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This paper aims to determine via responses to three questionnaire surveys how sexuality education programs are conducted at junior high schools in Japan. Study 1 examined the practice of sexuality education in schools, Study 2 investigated junior high school students' (age 12–13 and 14–15 years) knowledge of sexuality, and Study 3 examined parents'/guardians' views on sexuality education. For Study 1, 703 principals of 5158 junior high schools returned an original questionnaire (13.6% recovery rate), and for Studies 2 and 3, 9492 students and 5374 parents returned questionnaires (86.2% and 60.3% recovery rate, respectively). In Study 1, an average of 9.19 hours of instruction was allocated to sexuality education over three grades. In Study 2, the average correct response rate was as low as 34.5% for boys and 39.4% for girls, with many answering ‘I don't know.’ Approximately one-half of the boys indicated there was nothing in particular they wanted to know about sex and no-one they wanted to consult. In Study 3, parents viewed school as a more appropriate setting than home for teaching physiological aspects of sexuality and providing accurate information. From the results of the three studies, we discuss the current situation and future challenges for sexuality education in Japan. [ABSTRACT FROM PUBLISHER]

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Rules and regulations for ambulance operations differ across countries and regions, however, little is known about ambulance crashes outside of the United States. Japan is unique in several aspects, for example, routine use of lights and sirens during response and transport regardless of the urgency of the case and low speed limits for ambulances. The aim of this study was to describe the incidence and characteristics of ambulance crashes in Japan. We retrospectively analyzed data from the Institute for Traffic Accident Research and Data Analysis (ITARDA) that include all traffic crashes resulting in injury or death in Japan. The study included all ambulance crashes from 2009 to 2018. We compared crashes that occurred during emergency operations with lights and sirens (i.e., when responding to a call or transporting a patient) to those that occurred during non-emergency operations without lights or sirens. We also used data on total number of ambulance dispatches from the Japanese Fire and Disaster Management Agency to calculate ambulance crash risk. During the 10-year period, we identified a total of 486 ambulance crashes out of 59,208,761 ambulance dispatches (0.82 in every 100,000 dispatches or one crash for every 121,829 dispatches) that included two fatal crashes. Among all ambulance crashes, 142 (29.2%) occurred during emergency operations. The incidence of ambulance crashes decreased significantly over the 10-year period. Ambulance crashes at an intersection occurred more frequently during emergency operations than during non-emergency operations (72.5% vs. 58.1%; 14.4% difference, 95% CI 5.0–22.9). Ambulance crashes occurred infrequently in Japan with crash rates much lower than previously reported crash rates in the United States. Ambulance crashes during emergency operations occurred more frequently at intersections compared to non-emergency operations. Further investigation of the low Japanese ambulance crash rates could provide opportunities to improve ambulance safety in other countries. [ABSTRACT FROM AUTHOR]

Kyphosis may reduce the force of coughing by affecting the factors related to cough peak flow (CPF). This study sought to compare cough strength and respiratory function between non-kyphotic and kyphotic elderly individuals and clarify the relationship between these factors. The non-kyphotic group comprised 17 elderly individuals with a kyphosis index of less than 15.1, while the kyphotic group comprised 21 elderly individuals with a kyphosis index of 15.1 or higher. Cough strength, respiratory function, respiratory muscle strength, and maximum phonation time were measured, and comparison between two groups and correlation analysis between variables were performed. CPF, vital capacity, maximum expiratory pressure (PEmax), maximum inspiratory pressure (PImax), and chest expansion at the xiphoid process were significantly lower in the kyphotic group than in the non-kyphotic group. There were significant negative correlations between kyphosis index and CPF (r = −0.37, p < 0.05), PEmax (r = −0.45, p < 0.01), PImax (r = −0.44, p < 0.01) and chest expansion at the xiphoid process (r = −0.38, p < 0.05). Our results demonstrated that cough strength was significantly lower in the kyphotic compared to non-kyphotic individuals. Furthermore, cough strength decreased with increased severity of kyphosis. [ABSTRACT FROM AUTHOR]

This study aimed to examine the effects of substitute player allowance per match on running performance in Japanese professional football over three consecutive seasons with different numbers of maximum substitutes. Match running performance was obtained from all outfield players in the official matches of the 1st Division of the Japan Professional Football League over three seasons (2019/2020/2021; 22291 player files) by a 4th generation TRACAB® system which provided the total distance covered (TD) and the number of sprinting runs (SP; ≥24.0 km/h for≥1.0 s). The players were divided according to play time: full match (STA), replaced during match (REP), and substitutes during match (SUB). The number of SUBs increased significantly from 2019 to 2021 (p < 0.05). SUB had a significantly higher average speed than STA and REP. The analysis of covariance with the number of recovery days, ambient temperature, and relative humidity as covariates revealed that the TD and SP significantly differed based on the number of SUBs (p < 0.05). Stepwise regression analysis showed that the number of SUBs significantly contributed to the TD and SP. These results suggest that the new law, which increased the maximum SUB allowance from three to five, improved the match running performance in Japanese professional football. [ABSTRACT FROM AUTHOR]

This study investigated whether dual tasks comprising cognitive tasks and occupations related to daily living can improve the mental and cognitive function of Japanese community-dwelling older adults. Participants included 30 older adults, equally divided into intervention and control groups. The outcome measures were memory, attention, depression, and health-related quality of life. No adverse effects of the intervention were observed in any participant in the intervention group. Logical memory I, logical memory II, and Center for Epidemiologic Studies Depression Scale scores showed a significant interaction. Dual tasks combining cognitive tasks and occupations may help improve delayed recall and alleviate depression. A novel attempt to integrate cognitive stimulation and activities valued by individuals may help mediate age-related cognitive function decline and reduce depressive symptoms in community-dwelling older adults. [ABSTRACT FROM AUTHOR]

Home adaptations are integral for inpatients with fall-related fractures, especially during discharge. However, it is unclear as to how patient-implemented home evaluations can be prioritized with limited professional rehabilitation resources. This study examines the associations between predisposing, enabling, and needs factors with the implementation of home evaluations in the eastern district of Tokyo. Being a female and lower comprehension in cognitive function was significantly associated with the implementation of home evaluations. It may be necessary to consider patients' cognitive function when deciding who to target for housing evaluations and to seek strategies to best estimate their needs. [ABSTRACT FROM AUTHOR]

