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Background Discrepancies between parents' reports of paternal parenting have been gaining attention, but epidemiological evidence is scarce in Asia. This study aimed to clarify agreement/discrepancy between paternal and maternal recognition of paternal parenting, and the association between actual paternal parenting time and background factors. Methods Data from couples whose children attended 4-month-child health check-ups in Fukushima City were analyzed (N = 509). Based on paternal recognition of paternal parenting (PRPP) and maternal recognition of paternal support (MRPS), couples were classified into four groups. Each group's paternal household work and parenting time were analyzed. Univariable and multivariable analysis were performed to investigate the association between agreement/discrepancy and background factors of children and parents. Results Frequency of positive agreement (PRPP+ and MRPS+) was 83.9%, whereas negative agreement (PRPP- and MRPS-) was 2.6%. As for discrepancy, PRPP+ and MRPS- was 8.4% and PRPP- and MRPS+ was 5.1%. Fathers' total median parenting time was 2 (weekdays) and 6 (weekends) hours, and showed significant differences among the four groups. Multivariable analysis revealed that compared to positive agreement, maternal mental health condition and pregnancy intention were significantly associated with the discrepancy PRPP+ and MRPS-, paternal mental health condition and marital satisfaction with the discrepancy PRPP-and MRPS＋, and maternal mental health condition with negative agreement. Conclusions We identified differences in parenting time and mental health characteristics among couples depending on agreement/discrepancy in recognition of paternal parenting. Assessing both parents' profiles is necessary in clinical practice to promote paternal participation in childcare.

To promote radiation protection and health promotion among returning residents (returnees) in coastal areas of Fukushima, eHealth principles were used to develop a new application tool (app) that can record radiation exposure and health status while providing comprehensive support to returnees. Intended users are returnees and health and welfare workers. After assessing their needs, a flowchart and prototype for operational logic were created using commercially available software tools. Professional developers will focus on improving the user interface and ensuring data security. The finished app will be compatible with mobile telephones and tablets. Utility and ease of use are paramount to serve returnees of all ages effectively.

Background Inappropriate parental behaviors of mothers toward young children require further study; few epidemiological studies have utilized longitudinal analysis of region-based cohorts. This study examined the frequency of incidence of and improvements in inappropriate parental behaviors of mothers with young children and related factors. Methods Among the mothers who underwent a checkup in Fukushima City in 2017, 586 mothers with data from 4-, 18-, and 42-month-old checkups were included in analysis. In this retrospective cohort study, an anonymous database was created by transcribing and matching health checkup records with questionnaires stored at the city health center. Data were analyzed using chi-square tests and logistic regression analysis, using the SPSS Ver.20.0. Results In 28.5% of mothers, inappropriate parental behaviors were not reported in the 18-month-old data but were reported in the 42-month-old data. In 3.8%, inappropriate parental behaviors were reported in the 18-month-old data but were not reported in the 42-month-old data. The most common inappropriate parental behavior reported was “yelling at the child using emotional words” (18-month-old data, 16.2%; 42-month-old data, 39.5%). Mothers with financial difficulties were 2.19 times (95%CI: 1.13–4.26) more likely to begin inappropriate parental behaviors between 18 and 42 months. Improvements in parental behaviors were significantly higher in mothers under 30 years old (p = 0.03). Conclusions It is necessary to identify mothers with financial difficulties early and to examine how to provide childcare and financial support from a local government at the time of child health checkup.

Following the 2011 Fukushima Daiichi nuclear power station (FDNPS) accident, numerous initiatives emerged to address the needs of evacuees, including those eligible to return home. These came from multiple channels, timely in many cases, but in retrospect, needing better coordination. By embracing eHealth, we are attempting to coordinate efforts in Fukushima intended to link returnees with health information and care providers, not only for radiological protection in particular, but also for health promotion in general. We aim to establish a comprehensive support system for residents in municipalities around the FDNPS by developing a digital application for interactive communication regarding radiation and health promotion and to link the tool to other resources provided by local health care providers and radiation specialists. This paper explains the progress of our innovative trial to introducing eHealth in areas affected by the FDNPS accident. Based on international recommendations for developing a digital tool in response to a nuclear accident, we designed a comprehensive support package including development and implementation of the application, data management, and health counselling and ethical considerations arising from such outreach. Our trial of connecting disaster-affected citizens to health services using informatics could serve as a model eHealth program for long-term restoration after a nuclear accident.

Background: Digital tools can be powerful and effective in connecting people with life-saving and health-promoting support when facing a health crisis. To develop a digital application for radiation protection and health promotion for evacuees returning home after the Fukushima nuclear accident, we conducted a needs assessment survey and explored the association of people’s eHealth literacy (eHL) level with their digital tool knowledge, attitudes, and practice (KAP). Methods: From 339 responses to an online survey, data from 264 lay persons were analyzed. The KAP items were those used in a prior EU project, and eHL levels were assessed with a Japanese version of the eHealth Literacy Scale. Results: Multivariable analyses showed significant associations between eHL and the digital tool KAP for radiation protection (knowledge: adjusted odds ratio (aOR) = 1.10, attitude: 1.06, practice: 1.10) and for health promotion (knowledge: aOR = 1.13, practice: 1.16). Conclusions: People with a higher eHL had a more positive KAP. For those with a lower eHL, we are formulating easy-to-understand explanations to promote the utilization of the digital tool and enthusiasm for future community-oriented digital tools.

Objective: Various types of handbooks that summarize and record health information (health handbooks) have been used in Japan for many years. The purpose of this study was to explore ways to evaluate the understandability and usability of commonly used printed health handbooks in Japan.Methods: An internet search was performed to identify health handbooks used in Japan. The handbooks were then collected, searched, and evaluated for the quality and functionality of the health-information. The overall understandability was assessed using the Suitability Assessment of Material (SAM) and the Centers for Disease Control and Prevention Clear Communication Index (CCI), and overall usability was assessed using a purpose-user matrix.Results: A total of 14 health handbooks were extracted and analyzed. The median scores for SAM and CCI were 39 (min 25, max 45) and 81.5% (60%, 100%), respectively, and no significant association was observed between the two evaluation scores. Based on the matrix, the most common type of handbook was those designed for preventive purposes that the user or their family completed (n = 9).Conclusion: Our sampled health handbooks were used mostly for preventive purposes and their understandability varied. SAM and CCI assess different aspects of written materials and it is recommended they be used together when evaluating the understandability of health handbooks. To facilitate more effective use of health handbooks in public health activities, we suggest the content of handbooks be assessed by a purpose-user matrix.

