corrected visual acuity, fundus photographs, FAF images, and retinal sensitivity on microperimetry were measured periodically for 12 months. The FAF images were classified into eight patterns based on the International Fundus Autofluorescence Classification Group. The points measured by microperimetry were superimposed onto the FAF images and fundus photographs and classified as “within,” “close,” and “distant,” based on the distance from the abnormal FAF and other findings. The relationship between the location of the baseline abnormal FAF and retinal sensitivity was investigated. Results: In Japanese patients, patchy (33.3%) and focally increased (30.3%) patterns predominated in the abnormal FAF. Intermediate-to-large drusen was associated predominantly with hyperfluorescence and hypofluorescence. Neovascular AMD developed within 1 year in six (9.1%) eyes, the mean baseline retinal sensitivity of which was 12.8 ± 4.7 dB, significantly (p<0.002) lower than the other eyes. In 44 of the other 60 eyes, microperimetry was measurable at baseline and month 12 and the mean retinal sensitivity improved significantly from 13.5 ± 4.4 to 13.9 ± 4.8 dB (p<0.001), possibly associated with lifestyle changes (e.g., smoking cessation, antioxidant and zinc supplementation). The mean retinal sensitivities of points within and close to the abnormal FAF were 9.9 and 11.7 dB, respectively, which were significantly lower than the 14.0 dB of the points distant from the abnormal FAF. Conclusion: In Japanese patients, patchy and focally increased patterns predominated in the abnormal FAF. The retinal sensitivity was lower close to/within the abnormal FAF. FAF and microperimetry are useful to assess macular function before development of neovascular AMD or geographic atrophy. [ABSTRACT FROM AUTHOR]

Adolescent depression is a significant public health concern. Although skipping breakfast is associated with depressive symptoms in adolescents, the effects of dietary patterns on their depressive symptoms remain unknown. Therefore, this study aims to determine whether dietary patterns are associated with depressive symptoms among junior and senior high school students in Japan. A total of 441 junior high school students and 417 senior high school students participated in this study. The Center for Epidemiologic Studies Depression scale (CES-D) was used to measure the participants’ depressive symptoms. We surveyed the participants’ breakfast consumption pattern, as well as their general dietary patterns (meat, fish, green and yellow vegetables, milk and dairy products, and fruits), using a self-report questionnaire. The results indicated that the senior high school students had a significantly higher CES-D score than the junior high school students. We found negative and significant partial correlations between regular consumption of breakfast and depressive symptoms, and between regular consumption of green and yellow vegetables and depressive symptoms in both junior and senior high school students, after controlling for age, sex, and sleep duration. Furthermore, a one-way analysis of covariance (ANCOVA) revealed that adolescents who consumed green and yellow vegetables every day (one or more times per day) had significantly lower depressive symptoms than those from the “Never/1–2 times a week” group. The findings of this study reveal that the regular consumption of green and yellow vegetables is associated with lower depressive symptoms in adolescents, that is, the consumption of green and yellow vegetables may be vital in the context of adolescents’ mental health. [ABSTRACT FROM AUTHOR]

Concern about mental health issues and the treatment of mentally disordered offenders attracts considerable public attention. This study aimed to gather the experiences and opinions of people who have experienced admission to a psychiatric ward in order to grasp their reaction to, and understanding of, the legislation behind the involuntary admission of psychiatric patients. A web-based questionnaire survey was conducted with a total of 379 participants, using a cross-sectional, exploratory design. The data were analyzed using a chi-squared test, Fisher’s exact test, and a logistic regression analysis. According to the results, many patients were satisfied with their treatment during psychiatric admission; however, only few participants said that they had been given an adequate explanation for their involuntary treatment. Most participants expected qualified assistance after discharge, although the prospect of a regular visit from an official was not entirely supported by the participants. Patient satisfaction was relevant to the discussion of their needs after discharge and in developing a crisis plan during admission. These findings suggest that psychiatric patients accept inpatient treatment as long as they receive an adequate explanation. More qualified care such as relapse prevention would be expected to lead to better satisfaction. For them to welcome regular visits from an official, patients may need more information and discussion. [ABSTRACT FROM AUTHOR]