After the Great East Japan Earthquake in March 2011, providing support for older adults who continued to live in the affected areas has been a critical issue. We examined the effects of programs to address how challenges of daily living impact individuals' health-related quality of life (HRQOL). This was a 14 session, quasi-experiment trial that included 89 older adults aged 65 years or older who continued to live in the earthquake-affected areas. Participants were assigned to one of two programs: 48 older adults participated in the program "activities and participation", aimed at addressing the challenges of daily living such as loss of habits, meaning to live, social and domestic roles, and leisure; and 44 older adults participated in the program "body functions and structures", aimed at improving their physical functions. Differences between groups were assessed using chi-square tests, t-tests, Mann-Whitney U tests, and Wilcoxon signed-rank tests. The "activities and participation" program was effective in advancing participants' HRQOL (p <.01, effect size = 0.51). Further, it may lead to improved physical functions. This study indicates that, in a post-disaster response, it is effective to focus on challenges of daily living while considering the QOL of affected older adults. The program was useful in helping older adults affected by disasters to rebuild their lives as part of a disaster response. [ABSTRACT FROM AUTHOR]

Processing fluency (the inferred subjective ease with which people process information) has been a topic of increasing research attention in the field of psychology over the past decade. We examined the effect of improving written materials in terms of processing fluency with regard to encouragement for obtaining breast and cervical cancer screening. We randomly assigned 670 women to intervention or control conditions; the 215 who mailed back distributed questionnaires were the study participants. A standard leaflet for cancer screening was mailed to the control group, while the materials mailed to the intervention group were improved in terms of perceptual fluency (e.g., legibility), linguistic fluency (e.g., readability), retrieval fluency (e.g., reducing amount of information) and imagery fluency (having recipients imagine future behavior and events). The screening rate of the intervention group was significantly higher than that of the control group (29.4% vs. 14.2%, χ2 = 7.275, df = 1, p = .007, φ = .184). Improving the processing fluency of written materials may be useful for encouraging individuals to obtain breast and cervical cancer screening. [ABSTRACT FROM AUTHOR]

Background: As context may impact everyday technology (ET) use it is relevant to study this within different contexts. Aims: To examine the usefulness of the Everyday Technology Use Questionnaire (ETUQ) in different contexts by investigating and comparing (1) the level of challenge of ETs in the ETUQ and (2) the relevance of and perceived ability to use ET in samples of Swedish and Japanese older adults. Materials and methods: The Swedish and the Japanese samples (n = 86/86) were interviewed using the ETUQ about relevance of and perceived ability to use ET. Data were analyzed using Rasch analysis, chi square and a general linear model. Moreover, Differential Item Functioning (DIF) was investigated. Results: The hierarchy of ETs' level of challenge was generally stable in the two contexts. On group-level, the relevance was somewhat higher and the perceived ability to use ET significantly higher in the Swedish sample than in the Japanese. Conclusions and significance: The similarities and differences between the technological landscapes of Sweden and Japan could be detected by ETUQ, demonstrating its usefulness in both countries. The potential causes to the differences in relevance of and perceived ability to use ET between older adults in Sweden and Japan need further exploration. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to evaluate the relationship between sexual activity and sexual function using questionnaires distributed to middle-aged Japanese patients with localized prostate cancer.Methods: A total of 145 patients who underwent radical prostatectomy were enrolled in the survey reported on herein. Sexual activity and sexual function were investigated via the Expanded Prostate Cancer Index Composite (EPIC) and an original self-reported questionnaire.Results: Of participants, 24.1% and 20.7% had sexual activity within a month period as investigated via the EPIC and original questionnaire, respectively. However, 29.7% of all those who reported sexual activity rate reported "about once every 2 months to a year," as shown in the original questionnaire. Regarding sexual function as addressed through EPIC, no results within that questionnaire's measure of sexual function showed significant differences among patients with a rate of actual sexual activity.Conclusions: The present survey showed that more than quarter of preoperative middle-aged Japanese prostate cancer patients surveyed had actual sexual activity, though not within the preceding 4 weeks. To precisely evaluate sexual function of middle-aged Japanese patients, it is necessary to consider actual sexual activity. [ABSTRACT FROM AUTHOR]

Objectives: Using a large-scale nationwide survey database, we investigated the epidemiological characteristics for idiopathic SSNHL in Japan. Methods: The subjects for this analysis were patients registered in a Japanese multicentre database between April 2014 and March 2016. A total of 3419 idiopathic SSNHL patients were registered in the database, and the clinical characteristics of the idiopathic SSNHL patients were obtained. Several factors associated with the severity of hearing impairment and prognosis were then investigated. Statistical analysis was performed to clarify the factors associated with the severity of hearing impairment and prognosis. Results: There were significant correlations between the severity of hearing loss and diabetes mellitus, kidney disease, past history of brain infarction, heart disease, age (under 16 years/elderly), and symptoms of vertigo/dizziness. We also analyzed the prognostic factors for idiopathic SSNHL, and found that the severity of hearing loss (Grade 3 or 4), heart disease, aged 65 years or over, time from onset to treatment (over 7 days), and symptoms of vertigo/dizziness were all significantly related to poor prognosis. Conclusion: The present large-scale clinical survey revealed current epidemiological trends for idiopathic sudden sensorineural hearing loss (SSNHL) and various factors associated with the severity of hearing impairment and prognosis. [ABSTRACT FROM AUTHOR]

Objectives: A nationwide epidemiological survey involving 23 hospitals in Japan was conducted and the predictive values of demographic data were examined statistically. Methods: A total of 642 patients from 23 hospitals, including 20 university hospitals, in Japan were enrolled in the study. Age ranged from 8 to 87 years, and all were diagnosed with acute low-tone sensorineural hearing loss (ALHL) between 1994 and 2016. Demographic data for the patients, such as symptoms, gender, mean age, and distribution of ALHL grading, were collected and analyzed in relation to prognosis using Student’s t-test, χ2 test and logistic regression. Results: Female gender (p < .013), younger age (p < .001), low-grade hearing loss (p < .001), and shorter interval between onset and initial visit (p < .004) were significantly predictive of a good prognosis. The prognosis for definite ALHL was significantly better than that for probable ALHL (p < .007). Conclusions: The severity of initial hearing loss, interval between onset and initial visit and age were important prognostic indicators for ALHL, while female gender was an important prognostic indicator peculiar to ALHL. [ABSTRACT FROM AUTHOR]