Patients with cognitive dysfunction caused by dysmnesia face difficulties in memorizing and learning general concepts; therefore, they encounter trouble in taking medications. Recently, a prescription notebook has been shown to be useful for patients receiving pharmacotherapy; however, it is not yet clear whether a common prescription notebook is useful for patients with a memory disorder. In our study, using a questionnaire for 61 patients, we first determined the benefits of and improvement in the drug administration guidance provided by a pharmacist to patients with a memory disorder compared with those undergoing medical examination by a doctor. Although 35-74% of patients could not communicate with a pharmacist or doctor, most found it easier to communicate with a pharmacist than with a doctor. Moreover, we investigated whether a common prescription notebook and our designed notebook, called the personal notebook, were useful to patients with a memory disorder. Although 89% of patients with a memory disorder use a common prescription notebook, 41% of them answered that they found it difficult to use. On the other hand, 66% of the patients with a memory disorder answered that they wished to use the personal notebook. Remarkably, all patients within 5 years of onset of a memory disorder wished to use this notebook. These findings indicate that it is useful for patients within 5 years of onset of a memory disorder to use the personal notebook. We propose a method to improve the use of a prescription notebook for patients with a memory disorder through this survey.

Postpartum depression is a serious problem not only for mothers, but also for their children and families. Evidence is scarce on the effectiveness of couple-targeted antenatal interventions aimed at preventing postpartum depression in Asia. Therefore, we implemented an antenatal parenting support program from Australia ("empathy program") at three sites in Japan, and assessed the characteristics of participating couples and changes in their mental health indicators before and after the program (during pregnancy and 6 weeks postpartum, respectively). In this program, participant couples discussed concerns during pregnancy and a "difficult day" scenario with other same-gender participants and then with their own partners. In total, 100 couples attended the program. Among 60 participating mothers, 20% screened positive for maternal depression symptoms (defined as an Edinburgh Postnatal Depression Scale greater than 9). Changes in paternal empathy and maternal antenatal Edinburgh Postnatal Depression Scale score were significantly associated with maternal postpartum Edinburgh Postnatal Depression Scale score in multivariable analyses. Our results indicate that a key in preventing postpartum depression is paternal involvement and long-term support from antenatal phase.

Objectives: This study aimed to assess the effects of the Great East Japan Earthquake on hypertensive disorder of pregnancy (HDP) in the Fukushima Prefecture.Methods: We used the results of the Fukushima Health Management Survey which targeted women who gave birth from 2011-2012. Pregnant women were divided into three groups according to their residential area during the disaster (affected, middle, and less-affected area), and four groups according to pregnancy trimester during the disaster (first, second, third trimester, or conception after the disaster). Adjusted odds ratio (aORs) for HDP of each residential area was calculated using logistic regression models, with pregnancy trimester during the disaster as references.Results: Overall, 8323 women participated in the study (affected area: 2207; middle area: 5183; and less-affected area: 933). For women living in the affected and middle areas in the third trimester, the disaster was a significant risk factor for HDP (aOR: 2.61, 1.02-6.66, aOR: 1.93, 1.10-3.40, respectively).Conclusions: To our knowledge, this is the first study to integrate patient residential areas and gestational age during the time of a disaster to estimate the risk of HDP. The third trimester of pregnancy at the time of the disaster was associated with HDP for the women living in the affected and middle areas. The knowledge of the data on disaster-related obstetrical complications can help obstetric care providers in a disaster area provide appropriate medical aid in an emergency.

A 33-year-old man developed a left Achilles tendon rupture and skin necrosis. We reconstructed the defect using an anterolateral thigh flap and a tensor fasciae lata muscle flap in a chimeric fashion. he was able to stand on a toe of the operated foot without help 6 months postoperatively.

Introduction The Australian "empathy session," which is a parenting program aimed at alleviating postpartum depression by increasing empathy among expecting couples, was adapted to a life-planning education program for Japanese high school students. In this present study, we aimed to assess changes in high school students' empathy levels. Methods A nonrandomized, controlled, waitlist intervention was performed in 210 first-year students. They were divided into intervention and waitlist control groups. The life-planning lecture consisted of two parts: (1) reproductive health and (2) empathy and communication skills. The main outcome indicator was the Perspective-Taking subscale of an empathy index. Logistic regression was used to examine the association between the intervention and change in the Perspective-Taking scale score controlling for background factors. Results As per our findings, a significant difference was noted in the scale scores of Perspective-Taking before and after the program within the intervention group (3.76 ± 0.61 before the lecture and 3.86 ± 0.64 after the lecture; P = 0.01). In the between-group analysis, the likelihood of an increase in the scale score of Perspective-Taking was significantly higher in the intervention group (OR = 2.29, 95 % confidence interval = 1.23-4.26). Conclusions Japanese high school students' Perspective-Taking improved through learning reproductive life-planning and communication skills.

Childhood idiopathic nephrotic syndrome (NS) is defined by proteinuria and hypoproteinemia. The incidence of childhood idiopathic NS varies with age, race, residential areas, and social conditions. In Japan, its incidence was estimated to be 6.49 cases/100,000 children. Our study aimed to investigate the incidence, characteristics, and rate of relapse of idiopathic NS in Fukushima between 2006 and 2016. Overall, 158 children aged from 6 months to 15 years old (65.8% male) developed idiopathic NS (median age at onset, 5.3 years). The peak age at onset was three years. The average annual incidence of childhood idiopathic NS was 5.16 (range, 3.47-9.26) cases/100,000 children. The highest incidence was in 2011, which was the year of the Great East Japan Earthquake and nuclear power plant accident, and reportedly caused psychological distress in the children at the time. Conversely, the five-year birth cohort showed minor difference from 2008 to 2012. The rate of incidence in males aged < 5 years was thrice greater than in females of the same age and almost the same for males and females aged 11-15 years. Of 507 total relapses in 115 NS children, common triggers of relapses were steroid discontinuation or reduction and infection. The average annual incidence of childhood NS based on the Fukushima population was lower than previously reported in Japan, and the annual incidence has changed over an 11-year period. These changes may be affected by social or environmental factors, including mental stress associated with lifestyle changes after the disaster.