Various studies have determined that the Great East Japan Earthquake (GEJE) caused mental distress among residents in affected areas. However, previous studies had not considered the prevalence of mental distress before the GEJE, and ignored the impact of an aged society on mental distress. Therefore, we aimed to describe the prevalence of mental distress before the GEJE in Miyagi Prefecture, Japan and elucidate the effect of an aged society on mental distress. We conducted an ecological study, using municipality in Miyagi Prefecture as the study unit. We used the cross-sectional mail survey data conducted in February 2011. We performed a correlation analysis in each of the 39 municipalities in Miyagi Prefecture. The prevalence of serious mental distress was 9.1%. The proportion of the population aged 65 years or older was related to the prevalence of serious mental distress in municipalities with a low proportion of all workers engaged in primary industry and with a high estimated number of inpatients with mental illness. We found that residents in Miyagi Prefecture suffered from poor mental health before the GEJE. Aged society was related to serious mental distress in the areas with advanced industrial structure and more patients with mental illness. We should approach mental health problems in the context of social structure, particularly in an aged society, based on facts about mental distress before the GEJE. [ABSTRACT FROM AUTHOR]

Genome-wide association studies (GWASs) have identified many single nucleotide polymorphisms (SNPs) that are significantly associated with pancreatic cancer susceptibility. We sought to replicate the associations of 61 GWAS-identified SNPs at 42 loci with pancreatic cancer in Japanese and to develop a risk model for the identification of individuals at high risk for pancreatic cancer development in the general Japanese population. The model was based on data including directly determined or imputed SNP genotypes for 664 pancreatic cancer case and 664 age- and sex-matched control subjects. Stepwise logistic regression uncovered five GWAS-identified SNPs at five loci that also showed significant associations in our case-control cohort. These five SNPs were included in the risk model and also applied to calculation of the polygenic risk score (PRS). The area under the curve determined with the leave-one-out cross-validation method was 0.63 (95% confidence interval, 0.60–0.66) or 0.61 (0.58–0.64) for versions of the model that did or did not include cigarette smoking and family history of pancreatic cancer in addition to the five SNPs, respectively. Individuals in the lowest and highest quintiles for the PRS had odds ratios of 0.62 (0.42–0.91) and 1.98 (1.42–2.76), respectively, for pancreatic cancer development compared with those in the middle quintile. We have thus developed a risk model for pancreatic cancer that showed moderately good discriminatory ability with regard to differentiation of pancreatic cancer patients from control individuals. Our findings suggest the potential utility of a risk model that incorporates replicated GWAS-identified SNPs and established demographic or environmental factors for the identification of individuals at increased risk for pancreatic cancer development. [ABSTRACT FROM AUTHOR]

Background: Studies have suggested that musculoskeletal symptoms increase after natural disasters. The Great East Japan Earthquake (GEJE) and accompanying tsunami placed a huge financial burden on the local population. This study determined whether subjective economic hardship influenced the new onset of neck pain (katakori) in the chronic phase after the GEJE.Methods: This study used longitudinal data from 1359 adults who had responded to the self-report questionnaire at 2 and 3 years after the GEJE. New-onset neck pain was defined as neck pain absent at 2 years and present at 3 years. Subjective economic hardship at 2 years after the GEJE was categorized into 4 groups: "normal," "a little bit hard," "hard," and "very hard." Multiple logistic regression analysis was used to estimate the odds ratio (OR) and 95% confidence interval (CI) in order to examine the association between subjective economic hardship and new-onset neck pain.Results: Among the participants, 12.9% (n = 175) reported new-onset neck pain. A significantly higher rate of new-onset neck pain was observed in participants who considered their subjective economic hardship to be "hard" (OR = 2.10, 95% CI = 1.34-3.30) or "very hard" (OR = 3.26, 95% CI = 1.83-5.46; p for trend <0.001) compared with those who considered their hardship to be "normal."Conclusions: Subjective economic hardship was significantly associated with new-onset neck pain in the chronic phase of the GEJE. (228/300). [ABSTRACT FROM AUTHOR]