Conclusions:The comorbidity of sleep disturbance with chronic dizziness in women was related to the intensity of distress and interference with their lives due to dizziness, although it was not related to objective variables of dizziness. In addition, the presence of sleep disturbance was associated with severe anxiety and depression, and low health-related quality-of-life (QoL). Objectives:This study investigated the effect of sleep disturbance in patients with chronic dizziness on symptoms of dizziness, handicaps due to dizziness, health-related QoL, and emotional distress. Method:The participants of this study were 252 in-patients with chronic dizziness. Participants completed questionnaires containing the Dizziness Handicap Inventory (DHI, three sub-scales: Physical [DHI-P], Emotional [DHI-E], and Functional [DHI-F] scores), Pittsburgh sleep quality index (PSQI-J), Hospital Anxiety and Depression Scale (HADS), and Medical Outcomes Study 8-items Short Form Health Survey (SF-8, health-related QoL). The participants then underwent gravity center fluctuation measurement as an objective indicator of the severity of dizziness. Results:The prevalence of sleep disturbance (PSQI-J global score ≧6) was 65.1% in these participants. Two-way ANOVA of the DHI scores showed significant interaction between sleep disturbance and sex in DHI total, DHI-E score, and DHI-F score, indicating that these scores were higher in women with sleep disturbance. Regarding DHI-P score, only the main effect of sex was significant (women > men). Sleep disturbance had no significant effect on objective indicators of severity of dizziness. Patients with sleep disturbance had significantly higher HADS scored and a lower SF-8 scored than patients without sleep disturbance. [ABSTRACT FROM PUBLISHER]

Conclusion:All definite Meniere’s disease (MD) had endolymphatic hydrops (EH) at least in the cochlea or the vestibule. Symptoms of MD may appear after formation of EH. It is assumed that the probability of immediate progression to bilateral MD from unilateral MD is very low in patients without EH on the non-affected side. Objective:To evaluate the EH on both sides in patients with unilateral and bilateral MD, and to investigate factors with progression to bilateral MD including the degree of EH, hearing level, and the duration of MD. Patients and methods:The study included 29 patients with unilateral definite MD and 12 patients with bilateral definite MD. The endolymphatic space size was visualized by using 3-Tesla magnetic resonance imaging. Results:All patients with unilateral and bilateral MD had significant or mild EH at least in the cochlea or the vestibule on the affected side. On the non-affected side, EH was not observed at all in eight patients, but asymptomatic EH was observed in the cochlea in 14 patients and in the vestibule in 16 patients. There was no relationship between the EH on the non-affected side and the duration of MD. [ABSTRACT FROM PUBLISHER]

Objective: To investigate the impact of stroke on health status and the effects of repetitive facilitation exercises (RFEs) for convalescent patients after stroke. Methods: The study was a prospective observational study of patients enrolled in an RFE programme. Between April 2008 and March 2012, 468 patients with stroke were enrolled in an intensive, comprehensive RFE programme. Patients participated in this interdisciplinary programme for 12 weeks, for an average of 5 hours per week. Before and immediately after the programme, several measures of rehabilitation outcomes and health-related quality-of-life were evaluated. Results: At baseline, most patients (95.4%) had modified Rankin scale scores of 3–5. Their health-related quality-of-life was significantly impaired, with physical and mental component summary scores on the Short Form 36-item questionnaire (SF-36) of 30.7 and 35.8, respectively. After the RFE programme, all outcome measures improved significantly. Conclusions: The results demonstrate that convalescent patients after stroke may benefit substantially from RFE programmes in stroke rehabilitation centres, even when patients have impaired health status or high levels of healthcare utilization. Thus, an RFE programme is a simple yet highly effective means to improve rehabilitation outcomes and health-related quality-of-life, with a relatively low dropout rate. [ABSTRACT FROM PUBLISHER]

We examined the cultural influence on perceived body weight and the level of health practices at a national and individual level. At a national level, we found that Japanese women (n = 80) overestimate body weight more than Korean (n = 82) and American (n = 63) women. At an individual level, individuals with interdependent self-construal were more prone to overestimate weight than those with independent self-construal (N = 182; American women). Based on the data, we identify that the relationship is mediated by self-criticism, and, importantly, it is self-criticism rather than perceived overweight that predicts the level of health activities. Health practitioners and campaign designers across cultures are recommended to concentrate on promoting positive body esteem instead of encouraging engagement in corrective health behaviors for weight loss. [ABSTRACT FROM AUTHOR]

End-of-life care decision making has become a matter of serious ethical and legal concern in the three Far East Asian Countries of China, Japan, and Korea. Researchers in the three countries collaboratively conducted a comparative descriptive study with respect to physicians’ perspectives concerning end-of-life care decisions. In spite of cultural similarities, each country has its own unique set of social, cultural, and political circumstances. So the content and scope of policies and laws on end-of-life decision reflect the differing views of people based on their social status, moral values, religious beliefs, and economic status. [ABSTRACT FROM PUBLISHER]

Conclusion:Red cell distribution width (RDW) can predict outcome in patients with idiopathic sudden sensorineural hearing loss (ISSNHL). Further studies are required to clarify the potential pathophysiological explanations for these findings. Objectives:RDW is one of the parameters reported in a complete blood count, and is elevated in direct proportion to variation in red cell size (anisocytosis). High RDW values are strongly associated with poor clinical outcomes in various diseases, including inflammatory and thrombotic diseases. To identify a prognostic biomarker that better predicts outcomes after ISSNHL, the association between RDW values at hospitalization and prognosis in patients with ISSNHL was assessed. Method:This study measured RDW and performed hearing assessments in 89 consecutive patients with ISSNHL. Patients were then divided into two groups (‘recovered’ and ‘unrecovered’), according to their response to the treatment, and further analysis undertaken. Results:Mean RDW was significantly higher in the unrecovered group (13.2% ± 1.0% compared with 12.7% ± 0.7% in the recovered group,p = 0.031). After adjusting for potentially confounding factors in a binary logistic regression model, only RDW was associated with recovery from ISSNHL (odds ratio = 2.33, 95% confidence interval = 1.20–4.51,p = 0.012). [ABSTRACT FROM PUBLISHER]