In recent years, there has been an increase in the number of hypertensive diseases and the various diseases associated with them. A major cause of these is excessive salt intake. The purpose of the present study was to examine whether chewing hard foods lowers the saltiness threshold. Fifteen subjects (fourteen women and one man) participated in the present study. Two types of gummies are available as ingredients: hard and soft gummies. The saltiness thresholds before and after chewing of each gummi were studied using 11 different NaCl solutions. Then, points of subjective equality (PSEs) were calculated to detect changes in the saltiness for each subject. In the soft Gumi condition, there was no significant difference in PSE for the saltiness between before and after ingesting Gumi (p>0.05), while in the hard Gumi condition, the PSE for the saltiness significantly decreased after ingesting Gumi compared with the value of before ingesting Gumi (p=0.001). From these results, we concluded that sensitivity to saltiness would increase after mastication of hard foods such as hard Gumi.

Aim The objective of the present study was to develop a tool for mothers to assess their children’s skin condition with the ultimate goal of its wider use in general health checkups for infants and toddlers. Methods This was a single-institution, cross-sectional study in Japan, targeting parents of 200 infants and toddlers who visited a dermatology clinic between December 2018 and March 2019. The parents completed a self-administered survey of the mother’s perception of her child’s dermatological symptoms, itchiness, and sleep status, and a quality-oflife assessment, using a nine-question version of the Quality of life in Primary Caregivers of children with Atopic Dermatitis questionnaire (QP9). The attending physician was asked to complete a form about the child’s dermatological condition and the treatment prescribed. The severity of the dermatological condition noted by the physician was compared with the combined response to the 3 perception items (dermatological condition, itchiness, and sleep) reported by the parents, in order to identify the optimal cutoff score. Results Of 200 parent questionnaires distributed, 198 (99% response rate) were returned and analyzed, along with the responses from 198 physician records (100% response rate). The optimal cutoff score was 2/3 for the total score (range 0-6) for 2 items, itchiness and sleep status (sensitivity 73%, specificity 64%). There was a significant difference in QP9 scores between the 2 groups categorized by the cutoff score Conclusions A pediatric dermatological screening tool based on 2 symptoms reported by the parents of children with atopic dermatitis was developed, and its precision and criterion-related validity were confirmed. This simple tool could help parents become better aware of their children’s skin condition and allow healthcare workers to provide adequate skin care advice. This practical tool could be widely applicable in primary child care and public health service settings.

As the COVID-19 virus spread rapidly around the world, information related to the pandemic also spread quickly and in massive amounts. Uncertainty and unknowns about the pandemic together with the explosion of information created confusion and fear among many populations. A major challenge for public health practitioners is to provide clear and consistent messages that can be understood by different types of audiences, including vulnerable populations such as pregnant women and children who are often forgotten in this process. We compared and analyzed the development processes of health communication products for pregnant women in Madagascar and for elementary school children in Japan during the COVID-19 pandemic. This study compared these two field experiences in different socioeconomic settings to identify common strategies for the development of communication materials in a health crisis. The two cases both developed communication materials developed in collaboration with key local communicators and the target audiences. Both products used a simple and clear structure and included do's and don'ts. Messages were tailored toward the lifestyles of the target audience and phrased to fit with cultural and linguistic contexts. Both developer teams paid attention to easy-to-understand words and culturally accepted design and colors. The final products were distributed swiftly and widely through multiple channels with the local community. These two field experiences demonstrate common strategies for developing health communication materials that are culturally-tailored and visually-appealing in a timely manner and can be disseminated through existing channels in a health crisis. Our experiences emphasize that collaborative and iterative efforts based on an existing trust relationship with the target community can provide the foundation for a rapid communication response in a health crisis.

Objectives This study analyzes the change in the sense of food safety over time, from 2 years before to 8 years after the Fukushima accident in 2011, and its association with social connectedness using cohort data, taking into account regional differences in Fukushima Prefecture. Study design Repeated cross-sectional data from Fukushima Prefectural Government from 2009 to 2018 were used. Methods We randomly selected 1300 people every fiscal year (FY). The survey gathered data on age, gender, occupation, residential region, and the explanatory variables ‘sense of social connectedness’ and ‘recovery-related information source’ (information source). The prefecture was divided into three regions for the survey—Hamadori region, where the nuclear power plant is located, Nakadori region, where the air dose rate after the earthquake was high, and in Aizu, far from the nuclear power station but has suffered from harmful rumors. Results Focusing on FY 2014, when the sense of safety first showed recovery, we performed a binominal logistic regression analysis with ‘sense of safety’ as the outcome and ‘sense of social connectedness’ and ‘information source’ as the explanatory variables. The sense of safety significantly decreased in all regions in 2011 relative to earlier years. The sense of food safety decreased markedly in Hamadori and Nakadori but started to improve 3 years after the earthquake and reached the pre-earthquake level in 2018. The effect sizes were larger in the Hamadori region and in Nakadori than in Aizu. In FY 2014, multivariate analysis found that a sense of food safety was significantly positively associated with a sense of social connectedness, whereas the use of information from newspapers and TV and word of mouth was negatively associated. Conclusion Although the recovery of a sense of food safety may take some time, a focus on social connectedness during recovery and scrutiny of information sources may facilitate recovery. Health communication has an important role when the provider sends information intelligibly and the recipient can distinguish good news from bad and link it to self-determination. It is necessary to improve literacy.