After the severe nuclear disaster in Fukushima, which was triggered by the Great East Japan earthquake in March 2011, nuclear power plants in Japan were temporarily shut down for mandatory inspections. To prevent large-scale blackouts, the Japanese government requested companies and households to reduce electricity consumption in summer and winter. It is reported that the domestic electricity demand had a structural decrease because of the electricity conservation effect (ECE). However, quantitative analysis of the ECE is not sufficient, and especially time variation of the ECE remains unclear. Understanding the ECE is important because Japan’s NDC (nationally determined contribution) assumes the reduction of CO2 emissions through aggressive energy conservation. In this study, we develop a time series model of monthly electricity demand in Japan and estimate time variation of the ECE. Moreover, we evaluate the impact of electricity conservation on CO2 emissions from power plants. The dynamic linear model is used to separate the ECE from the effects of other irrelevant factors (e.g. air temperature, economic production, and electricity price). Our result clearly shows that consumers’ electricity conservation behavior after the earthquake was not temporary but became established as a habit. Between March 2011 and March 2016, the ECE on industrial electricity demand ranged from 3.9% to 5.4%, and the ECE on residential electricity demand ranged from 1.6% to 7.6%. The ECE on the total electricity demand was estimated at 3.2%–6.0%. We found a seasonal pattern that the residential ECE in summer is higher than that in winter. The emissions increase from the shutdown of nuclear power plants was mitigated by electricity conservation. The emissions reduction effect was estimated at 0.82 MtCO2–2.26 MtCO2 (−4.5% on average compared to the zero-ECE case). The time-varying ECE is necessary for predicting Japan’s electricity demand and CO2 emissions after the earthquake. [ABSTRACT FROM AUTHOR]

Spawning ground of Japanese eel (Anguilla japonica) is located near the West Mariana Ridge seamount. The species travels through the North Equatorial Current (NEC) and then enters the Kuroshio Current (KC) on the migration toward East Asian growth habitats. Therefore, El Niño–Southern Oscillation (ENSO) events serve as the potentially important drivers of interannual variability across the equatorial Pacific. Because the NEC bifurcation and salinity profiles are related to ENSO events, we investigated the influence of locations of the NEC bifurcation and salinity front on the success of larval entry to the KC by numerically modeling particle transport in ocean currents from 1972 to 2013 and possible effects on the size of glass eels at continental recruitment and, via otolithometry on the duration of larval migration. Circulation and hydrography used for particle tracking were obtained from the results of the Model for Interdisciplinary Research on Climate (MIROC) high-resolution forecasting experiment. Our results demonstrated that during El Niño years, (1) the southward movement of the salinity front might cause the larvae to experience slower currents and (2) the northward movement of the NEC bifurcation might broaden the separation between their spawning ground and NEC bifurcation, thus prolonging the time needed for the larvae to enter the KC from their spawning ground, because of which the duration of entrainment in the water column and body size increase when eels reach estuarine waters. In addition, this might cause more water to flow into the Mindanao Current (MC), leading to a decline in the rate at which larvae get entrained into the KC. [ABSTRACT FROM AUTHOR]

The 2011 Great East Japan Earthquake and Tsunami resulted in widespread property destruction and over 250,000 displaced residents. We sought to examine whether the type of housing arrangement available to the affected victims was associated with a differential incidence of depressive symptoms. In this prospective cohort study, which comprised participants aged ≥65 years from Iwanuma as a part of the Japan Gerontological Evaluation Study, we had information about the residents' mental health both before the disaster in 2010 and 2.5 years afterward. The Geriatric Depression Scale was used. Type of accommodation after the disaster was divided into 5 categories: no move, prefabricated housing (temporary housing), existing private accommodations (temporary apartment), newly established housing, and other. Poisson regression analysis was adopted, with and without multiple imputation. Among the 2,242 participants, 16.2% reported depressive symptoms at follow-up. The adjusted rate ratio for depressive symptoms among persons moving into prefabricated housing, compared with those who did not, was 2.07 (95% confidence interval: 1.45, 2.94). Moving into existing private accommodations or other types of accommodations was not associated with depression. The relationship between living environment and long-term mental health should be considered for disaster recovery planning. [ABSTRACT FROM AUTHOR]

Earthquakes are a devastating phenomena of nature, causing significant destruction and extensive damage. Most earthquake-related injuries result from collapsing buildings, flying debris, and falling objects. Medical imaging modalities, in particular digital radiography, computed tomography, and sonography, are used to help manage and treat patients injured during an earthquake. Therefore, health care providers, including radiologic technologists, must be aware of the imaging considerations associated with earthquake-related injuries. [ABSTRACT FROM AUTHOR]