Background/Study Context: Older adults tend to be affected by task-irrelevant distracters. However, whether or not this aging effect is evident when task-irrelevant and relevant stimuli are presented across different sensory modalities is still a subject of debate. The purpose of the present study was to clarify age-related differences in the effects of auditory distraction on visual information processing. Methods: Participants included 20 young individuals, 20 younger-old individuals in their 60s, and 20 older-old individuals in their 70s. Visual n-back (1-back, 2-back) working memory (WM) tasks using Japanese words were examined with and without auditory distracter conditions. Participants' performances were analyzed using a three-way analysis of variance: 3 (age group) × 2 (distraction) × 2 (working memory load). Results: The effects of auditory distractions were influenced by aging and WM load. Auditory distractions disturbed WM performances preferentially in older adults. Further, participants in the older-old group were more affected by auditory distractions than those in the younger-old group, especially during the 2-back task. Conclusion: These results suggested that the WM performances for visual n-back tasks were largely disturbed by auditory distractions in older adults but not in young adults. [ABSTRACT FROM AUTHOR]

ConclusionThe results suggest that SOD1 rs4998557 could be associated with susceptibility to SSNHL in the Japanese population.ObjectivesTo assess the gene association with sudden sensorineural hearing loss (SSNHL).MethodsA two-stage case control study was conducted to explore the relationship of the candidate genes to SSNHL. The 192 gene samples from SSNHL patients registered in the intractable inner ear disease gene bank were enrolled. As the candidate genes, 39 SNPs from 31 genes were selected for the first stage study. The second stage study examined whether the SOD1 gene polymorphisms, defined by significant differences between cases and controls in the first stage study, are associated with SSNHL.ResultsSignificant differences were observed in four SNPs from three genes, Glutathione-S-transferase pai 1 (GSTP1), proteine kinase C heta (PRKCH), and superoxide dismutase 1 (SOD1), in terms of allele frequency between SSNHL patients and HapMap controls. In the SOD1 gene, a significant difference was observed in the dominant model study of the SNP rs4998557 in the second stage study. Furthermore, as a result of dividing SSNHL patients based on the clinical data, the difference was more apparent in the case of the over 60 dB group and the tinnitus–positive group. [ABSTRACT FROM PUBLISHER]

We clarified the preparedness necessary to protect the health of community-dwelling vulnerable elderly people following natural disasters. We collected data from 304 community general support centres throughout Japan. We found the following in particular to be challenging: availability of disaster-preparedness manuals; disaster countermeasures and management systems; creation of lists of people requiring assistance following a disaster; evacuation support systems; development of plans for health management following disasters; provision of disaster-preparedness guidance and training; disaster-preparedness systems in the community; disaster information management; the preparedness of older people themselves in requiring support; and support from other community residents. [ABSTRACT FROM PUBLISHER]

Conclusion: The prevalence of low-tone hearing loss (LTHL) is significantly high in spinocerebellar degeneration (SCD) with cerebellar predominance, including multiple-system atrophy C (MSA-C) and cortical cerebellar atrophy (CCA).Objective: This study aimed to test the hypothesis that SCD with cerebellar predominance, MSA-C and CCA may cause auditory symptoms.Methods: The shape and threshold of pure-tone audiograms were evaluated for MSA-C (n = 47; mean (± SD) age, 61.6 ± 8.9 years), CCA (n = 16; 62.8 ± 9.5 years), and age-matched controls (n = 169; 62.5 ± 10.7 years). To differentiate specific hearing loss for MSA-C and CCA from presbycusis, the shape of audiograms was examined based on previously established audiological criteria.Results: When audiogram shape was defined according to audiological criteria, the odds ratio for LTHL in SCD compared to controls was 2.492 (95% confidence interval (CI) = 1.208–5.139;p < 0.05, Pearson’s Chi-square test) in MSA-C and 2.194 (95% CI = 0.709–6.795) in CCA. When the selection of audiogram shape according to these criteria was verified by three certified audiologists, odds ratios for LTHL in MSA-C and CCA were 3.243 (95% CI = 1.320–7.969) and 3.692 (95% CI = 1.052–12.957), respectively, significantly higher than in controls. [ABSTRACT FROM PUBLISHER]

Relative age effect (RAE) in sports has been well documented. Recent studies investigate the effect of birthplace in addition to the RAE. The first objective of this study was to show the magnitude of the RAE in two major professional sports in Japan, baseball and soccer. Second, we examined the birthplace effect and compared its magnitude with that of the RAE. The effect sizes were estimated using a Bayesian hierarchical Poisson model with the number of players as dependent variable. The RAEs were 9.0% and 7.7% per month for soccer and baseball, respectively. These estimates imply that children born in the first month of a school year have about three times greater chance of becoming a professional player than those born in the last month of the year. Over half of the difference in likelihoods of becoming a professional player between birthplaces was accounted for by weather conditions, with the likelihood decreasing by 1% per snow day. An effect of population size was not detected in the data. By investigating different samples, we demonstrated that using quarterly data leads to underestimation and that the age range of sampled athletes should be set carefully. [ABSTRACT FROM AUTHOR]

Conclusions: Tracheoesophageal diversion (TED) and laryngotracheal separation (LTS) can prevent aspiration pneumonia and improve the morbidity of patients with severe motor and intellectual disability (SMID). By improving hospitalization rates and care needs, the quality-of-life can be improved for the patients and their parents. Objectives: This study evaluated the clinical outcomes of TED and LTS in patients with intractable aspiration and SMID. Methods: This study retrospectively reviewed patients with SMID and intractable aspiration pneumonia who underwent TED or LTS at the institution between January 2008 and January 2015. It assessed the frequency of sputum suctioning, the number of pre-operative and post-operative hospitalizations, the operative time, and complications. Results: Forty patients were identified during the study period. After surgery, there were significant reductions in the frequency of secretion suctioning (from 165.0 times/day to 33.0 times/day) and the number of hospitalizations because of aspiration pneumonia (from 5.4 times/year to 0.2 times/year). A tracheocutaneous fistula occurred in one (2.5%) patient, and two (5.4%) patients developed tracheoinnominate artery fistulas. In the latter group, the innominate arteries were successfully ligated and endovascular embolization was performed. [ABSTRACT FROM AUTHOR]