Background Japan Environmental and Children's Study (JECS) was under way in Fukushima at the time of the triple disaster. It was initially to assess the effects of environmental factors on children's health, but given the situation particular to the accident, it could also offer an additional source of material with which to examine the psychological impacts of the disaster on mothers. This study aimed to examine the characteristics of mental health of Fukushima mothers after the triple disaster by comparing the scores in Fukushima with the nationwide scores. Then, it aimed to examine associations between their maternal bonding and mental health both during pregnancy and following birth. Methods The JECS administered the Kessler 6-item psychological distress scale (K6) during pregnancy and the Edinburgh Postnatal Depression Scale (EPDS) 1 month following birth to 97 454 eligible women. In conjunction with the JECS, this study analysed the scores of 11 630 women in Fukushima which were obtained in the JECS between 2011 and 2015, and compared them with the nationwide scores during the same time period. Results The proportion of mothers having ‘negative feelings toward pregnancy’ was significantly higher in Fukushima Regional centre (RC) than in the other 13 RCs between 2011 and 2014. No significant difference in the ‘lack of affection’ scores following birth was found between Fukushima RC and other RCs in 2012 and 2013, but the score in Fukushima RC was significantly lower in 2014 and 2015. The K6 scores in Fukushima RC were significantly higher than in other RCs in all years, and the EPDS scores following birth in Fukushima RC were also higher than in the 13 RCs in all years. The results of multivariate analysis showed a significant association between ‘mothers’ negative feelings toward pregnancy’ and depressive symptoms, except in Fukushima RC in 2011. Also, it showed another significant association between ‘lack of affection’ and postpartum depressive symptoms from 2012 to 2015 in both Fukushima RC and 13 RCs. K6 scores during pregnancy were significantly associated with EPDS scores throughout the study period in both Fukushima RC and 13 RCs. Limitations Due to the lack of information on participants’ residential region at the municipal level in the JECS, it was unable to measure regional differences within Fukushima prefecture. Conclusion This study shed light on the relationship between maternal bonding and mental health both during pregnancy and following birth by using the sequential and periodic national data sets. While showing the maternal characteristics associated with depressive symptoms during pregnancy and following birth in Japan, it distinguished the characteristics between Fukushima and nationwide. It raised the possibility that providing mothers in Fukushima with supports to increase their bonding toward their pregnancy could prevent the development of depressive tendency. The results could suggest that not only depression prevention measures but also maternal bonding support could be necessary in the region.

Aim High-income countries are now experiencing a decline in fertility. After experiencing baby booms in 1947–1949 and 1971–1974, Japan's population has been decreasing since 2015. In an attempt to predict the next baby boom, we searched for any upward demographic trends occurring after 1974. Methods We analyzed time trends of the numbers and rates of live births, stillbirths and induced abortions using Japanese government data from 1975 to 2014. We then selected two birth cohorts: the first baby boomers who were 0–4 years old in 1950, and the second baby boomers who were 0–4 years old in 1975, and analyzed their rates of live births, stillbirths, and abortions by five-year age groups. Results There was no upswing in the numbers of births, stillbirths, or induced abortions; however, the abortion rate increased during 1996–2002. Compared with the first baby boomer cohort, the second baby boomer cohort had half the peak live birth rate for the same age group (25–29 years old), and half the peak rate of abortions, with a shift toward a younger age group (20–24). Conclusions This analysis of Japanese fertility trends derived from all pregnancy outcomes showed no upward trend in fertility in Japan since 1974.

Background: We hypothesized that gallbladder (GB) volume is affected by serial changes during the early infancy period in extremely premature infants. Methods: We conducted a prospective study of extremely premature infants admitted to the neonatal intensive care unit of Fukushima Medical University Hospital, Fukushima City, Japan between January 2014 and December 2015. GB volume was measured by an abdominal ultrasound ellipsoid method between Day 0 and Day 56 after birth within 60 minutes before enteral feeding. We calculated GB volume (mL)/weight (kg), which was evaluated as GV/W. Results: In total, 30 infants were included. The median gestational age of the infants was 26 weeks 5 days (range, 23 weeks 1 day–28 weeks 6 days), and the median birth weight was 731 g (range, 398–1220 g). The detection rate of GB decreased in the infants over time; the rates were > 93% between Day 0 and Day 7 and < 77% between Day 10 and Day 56 after birth. GV/W decreased in the infants over time. The median GV/W values were 0.18 (range, 0.05–0.59) in infants on admission and constantly

Collaboration with multiple healthcare professionals is important to provide safer and higher quality care. Interprofessional education (IPE) promotes the practice of team-based care. The establishment of Tsurumai-Meijo IPE, including interprofessional education and practice (IPEP) and video-teaching materials, was conducted in collaboration with school of medicine/nursing in Nagoya University and Fujita Health University, because Meijo University does not have its own clinical settings and faculties except for pharmacy. In the established Tsurumai-Meijo IPE, pharmacy, medicine, and nursing students interviewed simulated patients (SP) together or separately and practiced team-based care through Tsurumai-Meijo IPEP. Students could learn in advance and on their own about each professional's knowledge related to patient care by using video-teaching materials from the Meijo IPE homepage. Using a questionnaire survey at the end of program, this study was examined whether Tsurumai-Meijo IPEP, and video-teaching materials were useful for understanding importance of team-based care. More than 83% of students indicated that Tsurumai-Meijo IPE is useful on future clinical practice. This suggests that the program and materials are beneficial to the medical student education. In the optional survey of some clinical pharmacists, who had participated in Tsurumai-Meijo IPE before graduation, they utilized it in their work and it facilitated their work related to team-based care. Tsurumai-Meijo IPE collaborating with SP is likely to contribute to provide high quality and safe team-based care by taking advantage of specialized professional ability of healthcare professionals.

