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Background: The previous Japanese clinical practice guidelines for multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD) were published in 2017. Recently, for the first time in 6 years, the MS and NMOSD guideline development committee revised the Japanese guidelines for MS, NMOSD, and myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD)., Methods: The committee utilized the Grading of Recommendations Assessment, Development, and Evaluation system based on the "Minds Handbook for Clinical Practice Guideline Development 2020 Ver. 3.0″ with a focus on clinical questions (CQs). The committee also discussed clinical issues other than CQs, categorizing them as a question-and-answer (Q&A) section, including "issues on which experts' opinions agree to a certain extent" and "issues that are important but not included in the CQ"., Results: The committee identified 3, 1, and 1 key CQs related to MS, NMOSD, and MOGAD, respectively, and presented recommendations. A Q&A session regarding disease-modifying therapies and relapse prevention therapies for MS, NMOSD, and MOGAD was conducted. The revised guidelines were published in September 2023., Conclusions: The Japanese guidelines for clinical practice on MS, NMOSD, and MOGAD were updated. Treatment strategies for MS, NMOSD, and MOGAD are changing, and these updated guidelines may assist with treatment decisions for these diseases in clinical practice., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this study., (Copyright © 2024. Published by Elsevier B.V.)

Introduction: Individuals with mental illness and their families often undergo their recovery process in their communities. This study explored the long-term outcome trajectories of individuals and families who received case management services provided by multidisciplinary outreach teams in a community setting. The primary objective of this study was to determine whether trajectories of subjective quality of life (QoL) related to personal recovery were linked to those clinical and societal outcomes and changes in outreach service frequency., Methods and Analysis: The protocol of this 10-year multisite cohort study was collaboratively developed with individuals with lived experience of psychiatric disorders who had received services from participating outreach teams, and with family members in Japanese family associations. The participants in the study include patients and their key family members who receive services from 23 participating multidisciplinary outreach teams. The participant recruitment period is set from 1 October 2023 to 30 September 2025. If necessary, the recruitment period may be extended and the number of participating teams may be increased. The study will annually evaluate the following outcomes after participants' initial utilisation of services from each team: QoL related to personal recovery, personal agency, feelings of loneliness, well-being and symptom and functional assessments. The family outcomes encompass QoL, well-being, care burden and family relationships. Several meetings will be held to monitor progress and manage issues during the study. Multivariate analyses with repeated measures will be performed to investigate factors influencing changes in the patients' QoL scores as the dependent variable., Ethics and Dissemination: The study protocol was approved by the ethical committee of the National Center of Neurology and Psychiatry (no. A2023-065). The study findings will be reported in peer-reviewed publications and presented at relevant scientific conferences., Trial Registration Number: UMIN-CTR, No. UMIN000052275., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Aim: This study aimed to compare the 12-item and 36-item versions of the World Health Organization Disability Assessment Schedule (WHODAS) 2.0 using longitudinal data from community mental health outreach service users., Methods: Using data from Tokorozawa City mental health outreach service users in Japan, total and domain WHODAS-12 and WHODAS-36 scores were compared. First, we examined score-change differences by domain at the start of outreach services (T1) and 1 year later (T2) for each version. Next, we compared differences between the two versions using Pearson's correlation, Wilcoxon signed-rank test, and Bland-Altman analysis., Results: Among 20 participants, total scores and scores of some domains (i.e., cognition, getting along, life activities, and participation) were significantly lower at T2 than at T1 on both versions (p < 0.010). WHODAS-36 scores were significantly lower at T2 than at T1 for the self-care domain (p = 0.018). Except for self-care, strong correlations were found between scores from the two versions (p < 0.001). In the Wilcoxon signed-rank test and Bland-Altman analysis, we found significant differences between the scores of the two versions in the mobility, self-care, and participation domains. There were no significant differences in the distribution or systematic errors between the two versions in scores for the other domains or total score., Conclusion: We found strong positive correlations between WHODAS-12 and WHODAS-36 total scores with no statistical differences between them. For some domains, differences in distribution and systematic errors were found., (© 2024 The Authors. Neuropsychopharmacology Reports published by John Wiley & Sons Australia, Ltd on behalf of The Japanese Society of Neuropsychopharmacology.)

This paper introduces a forensic psychiatry database established in Japan and discusses its significance and future issues. The purpose of this Database, created under the Medical Treatment and Supervision Act (MTSA) Database Project, is to improve the quality of forensic psychiatry treatment. It can collect monthly data on "basic information," "Orders and hospitalizations under the MTSA," "Treatment process," "Criminal and medical treatment history," and "problematic behavior in the unit." The online system has accumulated data on more than 8,000 items in 24 broad categories. Medical data are exported from the medical care assisting system of 32 designated inpatient facilities in XML format and then saved on USB memory sticks. The files are imported into the Database system client, which sends the data to the Database server via a virtual private network. This system minimizes errors and efficiently imports patient data. However, there is a limitation that it is difficult to set items that need to be analyzed to solve everyday clinical problems into the database system because they tend to change over time. By evaluating the effectiveness of the Database, and collecting appropriate data, it is expected to disseminate a wide range of knowledge that will contribute to the future development of mental health and welfare care., (© 2024. The Author(s).)