Conclusion: The infiltrative growth pattern may predict tumor depth and lymph node metastasis. INF-a seems to fall into a low-risk category, and no additional treatment may be required immediately. Objectives: Tumor depth is a predictor of lymph node metastasis in early pharyngeal cancers. An infiltrative growth pattern is also a prognostic factor in other cancers. This study aimed to elucidate the predictive role of infiltrative growth pattern in early pharyngeal cancers. Methods: Thirty-eight lesions from 37 patients who had undergone trans-oral resection of pharyngeal cancers were included. According to the Japanese Classification of Esophageal Cancer, infiltrative growth pattern was classified into three groups; INF-a, INF-b, and INF-c. The correlation between infiltrative growth pattern and tumor depth, cervical lymph node metastasis was analyzed. Results: Of the 38 lesions, 25 were INF-a, nine were INF-b, and four were INF-c lesions. Lymph node metastasis was observed in three INF-b and one INF-c lesions. In contrast, no INF-a had lymph node metastasis. All INF-a lesions showed shallow invasion of the sub-epithelium; INF-b and INF-c lesions had significantly greater depth than INF-a. [ABSTRACT FROM AUTHOR]

Conclusions: The head and neck cancer patients with more co-morbidities and those dependent on tube feeding are at a high risk of severe infections during chemotherapy. Therefore, prophylaxis with colony-stimulating factors and/or antibiotics should be considered for those patients. Objectives: To investigate the risk factors for severe infection during chemotherapy in head and neck cancer patients. Methods: A retrospective study was conducted of 129 patients with head and neck cancer who received taxane-based and platinum-based chemotherapy between 2008–2013. Logistic regression models were used to evaluate risk factors. Results: Febrile neutropenia occurred in 50 patients out of the 129 (39%), severe infections occurred in 24 patients (19%), and bacteremia in two patients (2%). In univariate analysis, low serum albumin levels and tube feeding were significantly associated with severe infections (p = 0.015 and < 0.001, respectively). In multivariate analysis, the odds ratios for a higher modified Charlson co-morbidity index and tube feeding were 2.80 and 9.74, respectively. These two were independent predictive factors for severe infections (p = 0.020 and 0.001, respectively). [ABSTRACT FROM AUTHOR]

The aim of the study was to carry out a survey of Japanese high school students in order to assess their beliefs about how best to help those with depression, social phobia and psychosis/schizophrenia. In 2011, 311 Japanese high school students aged 15–19 years filled out an anonymous self-report questionnaire distributed via teachers. Participants were given a case vignette describing depression, schizophrenia or social phobia. Subsequent questions covered their beliefs about the best way to help the person (mental health first-aid actions). The first-aid actions most commonly rated as helpful were listening to the person's problems in an understanding way and talking to the person firmly about getting their act together. Less than 20% of respondents rated suggesting professional help seeking as likely to be helpful. First-aid intentions and beliefs about first-aid behaviours in young Japanese people are of relatively low quality. As part of education to improve mental health literacy in Japan, young people need to be informed about avoiding potentially harmful forms of interaction with those developing mental disorders, as well as about potentially helpful ones, with a particular focus on facilitating professional help seeking. [ABSTRACT FROM PUBLISHER]

The aim of the study was to carry out a survey of Japanese high school students in order to assess recognition and beliefs about treatments for mental disorders. In 2011, 311 Japanese high school students aged 15–19 years filled out an anonymous self-report questionnaire containing a case vignette describing depression, schizophrenia or social phobia. Subsequent questions covered: what was wrong with the person, help-seeking intentions and the likely helpfulness of treatments. Only 14.3% of students correctly labelled depression. Rates of recognition for schizophrenia (or psychosis) and social phobia were 8.3% (or 23.1%) and 26.8% respectively. Friends were nominated as the most likely source of help. The most commonly nominated barrier to help seeking was concern about what other people might think. Views about the helpfulness of treatments generally diverged from those of health professionals. Between 36.8% and 52.6% of students thought dealing with the problem alone would be helpful. Japanese high school students show low levels of mental health literacy relating to depression, social phobia and schizophrenia. Interventions to improve mental health literacy should be targeted towards young people and their parents and should address signs and symptoms of disorders, evidence-based treatments and barriers to help-seeking, particularly concern about what others might think. [ABSTRACT FROM PUBLISHER]

Conclusions: Serum squamous cell carcinoma antigen (SCC-Ag) level was an independent prognostic factor for survival in patients with head and neck squamous cell carcinoma (HNSCC), and the prognostic value depended on the carcinoma site. Objectives: To assess the value of SCC-Ag as a prognostic indicator in patients with HNSCC and to determine the effect of primary tumor site on prognosis. Methods: We reviewed 493 patients with HNSCC between 2004 and 2012. The chi-squared test was used to assess associations between SCC-Ag levels and TNM classification. A Cox proportional hazard model was used to assess the hazard ratio of SCC-Ag at different sites for death, and it was analyzed as a continuous variable. Results: The median serum level of SCC-Ag was 1.1 ng/ml (range 0-20). SCC-Ag was significantly higher in patients with advanced T and N classification tumors. Primary sites in the oral cavity, in the hypopharynx, advanced T and N classification, distant metastasis, and SCC-Ag were negatively associated with survival in univariate analysis. Multivariate analysis revealed that SCC-Ag was a significant risk factor for overall survival in cancers of the oral cavity, hypopharynx, and larynx, but not in oropharyngeal cancer. [ABSTRACT FROM AUTHOR]

Conclusion: The present results demonstrate that a small implant size, undercorrection of the vocal fold, antero-posterior implant malposition, and the use of expanded polytetrafluoroethylene (ePTFE) are the primary factors that cause a poor outcome of medialization thyroplasty (MT). Objectives: To assess the postoperative laryngeal condition using computed tomography (CT) in patients with unilateral vocal fold paralysis who underwent MT alone, and to identify the primary causal factors in terms of the surgical procedures that affect the outcomes of MT. Methods: Twenty-two patients who underwent MT alone were divided into two groups based on either the maximal phonation time or the perceived vocal breathiness. Two laryngologists assessed the postoperative laryngeal CT images during sustained vowel phonation and judged whether there were abnormalities of the arytenoid cartilage position, window position, implant size, and implant position, as well as the degree of correction of the vocal fold. As implant material, a silicone block, ePTFE, and hydroxyapatite had been inserted in 2, 9, and 11 patients, respectively. Comparisons of the prevalence of abnormalities in the abovementioned factors between the different outcomes and between the types of material used for the implant were performed. Results: Twelve patients with a poor outcome and 10 with a good outcome showed 36 and 18 abnormal findings identified by either of the two laryngologists, respectively. In the poor outcome group, a smaller implant size and undercorrection of the vocal fold showed both high kappa values and a significantly higher prevalence than those in the good outcome group ( p < 0.001 and p < 0.05), respectively. The comparison between material types demonstrated that the sheet-like material (ePTFE) group exhibited a significantly higher prevalence of undercorrection than the block-like material group ( p < 0.05). [ABSTRACT FROM AUTHOR]