The Fukushima nuclear accident in March 2011 posed major threats to public health. In response, medical professionals have tried to communicate the risks to residents. To investigate forms of risk communication and to share lessons learned, we reviewed medical professionals’ activities in Fukushima Prefecture from the prefectural level to the individual level: public communication through Fukushima Health Management Surveys, a Yorozu (“general”) health consultation project, communications of radiological conditions and health promotion in Iitate and Kawauchi villages, dialogues based on whole-body counter, and science communications through online media. The activities generally started with radiation risks, mainly through group-based discussions, but gradually shifted to face-to-face communications to address comprehensive health risks to individuals and well-being. The activities were intended to support residents’ decisions and to promote public health in a participatory manner. This article highlights the need for a systematic evaluation of ongoing risk communication practices, and a wider application of successful approaches for Fukushima recovery and for better preparedness for future disasters.

The Pregnancy and Birth Survey was started by Fukushima Medical University as part of the Fukushima Health Management Survey in 2011 in order to assess the physical and mental health of mothers and provide parenting support (telephone counseling) for those in need. The present study reviewed the major findings from 4 annual surveys conducted from 2011 to 2014. Overall proportions of preterm deliveries, low birth weight infants, and congenital anomalies in the first year were almost the same as those in national surveillance data. The prevalence of depressive symptoms among the mothers held steady at about 25% over the 4 years. Regarding the content of parenting counseling, the proportion of mothers who voiced concerns about radiation decreased each year. This survey should be continued to provide support to mothers in Fukushima.

The Fukushima nuclear power plant accident caused widespread radiation contamination. Mothers of young children were at risk of negative emotional and mental health consequences. Using data from 2 independent prefecture-wide surveys of pregnant women, we examined the associations of disaster-related stressors with both maternal self-confidence and depressive symptoms. Two postal surveys were conducted targeting women who registered their pregnancies in Fukushima Prefecture (n = 6686 in 2012 and n = 6423 in 2013). The proportions of mothers with lower self-confidence in child rearing and with depressive symptoms were 53% and 25% in 2012 and 55% and 24% in 2013, respectively. After adjusting for maternal and infant characteristics, evacuation and concern about radiation were significantly associated with depressive symptoms but not lower maternal confidence, although these 2 outcomes were significantly associated. Mothers in Fukushima showed resilience in parenting, whereas their experiences and concerns in the aftermath of nuclear disaster were associated with depressive symptoms.

This study aimed to clarify the frequency of and temporal changes in the content of mothers’ free written opinions obtained in the Fukushima Health Management Survey Pregnancy and Birth Survey from 2011 to 2013. A self-administered questionnaire was mailed to women who delivered babies in Fukushima Prefecture. The questionnaire asked about maternal and child health. Expression of mothers’ concerns about radiation decreased over time. Common to the top 5 codes across the 3 years were “radiation effect on fetus and infant” and “information provision including survey results.” Participants who wrote free opinions were significantly more likely to be aged ≥30 years and to have depressive symptoms. Our descriptive analysis of the qualitative data showed a clear shift in mothers’ concerns from radiation-related issues to their own physical and mental health. Mothers who expressed concerns were more likely to report negative physical and mental health.

// Hiroshi Yokouchi 1 , Hiroshi Nishihara 2 , Toshiyuki Harada 3 , Takashi Ishida 1,4 , Shigeo Yamazaki 5 , Hajime Kikuchi 6 , Satoshi Oizumi 6,7 , Hidetaka Uramoto 8,9 , Fumihiro Tanaka 8 , Masao Harada 7 , Kenji Akie 10 , Fumiko Sugaya 11 , Yuka Fujita 12 , Kei Takamura 13 , Tetsuya Kojima 14 , Mitsunori Higuchi 15,16 , Osamu Honjo 11,17 , Yoshinori Minami 18 , Naomi Watanabe 19 , Aya Goto 20 , Hiroyuki Suzuki 16 , Hirotoshi Dosaka-Akita 21 , Hiroshi Isobe 14 , Masaharu Nishimura 6 and Mitsuru Munakata 1 1 Department of Pulmonary Medicine, Fukushima Medical University, Fukushima, Japan 2 Department of Translational Pathology, Hokkaido University Graduate School of Medicine, Sapporo, Japan 3 Center for Respiratory Diseases, JCHO Hokkaido Hospital, Sapporo, Japan 4 Clinical Oncology Center, Fukushima Medical University Hospital, Fukushima, Japan 5 Department of Thoracic Surgery, Keiyukai Sapporo Hospital, Sapporo, Japan 6 First Department of Medicine, Hokkaido University School of Medicine, Sapporo, Japan 7 Department of Respiratory Medicine, National Hospital Organization Hokkaido Cancer Center, Sapporo, Japan 8 Second Department of Surgery, University of Occupational and Environmental Health, Kita-kyushu, Japan 9 Department of Thoracic Surgery, Kanazawa Medical University, Uchinada, Japan 10 Department of Respiratory Disease, Sapporo City General Hospital, Sapporo, Japan 11 Department of Respiratory Medicine, Teine Keijinkai Hospital, Sapporo, Japan 12 Department of Respiratory Medicine, National Hospital Organization Asahikawa Medical Center, Asahikawa, Japan 13 First Department of Medicine, Obihiro Kosei Hospital, Obihiro, Japan 14 Department of Medical Oncology, KKR Sapporo Medical Center, Sapporo, Japan 15 Department of Thoracic Surgery, Fukushima Red Cross Hospital, Fukushima, Japan 16 Department of Thoracic Surgery, Fukushima Medical University, Fukushima, Japan 17 Department of Respiratory Medicine, Sapporo-Kosei General Hospital, Sapporo, Japan 18 Respiratory Center, Asahikawa Medical University, Asahikawa, Japan 19 Department of Internal Medicine, Sunagawa City Medical Center, Sunagawa, Japan 20 Center for Integrated Science and Humanities, Fukushima Medical University, Fukushima, Japan 21 Department of Medical Oncology, Hokkaido University Graduate School of Medicine, Sapporo, Japan Correspondence to: Hiroshi Yokouchi, email: // Keywords : small-cell lung cancer, surgery, MED12, c-kit, immunohistochemistry Received : June 13, 2016 Accepted : December 01, 2016 Published : December 31, 2016 Abstract The limited number of available treatments for patients with small-cell lung cancer (SCLC) has prompted us to further investigate the biology of SCLC by molecular profiling. We collected formalin-fixed paraffin-embedded tumor samples from 127 patients with SCLC, who had undergone surgery at 16 institutions between January 2003 and January 2013, and analyzed the association between disease-specific survival and protein expression of c-kit, c-Met, epidermal growth factor receptor, human EGFR-related 2, vascular endothelial growth factor receptor II, anaplastic lymphoma kinase, mediator complex subunit 12 (MED12), and transforming growth factor beta receptor II (TGF-βRII) by immunohistochemistry (IHC). Of the 125 evaluable samples, all tumors expressed MED12, and 123 samples (98.4%) expressed TGF-βRII. MED12 was highly expressed in the nucleus in 92% of the positive samples while TGF-βRII was highly expressed in the cytoplasm in 55% of the positive samples. High c-kit expression was an independent favorable prognostic marker confirmed by multivariate analysis (hazard ratio: 0.543, 95% confidence interval: 0.310–0.953, p = 0.033). Both the relapse free-survival and overall survival of patients who underwent adjuvant chemotherapy were statistically longer in those with high c-kit expression (n = 38) than those with intermediate, low, or no c-kit expression ( n = 19) (not reached vs 11.6 months, p = 0.021; not reached vs 25.9 months, p = 0.028). IHC for c-kit may offer a prognostic marker for early-stage SCLC, and the results for MED12 and TGF-βRII may suggest the biological characteristics of SCLC. Further investigation of the roles of their related molecules in early stage SCLC is required.