Background and aim: It is supposed that enhanced oxidative stress and inflammation are involved with the poor clinical outcomes in patients on chronic dialysis treatment. Recent studies have shown that molecular hydrogen (H2) is biologically active as an anti-inflammatory agent. Thus, we developed a novel hemodialysis (E-HD) system which delivers H2 (30 to 80 ppb)-enriched dialysis solution, to conduct a prospective observational study (UMIN000004857) in order to compare the long-term outcomes between E-HD and conventional-HD (C-HD) in Japan. The present interim analysis aimed to look at potential clinical effects of E-HD during the first 12 months observation. Subjects and method: 262 patients (140, E-HD; 122, C-HD) were subjected for analysis for comprehensive clinical profiles. They were all participating in the above mentioned study, and they had been under the respective HD treatment for 12 consecutive months without hospitalization. Collected data, such as, physical and laboratory examinations, medications, and self-assessment questionnaires on subjective symptoms (i.e., fatigue and pruritus) were compared between the two groups. Results: In a 12-month period, no clinical relevant differences were found in dialysis-related parameters between the two groups. However, there were differences in the defined daily dose of anti-hypertensive agents, and subjective symptoms, such as severe fatigue, and pruritus, which were all less in the E-HD group. Multivariate analysis revealed E-HD was an independent significant factor for the reduced use of anti-hypertensive agents as well as the absence of severe fatigue and pruritus at 12 months after adjusting for confounding factors. Conclusion: The data indicates E-HD could have substantial clinical benefits beyond conventional HD therapy, and support the rationale to conduct clinical trials of H2 application to HD treatment. [ABSTRACT FROM AUTHOR]

Background: Suicide rates are vastly higher in Japan than in many other countries, although the associations between affective temperaments and suicide-related ideations in the general adult population remain unclear. Therefore, we aimed to elucidate these associations in the present study. Methods: We analyzed data from 638 Japanese volunteers who completed both the Patient Health Questionnaire (PHQ-9) and the Temperament Evaluation of the Memphis, Pisa, Paris, and San Diego Auto-questionnaire (TEMPS-A). Participants were then divided into three groups based on PHQ-9 summary scores and responses to the suicide-related ideation item: non-depressive control group (NC; N = 469), depressive symptoms without suicide-related ideations group (non-SI; N = 135), and depressive symptoms with suicide-related ideations group (SI; N = 34). The depressive symptoms were defined for PHQ-9 summary scores ≥5, and the suicide-related ideations were defined for PHQ-9 #9 score ≥1. We then compared TEMPS-A scores among the groups using Kruskal-Wallis tests. Then the 95% confidence intervals of differences in TEMPS-A subscale scores between the NC and non-SI groups, or between NC and SI groups, were calculated. Results: Participants of the SI group exhibited significantly higher scores on the depressive, irritable, and anxious temperament subscales than those of the non-SI group. Similarly, women of the SI group exhibited significantly higher scores of the depressive and irritable temperament subscales than women of the non-SI group, while men of the SI group exhibited significantly higher depressive temperament scores than those of the non-SI group. Among all participants and only men, cyclothymic subscale scores were higher in those of the SI group than the non-SI group (not significant), although the 95% confidence intervals did not overlap. Limitations: The cross-sectional study design was the main limitation. Conclusions: Depressive, irritable, and anxious temperaments are significant risk factors for suicide-related ideations in the Japanese general adult population. Furthermore, irritable temperament in women and depressive temperament in men are associated with suicide-related ideations. [ABSTRACT FROM AUTHOR]

Background: Little information is available concerning how patient delay may be affected by mass disasters. The main objectives of the present study are to identify whether there was a post-disaster increase in the risk of experiencing patient delay among breast cancer patients in an area affected by the 2011 triple disaster in Fukushima, Japan, and to elucidate factors associated with post-disaster patient delay. Sociodemographic factors (age, employment status, cohabitant status and evacuation status), health characteristics, and health access- and disaster-related factors were specifically considered.Methods: Records of symptomatic breast cancer patients diagnosed from 2005 to 2016 were retrospectively reviewed to calculate risk ratios (RRs) for patient delay in every year post-disaster compared with the pre-disaster baseline. Total and excessive patient delays were respectively defined as three months or more and twelve months or more from symptom recognition to first medical consultation. Logistic regression analysis was conducted for pre- and post-disaster patient delay in order to reveal any factors potentially associated with patient delay, and changes after the disaster.Results: Two hundred nineteen breast cancer patients (122 pre-disaster and 97 post-disaster) were included. After adjustments for age, significant post-disaster increases in RRs of experiencing both total (RR: 1.66, 95% Confidence Interval (CI): 1.02-2.70, p < 0.05) and excessive patient delay (RR: 4.49, 95% CI: 1.73-11.65, p < 0.01) were observed. The RRs for total patient delay peaked in the fourth year post-disaster, and significant increases in the risk of excessive patient delay were observed in the second, fourth, and fifth years post-disaster, with more than five times the risk observed pre-disaster. A family history of any cancer was the only factor significantly associated with total patient delay post-disaster (odds ratio: 0.38, 95% CI: 0.15-0.95, p < 0.05), while there were no variables associated with delay pre-disaster.Conclusions: The triple disaster in Fukushima appears to have led to an increased risk of patient delay among breast cancer patients, and this trend has continued for five years following the disaster. [ABSTRACT FROM AUTHOR]