Objective: This study examined the association between job tenure and job preference matching for five job preference domains for people with mental disorders enrolled in Individual Placement and Support (IPS) programs in Japan. The domains include occupation type, monthly income, weekly work hours, commute time, and illness disclosure., Methods: We conducted secondary analysis of participants who obtained employment in a longitudinal study during the 24-month follow-up period at 16 agencies routinely providing IPS programs. We included 112 participants who expressed job preferences and were employed at least once. A total of 130 employment cases were analyzed. Matches in the five domains were determined using participants' job preferences and employment information. The Match Level (0-5) indicates the number of domains that match the participant's job preferences. Job tenure (weeks worked) was compared between the matched and unmatched groups in each domain and between each match levels using linear regression mixed-effects models., Results: A match for a given domain did not show a significant relationship with job tenure, whereas Match Levels 3 ( B = 29.6, 95% CI [10.8, 48.4], p = .003) and 4 ( B = 37.0, 95% CI [17.1, 56.9], p < .001) had a significantly longer tenure than those with Match Level 1., Conclusions and Implications for Practice: A higher match level may be related to a longer job tenure. The results suggest that employment specialists should prioritize clients' preferences in job searches. Further replication studies in other settings and countries should be conducted to verify the findings in this study. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Topical metronidazole is not currently approved in Japan as a treatment for the indication of rosacea, although 0.75% metronidazole gel was authorized in 2014 for the management of cancerous skin ulcers. We conducted a randomized, double-blind, vehicle-controlled study to evaluate the efficacy and safety of 0.75% metronidazole gel in Japanese patients with inflammatory lesions (papules/pustules) and erythema associated with moderate to severe rosacea. Overall, 130 patients were randomly assigned to receive 0.75% metronidazole gel (n = 65) or vehicle (n = 65), and 120 patients completed 12 weeks of treatment. The primary efficacy outcome was the proportion of patients who achieved both of the following at week 12: an improvement of >50% in the number of inflammatory lesions (papules/pustules) and a positive change of at least one degree in erythema severity. This composite outcome was achieved by 72.3% of metronidazole-treated patients versus 36.9% of vehicle-treated patients, with the between-group difference demonstrating significant improvement with 0.75% metronidazole gel (p < 0.0001). All secondary efficacy endpoints (patients achieving a score of ≥3 for percent change in the number of inflammatory lesions at week 12; patients achieving a score of ≥3 for change in erythema severity at week 12; patients achieving an Investigator's Global Assessment score of 0 or 1 at week 12; percent change over time in the number of inflammatory lesions; change over time in erythema severity) also showed improvement in the 0.75% metronidazole gel group. The incidence of adverse events was higher with metronidazole (40.0%) than with vehicle (29.2%). Of these, treatment-related, treatment-emergent adverse events occurred in 9.2% and 6.2% in the metronidazole and the vehicle group, respectively, but there were no new safety concerns. Overall, the results of this study have confirmed the efficacy and safety of 0.75% metronidazole gel in Japanese patients with rosacea., (© 2021 The Authors. The Journal of Dermatology published by John Wiley & Sons Australia, Ltd on behalf of Japanese Dermatological Association.)

Objectives: The primary objective is to compare the prevalence of mental health problems, including psychological distress, anxiety and depressive symptoms in Japan Rugby Top League players in the new life with COVID-19 with those evaluated before COVID-19. Methods: An observational comparative web-based cross-sectional study was employed for Japan Rugby Top League players. We compared the data from 220 Japanese and 7 foreign players during the new life with COVID-19 with the data from before COVID-19, which was obtained from 233 Japanese and 18 foreign players. We measured anxiety and depression symptoms with the validated Kessler-6, which has been widely used in clinical and research settings among different populations. To investigate the distribution of K6 score and whether there are discrete clusters or not, we conducted the two-step cluster analysis. Results: In the new life with COVID-19, 15.0% of players reported mild symptoms, which was significantly lower than the 32.3% of players before COVID-19. The prevalence of moderate and severe symptoms was 6.7 and 3.5%, respectively, in the group during the new life with the COVID-19, and 4.8 and 5.2% in the pre-COVID-19 group, with no significant difference. A two-step cluster analysis supported the existence of these two qualitatively different clusters in both groups. Conclusions: With the spread of new lifestyles related to COVID-19, some rugby players may have improved mental health status due to changes in their daily living environment. Such environmental adjustments alone may not have been sufficient to change the mental health status of others. Rugby players or their teams may require mental health professionals and systems that ensure rest, adjust the environment, and sustainably provide more professional care., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Ojio, Matsunaga, Kawamura, Horiguchi, Yoshitani, Hatakeyama, Amemiya, Kanie and Fujii.)