Objectives The risk of aspiration pneumonia has been reported to increase with age, especially in elderly residents of nursing homes. However, the characteristics of those with swallowing impairments at elderly care facilities have not yet been evaluated using reliable instrumental examinations. The aims of the current study were to investigate the frequency of swallowing impairment and determine the characteristics of the elderly with swallowing disorders residing at care facilities. Methods To reveal the characteristics of the elderly with swallowing disorders, questionnaires for dysphagia screening and flexible endoscopic evaluation of swallowing (FEES) were used. Regarding the dysphagia screening, two types of questionnaires were sent to 451 elderly persons aged 65 years and older who were living in facilities for the elderly in Japan. FEES was performed to assess swallowing impairment at each facility for those who were found to be positive for dysphagia by the questionnaires. The frequency of swallowing impairment and the characteristics of elderly subjects with swallowing disorders were investigated. Results Among 413 subjects who completed both questionnaires, 229 were screened positive for dysphagia, 160 of whom underwent FEES. Swallowing impairment was observed in 93 subjects. The subjects with swallowing impairment had a significantly high prevalence of fever, sputum, and/or history of aspiration pneumonia. Their oral intake ability and activities of daily living were significantly low. Conclusion We demonstrated the frequency of swallowing disorders and the characteristics of elderly subjects with swallowing disorders living in care facilities using FEES. Our results suggest the importance of screening all elderly care facility residents for dysphagia.

IntroductionThe aim of breast reconstruction (BR) is to improve patients’ health-related quality of life (HRQOL). Therefore, measuring patient-reported outcomes (PROs) would clarify the value and impact of BR on a patient’s life and thus would provide evidence-based information to help decision-making. The Satisfaction and Quality of Life After Immediate Breast Reconstruction study aimed to investigate satisfaction and HRQOL in Japanese patients with breast cancer who undergo immediate breast reconstruction (IBR).Methods and analysisThis ongoing prospective, observational multicentre study will assess 406 patients who had unilateral breast cancer and underwent mastectomy and IBR, and were recruited from April 2018 to July 2019. All participants were recruited from seven hospitals: Okayama University Hospital, Iwate Medical University Hospital, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Showa University Hospital, University of Tsukuba Hospital, Osaka University Hospital and Yokohama City University Medical Center. The patients will be followed up for 36 months postoperatively. The primary endpoint of this study will be the time-dependent changes in BREAST-Q satisfaction with breast subscale scores for 12 months after reconstructive surgery, which will be collected via an electronic PRO system.Ethics and disseminationThis study will be performed in accordance with the Ethical Guidelines for Medical and Health Research Involving Human Subjects published by Japan’s Ministry of Education, Science and Technology and the Ministry of Health, Labour and Welfare, the modified Act on the Protection of Personal Information and the Declaration of Helsinki. This study protocol was approved by the institutional ethics committee at the Okayama University Graduate School of Medicine, Dentistry, on 2 February 2018 (1801-039) and all other participating sites. The findings of this trial will be submitted to an international peer-reviewed journal.Trial registration numberUMIN000032177.

Aim The aim of this study was to examine the association between medical institution change for perinatal care and gestational duration after the Great East Japan Earthquake using data from the Fukushima Health Management Survey. Methods The data of pregnant women who experienced the earthquake in Fukushima prefecture and participated in the Pregnancy and Birth Survey as part of the Fukushima Health Management Survey were analyzed. The primary and secondary outcomes of this study were gestational duration and preterm birth, respectively. The main study factor was prenatal checkup institution (only one institution, changed institution due to self-referral, changed institution due to medical indication, and went to parents' home for childbirth). Self-referral was considered as indicative of relocation after the disaster. Multiple linear and logistic regression analyses were conducted to examine the effect of earthquake on each outcome. Results A total of 5593 (60.2%) participants experienced the earthquake between the 4th and 37th weeks of their gestational period. After controlling for variables, pregnant women who changed their perinatal checkup institution due to medical indication were significantly associated with shorter gestational duration (β = −10.6, P

Objectives The objective of this study was to assess the frequency of and factors associated with infant feeding methods after the Fukushima nuclear power plant accident using data from the Fukushima Health Management Survey. Methods We conducted an anonymous self-administered questionnaire survey of 16,001 women who gave birth around the time of the Great East Japan Earthquake and registered their pregnancies at Fukushima Prefecture municipal offices between August 1, 2010 and July 31, 2011. The responses of 8366 women were analyzed. Chi square tests and multiple logistic regression analysis were used to compare various factors between women who had formula-fed their children because of concern regarding radioactive contamination or other reasons and those who had breastfed exclusively. Results The percentage of women who had breastfed exclusively was 30.9 %. The percentage of women who had both breastfed and formula-fed or formula-fed exclusively was 69.1 %, of which 20.3 % formula-fed because of concern regarding radioactive contamination of breast milk. The use of formula feeding because of concern about radioactive contamination was significantly higher in women who had resided within the evacuation area and those whose regular antenatal care had been interrupted. The use of formula feeding for other reasons was significantly higher in women who had resided within the evacuation area and lower for those who had willingly switched to another medical institution. Conclusions for Practice Our results suggest the importance of providing breastfeeding support to women who are forced to evacuate or whose antenatal care is interrupted after a disaster.