Background and Objectives: This study aimed to collect information on experiences in the Great East Japan Earthquake (hereafter, 3.11), current preparedness, and barriers to building up stockpiles in nursery schools in affected areas. Based on the needs heard from the staff, we decided what contents should be included in our manual developed with the Japan Dietetic Association.Methods and Study Design: A group interview was held in September 2012. We interviewed a principal, nurses, and registered dietitians working for a public and a private nursery school in Town A. We also invited an administrative dietitian who was an employee of Town A.Results: One of the barriers to building up stockpiles was that they did not have any idea of what and how many items they should store. To deal with this situation, we developed a formula that could be used to calculate the quantity of stockpiles for their facilities in a newly developed feeding manual. In terms of current preparedness, the registered dietitians were not prepared for alternative menus in emergencies or how to manage garbage when the garbage collection was disrupted by disasters. The manual recommends to obtain the services of at least two food service personnel and spare space for storing filled garbage bags until garbage collection resumes.Conclusion: Some improvements in stocks were found in both of the public and private nursery schools. To improve the situation further, more financial support and detailed guidelines should be provided by the local government and authoritative organizations. Our manual should be a great asset for all nursery schools to improve their stockpiles. [ABSTRACT FROM AUTHOR]

Background: On 11 March 2011, the Great East Japan Earthquake, followed by a tsunami and nuclear-reactor meltdowns, produced one of the most severe disasters in the history of Japan. The adverse impact of this 'triple disaster' on the health of local populations and the health system was substantial. In this study we examine population-level health indicator changes that accompanied the disaster, and discuss options for re-designing Fukushima's health system, and by extension that of Japan, to enhance its responsiveness and resilience to current and future shocks.Methods: We used country-level (Japan-average) or prefecture-level data (2005-2014) available from the portal site of Official Statistics of Japan for Fukushima, Miyagi, and Iwate, the prefectures that were most affected by the disaster, to compare trends before (2005-2010) and after (2011-2014) the 'disaster'. We made time-trend line plots to describe changes over time in age-adjusted cause-specific mortality rates in each prefecture.Findings: All three prefectures, and in particular Fukushima, had lower socio-economic indicators, an older population, lower productivity and gross domestic product per capita, and less higher-level industry than the Japan average. All three prefectures were 'medically underserved', with fewer physicians, nurses, ambulance calls and clinics per 100 000 residents than the Japan average. Even before the disaster, age-adjusted all-cause mortality in Fukushima was in general higher than the national rates. After the triple disaster we found that the mortality rate due to myocardial infarction increased substantially in Fukushima while it decreased nationwide. Compared to Japan average, spikes in mortality due to lung disease (all three prefectures), stroke (Iwate and Miyagi), and all-cause mortality (Miyagi and Fukushima) were also observed post-disaster. The cause-specific mortality rate from cancer followed similar trends in all three prefectures to those in Japan as a whole. Although we found a sharp rise in ambulance calls in Iwate and Miyagi, we did not see such a rise in Fukushima: a finding which may indicate limited responsiveness to acute demand because of pre-existing restricted capacity in emergency ambulance services.Conclusions: We analyze changes in indicators of health and health systems infrastructure in Fukushima before and five years following the disaster, and explored health systems' strengths and vulnerabilities. Spikes in mortality rates for selected non-infectious conditions common among older individuals were observed compared to the national trends. The results suggest that poorer reserves in the health care delivery system in Fukushima limited its capacity to effectively meet sudden unexpected increases in demand generated by the disaster. [ABSTRACT FROM AUTHOR]