Cedar pollinosis in Japan affects nearly 25 % of Japanese citizens. To develop a treatment for cedar pollinosis, it is necessary to understand the relationship between the time of its occurrence and the amount of airborne cedar pollen. In the spring of 2009, we conducted daily Internet-based epidemiologic surveys, which included 1453 individuals. We examined the relationship between initial date of onset of pollinosis symptoms and daily amount of airborne cedar pollen to which subjects were exposed. Approximately 35.2 % of the subjects experienced the onset of pollinosis during a one-week interval in which the middle day coincided with the peak pollen count. The odds ratio for this one-week time interval was 4.03 (95 % confidence interval: 3.34–4.86). The predicted date of the cedar pollen peak can be used to determine the appropriate date for initiation of self-medication with anti-allergy drugs and thus avoid development of sustained and severe pollinosis. [ABSTRACT FROM PUBLISHER]

Background: High- and low-frequency repetitive transcranial magnetic stimulation (HF-rTMS and LF-rTMS) has been shown to be beneficial for upper limb hemiparesis in patients with acute stroke. However, no study has examined the usefulness of bilateral application of HF- and LF-rTMS (BL-rTMS). Methods: Fifty-eight hemiparetic patients with acute stroke were randomly assigned into two groups: HF-rTMS group and BL-rTMS group. All patients were scheduled to receive five sessions of either HF-rTMS over the lesional hemisphere or BL-rTMS over both hemispheres for 5 days. Motor function of the affected upper limb was evaluated using the Brunnstrom Recovery Stage (BRS) for upper-limb and hand-fingers, grip strength and tapping frequency, before the first session and after the last session of rTMS. Results: Improvement of BRS for the upper limb and hand/finger was significantly greater in the BL-rTMS group than the HF-rTMS group ( p < 0.01). Improvement in grip strength and tapping frequency was also greater in the BL-rTMS group, although the differences were not statistically significant. Conclusions: The proposed BL-rTMS is safe and feasible and showed a greater improvement of BRS of the affected upper limb compared to HF-rTMS. This novel rTMS approach may be a useful intervention for hemiparetic patients with acute stroke. [ABSTRACT FROM AUTHOR]

In developed countries, human immunodeficiency virus (HIV) has become a chronic disease. The aims of this study were to clarify the physical, social, and psychological factors affecting Japanese HIV patients in a stable condition and to identify factors related to mental health of employed and unemployed HIV patients. The target subjects were people with HIV infection who were treated as outpatients at core hospitals for acquired immune deficiency syndrome (AIDS) treatment in Japan. A questionnaire including items from the Hospital Anxiety and Depression Scale (HADS) was sent to each medical facility with a request for participation from the HIV-infected outpatients. Responses from 1199 patients were analyzed. Mental health was reportedly better in the employed patients than in the unemployed patients. The unemployed patients were more likely to have resigned from their jobs because of poor health, to have resigned voluntarily, or to have been unfairly dismissed. Once the patients stopped working because of HIV, returning to work became difficult. In the employed patients, a good workplace environment was strongly related to lower scores on HADS. Higher HADS scores were recorded for employed patients infected with HIV for six years or more. For the unemployed patients, a relationship was observed between strong feelings of stigmatization and HADS scores. Quitting a job because of an experience related to HIV status may be related to feelings of stigmatization. [ABSTRACT FROM AUTHOR]

Conclusion: An epidemiological survey of hospitals and private clinics in Japan regarding idiopathic sudden sensorineural hearing loss (SSNHL) revealed that the incidence of SSNHL was 60.9 per 100 000 population. There were more females than males in the younger generation. Objective: The incidence of SSNHL varies largely by country. Because the Japanese criteria for diagnosing SSNHL have changed in accordance with those widely used in other parts of the world, a clinicoepidemiological study was undertaken using the new criteria. Methods: Ehime, Aichi, and Iwate Prefectures were selected from the western, central, and northeastern regions of Japan, respectively. The subjects for this study were patients who suffered SSNHL between April 1, 2012 and March 31, 2013. Questionnaires were mailed to all hospitals and private clinics in which ENT doctors were working. Initial and final audiograms were requested for 10% of the patients. Results: In all, 78 of 90 hospitals (87%) and 303 of 407 private clinics (74%) responded. It was reported that 1663 patients visited hospitals and 3090 patients visited only private clinics. It was estimated that 6205 SSNHL patients visited hospitals or private clinics in 1 year from a population of 10 145 000. Also, 23% of patients suffered acute low-tone SNHL (female to male ratio; 3:1 in definite cases). [ABSTRACT FROM AUTHOR]

Conclusion: Three-dimensional cone beam computed tomography (3DCT) images revealed characteristic malformations of the membranous labyrinth of the inner ear in Meniere's disease (MD). The morphology of the membranous region between the vestibular cecum of the cochlea and the saccule of ears with MD was compared to that of healthy ears. The present study supports the hypothesis proposed earlier that reuniting duct blockade is a result of the dislodgement of saccular otoconia. Objective: To visualize the membranous labyrinth using 3DCT and to investigate the pathology of MD. Methods: A preparatory study was conducted to determine the optimal 3DCT window settings for the detection of water, muscle, calcium carbonate (CaCO3), and bone. Based on this preparatory study, the ears of 13 healthy volunteers and 25 MD patients definitely diagnosed according to the criteria issued by the Committee on Hearing and Equilibrium of the American Academy of Otolaryngology, Head and Neck Surgery (AAO-HNS), were visualized. Results: The differences in the membranous labyrinth between MD ears and healthy ears could be visualized using 3DCT. The images were classified into three types based on their morphological pattern. The ears of patients with MD were different from normal ears in terms of this classification. [ABSTRACT FROM AUTHOR]