Objective: The Great East Japan Earthquake (magnitude, 9.0) followed by a large-scale tsunami caused a severe nuclear accident at the Fukushima Daiichi Nuclear Power Plant (Tokyo Electric Company). This study aimed to evaluate the obstetric outcomes in women in Fukushima prefecture during and after the Great East Japan Earthquake and Fukushima nuclear power plant accident. Methods: We collected information for 12,300 pregnant women who conceived during the 9 months before and after the disaster in Fukushima prefecture. The data of the subjects were analyzed according to the conception date for each pregnancy. Results: Among the women who conceived within 9 months before the disaster, adverse obstetric outcomes were not observed. In contrast, in the case of women who conceived within 6 months after the disaster, an increase in the incidence of preterm birth (less than 37 weeks) and low birth weight (less than 1500 g and less than 2500 g) was observed. Moreover, these women showed an increased incidence of medical complications, such as respiratory diseases and mental disorders. Conclusion: The results of the present study show that the occurrence of adverse obstetric outcomes was higher in the women who conceived within 6 months after the disaster than in those who were pregnant at the time of the disaster. The results may be related to emotional stress such as anxiety about the disaster and emphasize the need for continued investigations and careful management of pregnant woman in disaster areas in the future.

There are individual differences in the frequency of chemotherapy-induced nausea and vomiting (CINV) in cancer patients. We investigated the individual variability in susceptibility to CINV with focus on both behavioral factors and genetic factors in Japanese cancer patients. We performed a prospective study to investigate the association between patient attributes (backgrounds and habits as well as gene polymorphisms) and anorexia, nausea, or vomiting in 55 Japanese cancer patients undergoing chemotherapy at Nagoya University Hospital. We found that gender (female), use of non-steroidal anti-inflammatory drugs, susceptibility to motion sickness, and anxiety were associated with the frequency of CINV. Gene polymorphisms of rs1076560 (dopamine D2 receptor gene), rs6766410 (serotonin 5-HT3C receptor gene) and rs4680 (catechol-O-methyltransferase gene) were also associated. Our data suggest that these attributes may thus be risk factors for CINV. Our results provide novel information that can be used to predict the incidence of CINV in Japanese patients undergoing chemotherapy; this can help provide a substantial improvement in supportive care for patients with different types of cancer.

Young women in their late teens and early 20s are at the highest risk for depression onset. The present study aimed to assess depressive symptoms among female college students in Fukushima. More specifically, it aimed to clarify factors predicting possible symptom profiles, with an emphasis on determining how nuclear radiation risks affect the reporting of depression symptoms. A cross-sectional survey was conducted of 310 female students at a college in the Fukushima prefecture, Japan, in December 2015, and 288 participants submitted valid questionnaires. In total, 222 (77.1%) participants lived in Fukushima at the time of the Great East Japan Earthquake. The measures included the World Health Organization-Five Well-Being Index, the Fukushima Future Parents Attitude Measure, and risk perception of radiation health effects. A total of 46.5% of participants reported depressive symptoms. Path analysis revealed that higher radiation risk perceptions and reduced efficacy with reproduction related to a decline in self-esteem and self-efficacy, which was subsequently associated with increased depressive symptoms. These findings highlight the importance of radiation education among children and young adults, both after a nuclear accident and during disaster preparation, particularly in the context of reproductive and mental health.

We investigated the relationship of neonatal and maternal serum creatinine (nSCr and mSCr, respectively) with various maternal/infant characteristics at different gestational ages (GA). We reviewed medical records of neonates admitted to NICU. We collected data on birth weight, GA, Apgar scores, medications, etc. Spearman’s test was used to analyze the correlation between serum creatinine and continuous variables, and the Mann-Whitney U and Kruskal-Wallis tests for continuous variables between groups. The changes in nSCr, mSCr, and nSCr/mSCr ratio because of gestational age and the points in gestational changes in trends were estimated using joinpoint trend analysis. From 614 neonate and mother pairs, we found that nSCr was significantly correlated with GA. However, mSCr at >28 wks decreased with GA. The nSCr/mSCr ratio was correlated with GA. In infants born

Following the Fukushima nuclear accident in 2011, the central government provided health and radiation-related information that was incomplete, difficult to understand and contradictory, leading to widespread distrust in the community. Thus, from 2013 to 2014, we developed and implemented a series of health literacy training workshops for local public health nurses, often the first health care professionals with whom members of the community interact. The results from our program evaluation revealed that the task of paraphrasing professional terms and skills related to relaying numeric information to the community were difficult for the nurses to acquire. In 2016, to further support the communication efforts of public health nurses, we developed a pocket-size "health literacy toolkit" that contained a glossary explaining radiation-related terms in plain language and an index to measure the accessibility of both text and numerical information, so that nurses could calibrate and appreciate the literacy demand of information. This case study documents an interprofessional collaborative effort for the development of the toolkit, and highlights the iterative process of building health literacy skills in health care professionals.