Objective: The Great East Japan Earthquake occurred on 11 March 2011 near the northeast coast of the main island, ‘Honshu’, of Japan. It wreaked enormous damage in two main ways: a giant tsunami and an accident at the Fukushima Daiichi Nuclear Power Plant (FDNPP). This disaster may have affected the distribution of physicians in the region. Here, we evaluate the effect of the disaster on the distribution of hospital physicians in the three most severely affected prefectures (Iwate, Miyagi, and Fukushima). Methods: We obtained individual information about physicians from the Physician Census in 2010 (pre-disaster) and 2012 (post-disaster). We examined geographical distributions of physicians in two ways: (1) municipality-based analysis for demographic evaluation; and (2) hospital-based analysis for geographic evaluation. In each analysis, we calculated the rate of change in physician distributions between pre- and post-disaster years at various distances from the tsunami-affected coast, and from the restricted area due to the FDNPP accident. Results: The change in all, hospital, and clinic physicians were 0.2%, 0.7%, and −0.7%, respectively. In the municipality-based analysis, after taking account of the decreased population, physician numbers only decreased within the restricted area. In the hospital-based analysis, hospital physician numbers did not decrease at any distance from the tsunami-affected coast. In contrast, there was a 3.3% and 2.3% decrease in hospital physicians 0–25 km and 25–50 km from the restricted area surrounding the FDNPP, respectively. Additionally, decreases were larger and increases were smaller in areas close to the FDNPP than in areas further away. Conclusions: Our results suggest that the tsunami did not affect the distribution of physicians in the affected regions. However, the FDNPP accident changed physician distribution in areas close to the power plant. [ABSTRACT FROM AUTHOR]

Background: Antineutrophil cytoplasmic antibody-associated vasculitis is triggered by environmental factors, including silica dust exposure. Repeated tsunami waves brought a large volume of silica-containing sludge inland after the Great East Japan earthquake in 2011. We aimed to determine if the serious disaster influenced the clinical features of the microscopic polyangiitis. Methods: This is an observational retrospective study conducted in a single institute. A total of 43 patients were included based on the CHCC2012 criteria for microscopic polyangiitis from 2007 to 2015. We used the Poisson regression model to determine the incidence of microscopic polyangiitis within the annual population of the medical district. The participants were selected during a 3-year period from before (N = 13) to after the disaster (N = 20). The differences of parameters and the overall survival between the groups were analyzed. Results: The incidence of microscopic polyangiitis increased after the disaster (λ = 17.4/million/year [95%CI: 7.66–39.6] before the disaster and λ = 33.1/million/year [17.7–61.7] after the disaster, P = 0.044). A high Birmingham Activity Score was associated with a high incidence of microscopic polyangiitis after the disaster. The overall survival of the patients with microscopic polyangiitis declined significantly after the disaster. Conclusions: The Great East Japan earthquake influenced the development of the microscopic polyangiitis in our restricted area. The patients who developed after the disaster had severe symptoms and a high mortality rate. [ABSTRACT FROM AUTHOR]

Background: The Great East Japan Earthquake and devastating Tsunami hit hard everything on the northeastern coast of Japan. This study aimed to determine socio-psychological factors for "subjective shoulder pain" of the survivors at 2 years evaluated by a self-report questionnaire.Methods: Between November 2012 to February 2013, survivors replied to the self-report questionnaire, and 2275 people consented to join this study. Living status was divided into 5 categories (1. same house as before the earthquake (reference group), 2. temporary small house, 3. apartment, 4. house of relatives or acquaintance, 5. new house) and economic hardship was divided into 4 categories (1. normal (reference group), 2. a little bit hard, 3. hard, 4. very hard). Gender, age, body mass index, living areas, smoking and drinking habits, complications of diabetes mellitus and cerebral stroke, working status, and walking time were considered as the confounding factors. Kessler Psychological Distress Scale of ≥10/24 and Athens Insomnia Scale of ≥6/24 points were defined as a presence of psychological distress and sleep disturbance, respectively. We used multiple logistic regression analysis to examine the association of shoulder pain with living environment, economic hardship, psychological distress, and sleep disturbance at 2 years after the earthquake.Results: There were significant differences in the risk of having shoulder pain in those with "apartment" (OR = 1.74, 95% CI = 1.03-2.96), "house of relatives or acquaintance" (OR = 2.98, 95% CI = 1.42-6.25), economic hardship of "hard" (OR = 1.71, 95% CI = 1.08-2.7) and "very hard" (OR = 2.51, 95% CI = 1.47-4.29), and sleep disturbance (OR = 2.96, 95% CI = 2.05-4.27).Conclusions: Living status of "apartment" and "house of relatives or acquaintance", economic hardship of "hard" and "very hard", and "sleep disturbance" were significantly associated with shoulder pain. [ABSTRACT FROM AUTHOR]