Conclusions: Comorbidities as well as T classification were the primary determinants for the nutritional status of patients with head and neck cancer. Objectives: We aimed to elucidate the underlying conditions of malnutrition in patients with head and neck cancer. Methods: We retrospectively reviewed 726 patients diagnosed with head and neck cancer between 2004 and 2013. Associations between malnutrition and clinical parameters were assessed using univariate and multivariate analyses. Results: Median body mass index was 21.5 (range 11.6-38.0). According to World Health Organization criteria, the nutritional status of these patients was classified into four groups: underweight (18%), normal (63%), overweight (17%), and obese (1%). Comorbidities were detected in 40% of patients. Multivariate analysis revealed the following factors to be independent factors associated with malnutrition: advanced T stage, metachronous cancer, collagen disease, gastrointestinal disease, and pulmonary disease. [ABSTRACT FROM AUTHOR]

Background: Most children have a fear of needles. Suitable preparation can decrease the pain and fear of needles in hospitals; however, few have examined how such preparation affects healthy children. This study examined whether learning with needles decreases fear of needles and changes motivation to get vaccinations in school-age children and the possible association between fear of needles and motivation toward vaccinations. Methods: This study included children participating in the 'Let's Be Doctors' event, which was held in 4 child centers in Tsukuba city, Ibaraki, Japan. In this event, children learned about injections and how a vaccine works, and injected a vaccine (water) into skin (sponge) using a real syringe and imitation needle. Data were collected just before and after the event by anonymous self-assessment questionnaires that used a 4-point Likert scale to assess fear of needles, motivation to get vaccinations, recommendation of vaccinations, and fear toward doctors among the children. Answers were divided into two categories for statistical analysis. Results: In total, 194 children participated in the event and 191 children answered the questionnaire (response rate 98.5%). We analyzed 180 subjects, comprising 79 boys (43.9%) and 94 girls (52.2%), mean age of 8.1 ± 1.0 years. The number of children reporting a fear of needles decreased from 69 (38.3%) before the event to 51 (28.3%) after the event, and those unwilling to get vaccinations decreased from 48 (26.7%) to 27 (15.0%). Children who reported fear of needles before the event were more unwilling to get vaccinations than those with no fear of needles (36 [52.2%] vs. 12 [10.8%]), while after the event the number of needle-fearing children unwilling to get vaccinations decreased to 19 (27.5%). Conclusions: Children's fear of needles and unwillingness to get vaccinations were decreased after experiencing a learning event with needles. The fear of needles is associated with a negative motivation to get vaccinations in children. [ABSTRACT FROM AUTHOR]

Conclusion: In tongue squamous cell carcinoma (SCC), high levels of regulatory T-cell (Treg) infiltration in tumor nests are observed in the cases with poor prognosis. Objectives: The role of Tregs in head and neck cancers remains unclear. The aim of this study was to observe the distribution of Tregs in different stages of tongue SCC and estimate the effects on prognosis. Methods: Thirty-four cases with tongue SCC were examined immunohistochemically for CD4, CD8, and Forkhead box P3 (Foxp3). Immunoreactive cells were counted in cancer stroma and nest regions, and relationships between cell numbers and disease-free survival rates were analyzed. Results: In the 34 cases, univariate analysis for disease-free survival indicated high-level infiltration of Tregs (CD4+Foxp3+) into both cancer nests and stroma and presence of helper T (CD4+Foxp3-) cells in cancer stroma as potential predictors of significantly worse prognosis. In early-stage cases (stage I/II), high-level infiltration of Tregs in cancer nests correlated significantly with poor disease-free survival rate. Multivariate analysis for disease-free survival found no independent variables. [ABSTRACT FROM AUTHOR]

Conclusion: The outcome of this treatment was good, indicating that it is safe and effective. A favorable outcome was obtained, especially in patients with T3, N0-1, and N2a-b cancer, while outcome remained unfavorable in patients with T4a and N2c cancer. Consideration should be given to the need for intensity-modulated radiation therapy (IMRT) and maintenance therapy. Objective: To improve the survival and functional organ preservation rates in patients with lateral oropharyngeal squamous cell carcinoma. Methods: The primary site was treated conservatively by neoadjuvant chemotherapy and/or concurrent chemoradiation therapy. Chemotherapy was administered by superselective intra-arterial infusion and cervical lymph node metastasis was treated by radical neck dissection. Results: Among 71 patients, the 5- and 10-year overall survival rates were 85.1% and 63.5%, respectively; and the 5- and 10-year functional organ preservation rates were 61.0% and 51.6%, respectively. The outcomes were especially good in patients with T3 N0-1, and N2a-b cancer. All patients with N2c cancer had poor outcomes. [ABSTRACT FROM AUTHOR]

Intimate partner violence (IPV) during pregnancy can result in adverse outcomes for both mothers and their infants. This cross-sectional study examined the prevalence and risk factors of IPV associated with abuse during pregnancy via a self-administered questionnaire completed by 302 healthy pregnant women. Demographic information was also collected from medical records to analyze risk factors for abuse. Of the 302 women, 48 (15.9%) were identified as experiencing IPV. The identified risk factors were age over 30, multipara, previous abortion experience, and male partner aged under 30. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effectiveness of repetitive facilitative exercise (RFE) under surface neuromuscular electrical stimulation (NMES) in patients with post-stroke hemiplegia. Methods: This randomized, controlled, observer-blinded, pilot trial randomized 27 adults with severe arm impairment [Fugl-Meyer Arm scale (FMA) ≤ 20] due to stroke of 3-13 weeks duration into three groups and provided treatment on a 4-week, 40 minutes/day, 5 days/week schedule. The RFE-under-NMES group were given 100-150 repetitions of standardized movements of shoulder, elbow and wrist joints of their affected arm with concurrent low-amplitude NMES for each corresponding musculature. The RFE group was given the same exercise regimen but without NMES. The control group was treated with a conventional arm rehabilitation programme without NMES. FMA was assessed at baseline and 4 weeks. Results: All 27 participants (nine in each group) completed the trial. At 4 weeks, the RFE-under-NMES group evidenced significantly greater improvement compared with the control group on the FMA ( p = 0.003), but not with the RFE group ( p = 0.092). The RFE group showed improvement compared with the control group, but it was not significant ( p = 0.199). Conclusions: RFE under NMES is feasible in clinical settings and may be more effective than conventional rehabilitation in lessening arm impairment after sub-acute stroke. [ABSTRACT FROM AUTHOR]

The present study examines differences in systems development and difficulties in implementing procedures for elder abuse prevention in 1,119 private and 606 public community general support centers under the public long-term care insurance program in Japan. The private community general support centers showed more difficulty implementing procedures than the public community general support centers. Controlling for the type of municipality, progress in systems development did not differ between the private and public community general support centers. Further research should examine how the characteristics of municipal governments are related to systems development in community general support centers. [ABSTRACT FROM AUTHOR]