After the nuclear disaster in Fukushima on 11 March 2011, some businesses were permitted to continue operating even though they were located in the evacuation area designated by the Japanese government. The aim of this study was to examine differences in the mental health status, workplace, living environment, and lifestyle of employees in the evacuation and non-evacuation areas. We also investigated factors related to their mental health status. Data for this cross-sectional study were collected from the questionnaire responses of 647 employees at three medium-sized manufacturing companies in the evacuation and non-evacuation areas. Through a cross-tabulation analysis, employees who worked at companies in the evacuation areas showed an increase in the duration of overtime work, work burden, and commute time, and had experienced separation from family members due to the radiation disaster and perceived radiation risks. The results of a multivariate logistic regression analysis showed that, even in a harsh workplace and living environment, being younger, participating regularly in physical activity, having a social network (Lubben Social Network Scale-6 ≤ 12), laughing frequently, and feeling satisfied with one’s workplace and domestic life were significantly associated with maintaining a healthy mental health status after the disaster. These findings are applicable for workers’ health management measures after disasters.

Background: This work focuses on assessing the role of professional community health workers (CHWs) in strengthening the health system.Methods: This cross-national case study draws from two different sources, a program in Zambia and a program in Japan. For both programs, we examine CHWs, who were trained in education and health, as the link between community and health systems to explore issues related to identification and to task.Results: We conclude that there is a need to reconsider the conventional scientific and bureaucratic frames that CHWs have to navigate. Further, we identify the potential for professional community members to take on various tasks of CHWs and the subsequent necessities and opportunities for building competence in communicating with and representing community. Finally, we present the perceived challenges facing CHWs in terms of community governance as well as their contributions to strengthening the health systems in their areas.

Background : The Fukushima Pregnancy and Birth Survey was launched to monitor pregnant mothers' health after the Great East Japan Earthquake and Fukushima Daiichi Nuclear Power Plant (NPP) accident. Several lines of investigations have indicated that a disaster impacts maternal mental health with childbirth. However, there is no research regarding mental health of mothers with fetal loss after a disaster. In this report, we focus on those women immediately after the Great East Japan Earthquake and Fukushima NPP accident and discuss their support needs. Materials and Methods : Data regarding 61 miscarriages, 5 abortions, and 22 stillbirths were ana- lyzed among the women who were pregnant at the time of the accident in the present study. We used a two-item case-finding instrument for depression screening, and compared the childbirth group with the fetal loss groups. We also analyzed mothers' opinions written as free-form text. Results : Among the three fetal loss groups, the proportion of positive depression screens was sig- nificantly higher in the miscarriage and stillbirth group than in the childbirth group. Mothers' opin- ions were grouped into six categories, with pregnancy-related items being most common, especially in the miscarriage and stillbirth groups. Conclusion : A higher proportion of Fukushima mothers with fetal loss, especially those with mis- carriage and stillbirth, had depressive symptoms compared to those who experienced child- birth. Health care providers need to pay close attention to this vulnerable group and respond to their concerns regarding the effects on their fertility.

Background: On 11 March 2011, the Great East Japan Earthquake followed by a powerful tsunami hit the Pacific Coast of Northeast Japan and damaged Tokyo Electric Power Company's Fukushima Daiichi Nuclear Power Plant, causing a radiation hazard in Fukushima Prefecture. The objective of this report is to describe some results of a questionnaire-based pregnancy and birth survey conducted by the Radiation Medical Science Center for the Fukushima Health Management Survey. Materials and Methods: Questionnaires were sent to women who received maternal and child health handbooks from municipal officers in Fukushima Prefecture between 1 August 2010 and 31 July 2011, with the aim of reaching those who were pregnant at the time of the disaster. Mailing began 18 January 2012. Data were analyzed separately for six geographic areas in Fukushima Prefecture. Results: The total number of women meeting survey criteria was 15,972. The number of responses received to date is 9,298 (58.2%). Data from 8602 respondents were analyzed after excluding 634 invalid responses and 5 induced and 57 spontaneous abortions (less than 22 gestational weeks). The incidences of stillbirth (over 22 completed gestational weeks), preterm birth, low birth weight and congenital anomalies were 0.25%, 4.4%, 8.7% and 2.72%, respectively. These incidences are similar to recent averages elsewhere in Japan. Conclusion: Considering the pregnancy and birth survey data in aggregate, our disaster seemed to provoke no significant adverse outcomes over the whole of Fukushima prefecture. But post-disaster prenatal care and support intended for patients' safety and security should be coupled with ongoing surveillance and rigorous data analysis.

Objective. This study sought to estimate the prevalence of erectile dysfunction (ED) and to ascertain risk factors among Vietnamese men with diabetes. Methodology. One hundred and fifty one diabetic patients were recruited from the People’s Hospital 115 between August 2011 and March 2012. They were asked to complete a self-administered questionnaire that included the International Index for Erectile Function Questionnaire (IIEF-5) and the World Health Organization (WHO) - Five Well-being Index. Medical history, anthropometric measures, and laboratory test results were recorded. ED was classified based on the IIEF-5 total score. Results. Of the 151 diabetic men, 135 (89%) completed the IIEF-5. The overall prevalence of ED was 84%; majority (65%) were classified as mild to moderate, while 10% were considered severe. The prevalence of ED was higher among those with peripheral neuropathy [adjusted odds ratio (OR) 5.22, 95% confidence interval (CI) 1.14-21.89] and longer duration of diabetes (OR 1.11, 95% CI 1.00-1.24). Conclusion. ED represents a prevalent major complication among men with type 2 diabetes. The presence of peripheral neuropathy and long duration of diabetes may be useful indicators of ED.

The Fukushima nuclear power plant accident created many challenges, including those for families with small children who sought to assess and address the health risks of radiation exposure. Mothers' worries about their young children have been described in prior studies, but none has examined the impact of a nuclear power accident on their self-confidence as mothers. The present study focused on levels and associated factors of maternal confidence (one of the indicators used to evaluate Japan's national Maternal and Child Health Plan) before and after the accident. Comparing three samples of mothers with 18-month-old children in Fukushima City (218 in 2010; 300 in 2011, the year of the accident; and 188 in 2012) indicated that maternal confidence was lower in 2011 compared to 2010 and 2012. Interpersonal problems at home were significantly associated with lower maternal confidence in 2011, as well as increased depression in 2012. Other factors associated with lower maternal confidence across these...