This study examines physical and psychological mistreatment reported by Japanese elders who received care from family members. Data is based on structured face-to-face interviews with community-dwelling elders who utilized respite care services. Among the 118 elderly respondents, 12% reported being hit or almost being hit by their caregivers. Close to 54% reported at least one type of psychological mistreatment. Men who received care from their spouses were most likely to report abuse. Elders who were victimized reported increased levels of depressive symptoms. Logistic regression analyses indicated associations between physical abuse and past conflicts with the caregiver. Psychological mistreatment was associated with receiving care from a spouse, past conflicts with the primary caregiver, and depression. The findings suggest the need for increased awareness of the needs of community-dwelling Japanese elders who are at risk for abuse, mistreatment, and depression. [ABSTRACT FROM AUTHOR]

Objective: This study evaluated executive dysfunction in patients with subarachnoid haemorrhage (SAH) using the Behavioural Assessment of the Dysexecutive Syndrome (BADS) and correlated the occurrence of executive dysfunction with cerebral blood flow (CBF) reduction in the frontal lobe as assessed by single photon emission computed tomography (SPECT). Design: Correlational study. Subjects: Twenty-two patients who underwent microsurgical clipping at least 3 months after SAH. Methods: This study evaluated the BADS and the Wechsler Adult Intelligence Scale-III (WAIS-III). In addition, it assessed activities of daily living (ADL). CBF was evaluated using SPECT. The patients were divided into the following groups according to the results of SPECT: (1) those with reduced CBF in the frontal lobe (reduced CBF group, n = 8) and (2) those with intact CBF (intact CBF group, n = 14). Results: The BADS score was significantly lower in the reduced CBF group compared with that of the intact CBF group, while there was no significant difference in the WAIS-III scores and ADL scale between the two groups. Conclusion: Although this result was conducted with a small sample size, executive dysfunction correlates with reduced CBF in the frontal lobes of SAH patients. A detailed evaluation of executive function is suggested in SAH patients, even if the patient's intelligence test and ADL scale reveal no abnormalities. [ABSTRACT FROM AUTHOR]

Conclusion: The findings suggest that in patients with posterior semicircular canal (PSCC) benign paroxysmal positional vertigo (P-BPPV), head trauma and prolonged bedrest, but not inner ear disease, are risk factors for poor outcome of a single Epley maneuver and persistent residual positional vertigo. Objectives: We first examined the efficacy of a single Epley maneuver and then assessed the time course in remission of residual positional vertigo in patients with idiopathic P-BPPV and secondary P-BPPV. Methods: A total of 157 patients with idiopathic P-BPPV and 40 patients with secondary P-BPPV (secondary to head trauma in 8 patients, to prolonged bedrest in 14 patients, and to inner ear disease in 18 patients) were treated with a single Epley maneuver. Results: The negative rates of the Dix-Hallpike test on day 7 after a single Epley maneuver in both patients with P-BPPV secondary to head trauma (25%) and those with prolonged bedrest (36%) were significantly lower than that (73%) in patients with idiopathic P-BPPV. Additionally, the remission of residual positional vertigo in the former groups of patients was significantly delayed in comparison with that of the latter group. However, there were no significant differences in the efficacy of a single Epley maneuver and persistent residual positional vertigo between idiopathic P-BPPV and P-BPPV secondary to inner ear disease. [ABSTRACT FROM AUTHOR]

This study investigates the factors influencing seniors’ travel behaviors. One-hundred-ninety-three community-dwelling seniors in a Japanese city participated in a questionnaire survey. Twenty-one of them shared their travel experiences in interviews. Statistical analyses reveal gender differences in factors determining travel frequency. Qualitative analyses identify gender specific mobility adaptations in two domains: changes in social environments and maintaining means of travel. Men tend to focus on maintaining a driver's license, representing their social role as a provider, while women relate to adjustment to widowhood and travel safety. The results provide direction for community planning to promote active aging. [ABSTRACT FROM PUBLISHER]

Conclusion: It was proved that cyclin D1-positive status in surgical margins was an independent prognostic indicator of local recurrence. The expression of cyclin D1 in tumor-free surgical margins may better predict local recurrence in patients with head and neck squamous cell carcinoma (HNSCC) after surgical treatment with curative intent. Objective: This retrospective study aimed to determine the prognostic indicators for local recurrence in HNSCC. Methods: A total of 116 HNSCC patients who underwent surgical treatment with curative intent and had histopathologically tumor-free margins were eligible for this study. The expression of p53 and cyclin D1 was assessed by immunohistochemical staining in surgical margins as well as in tumor specimens. Results: In all, 63 patients (54.3%) had p53-positive tumor specimens and 34 patients (29.3%) had p53-positive margins. Seventy-six patients (65.6%) had cyclin D1-positive tumor specimens and 54 patients (46.6%) had cyclin D1-positive margins. A significant difference in local control rates was observed between patients with cyclin D1-positive and -negative margins (77.2% vs 91.5%, log rank test, p = 0.0139). Multivariate Cox proportional hazards testing indicated that the hazard ratio of cyclin D1-positive margins for local recurrence was 4.58 (95% confidence interval 1.14-21.69, p = 0.0304). [ABSTRACT FROM AUTHOR]

Undergraduate psychiatric education has an important role in developing psychiatric knowledge, decreasing stigma towards mental illness, and promoting psychiatry as a career choice. The attitudes and beliefs of medical students towards psychiatry have not been well understood, especially in non-western countries. To clarify this aspect, we have conducted a cross-sectional study between India and Japan. This study, conducted at two centres, one each in India and Japan, used a semi-structured questionnaire to evaluate the attitudes and beliefs of third-year medical students towards mental illness and psychiatry; such as emotions experienced dealing with psychiatric patients, aetiology and treatment of psychiatric disorders, and psychiatry as a career choice. A total of 79 medical students from India and 77 from Japan participated in the present study. Significant differences were observed in the emotions experienced by the medical students while dealing with psychiatric patients. Most medical students (> 90%) from both study sites favoured psychiatrists for treatment of psychiatric illness. Psychiatry as a carrier choice was significantly related to the nationality of the medical students. The findings of the current study provide insight in to the attitudes of third-year medical students from India and Japan towards psychiatric patients. [ABSTRACT FROM AUTHOR]