Glycopyrronium tosylate cloth, an anticholinergic drug, has been approved for the topical treatment of primary axillary hyperhidrosis in the USA, but its effects in Japanese patients have not been previously investigated. This 4-week, randomized, double-blind, vehicle-controlled, multicenter study was conducted to evaluate the efficacy and safety of glycopyrronium tosylate cloth for primary axillary hyperhidrosis patients in Japan. Eligible patients, who were ≥9 years of age and had primary axillary hyperhidrosis ≥6 months, with gravimetrically-measured sweat production ≥50 mg/5 min, and Hyperhidrosis Disease Severity Scale ≥3 (moderate) were randomized 1:1:1 to once daily topical glycopyrronium tosylate 3.75%, 2.5%, or vehicle. Overall, 497 patients (163 in the glycopyrronium tosylate 3.75% group, 168 in the glycopyrronium tosylate 2.5% group, and 166 in the vehicle group, hereinafter in this order) were randomized. Statistically higher proportions of patients in the glycopyrronium tosylate groups achieved ≥2-point improvement in Hyperhidrosis Disease Severity Scale and ≥50% reduction in sweat production from baseline versus vehicle at week 4 (51.6%, 41.1%, and 16.4%, respectively; p < 0.001 in both cases). Higher responder rates in the glycopyrronium tosylate groups compared with the vehicle group occurred as early as week 1. The most common treatment-emergent adverse events in patients treated with glycopyrronium tosylate were photophobia, mydriasis, thirst, and dysuria. Most treatment-emergent adverse events were mild as determined by the investigators. The incidence of treatment-emergent adverse events leading to treatment modification was low in the three groups. The 4-week use of topical glycopyrronium tosylate improved the patient-reported outcome measure Hyperhidrosis Disease Severity Scale and objectively-evaluated sweat production with a favorable benefit/risk profile., (© 2021 The Authors. The Journal of Dermatology published by John Wiley & Sons Australia, Ltd on behalf of Japanese Dermatological Association.)

Background: Treatment goals for mental illness have expanded from hospital discharge and improved functioning to employment, living alone, and personal realization. These changes in treatment goals have also influenced mental health research. Recent studies have addressed the development of core outcome sets focusing on clinical aspects of mental illness such as depression and anxiety. However, a well-developed framework of essential outcomes for people with mental illness (service users) who live in the community is lacking. In addition, recent worldwide trends suggest more patient and public involvement and the importance of considering multiple stakeholders' views in the area of mental health research. Purpose of this study is to explore consensus on high-priority outcome domains among multiple stakeholders in community mental healthcare fields in Japan., Methods: A three-step approach to developing an outcome list will be used. First, we developed a long list of outcomes for community mental health through a literature review, focus group interviews with key stakeholders, and online questionnaire surveys of service users and caregivers. Second, the long list was checked and revised in a pilot study. Third, the long list will be shortened to the outcome list through the Delphi methodology with participation from multiple stakeholders., Discussion: Identifying important common outcome domains through collaboration with multiple stakeholders appears to contribute to the development of evidence for community mental health research in Japan. In addition, the study process itself may help promote patient and public involvement in education, practice, and research in the field of community mental health., (© 2021 The Authors. Neuropsychopharmacology Reports published by John Wiley & Sons Australia, Ltd on behalf of The Japanese Society of Neuropsychopharmacology.)

Background: Globally increasing clinical and research interests are driving a movement to promote understanding and practice of mental health in elite athletes. However, few studies have yet addressed this issue. This study aims to describe the association of the intention to seek help with mental health knowledge and stigma and the severity of depressive symptoms in Japan Rugby Top League players., Methods: As a target population, we studied 233 Japan Rugby Top League male players (25-29 years = 123 [52.8%]), who were born in Japan, using a cross-sectional design. Surveys were conducted using anonymous, web-based self-administered questionnaires. Structural equation modelling was performed to evaluate the hypothesis of an interrelationship between mental health knowledge, stigma, and severity of depressive symptoms as factors influencing the intention to seek help., Results: Players with more severe depressive symptoms were more reluctant to seek help from others (β = - 0.20, p = 0.03). Players with greater knowledge about mental health tended to have less stigma toward others with mental health problems (β = 0.13, p = 0.049), but tended not to seek help with their own mental health problems., Conclusions: Rugby players in need of mental health support, even with greater knowledge, tend not to seek help from others, while having less stigma toward people with mental health problems. Rugby players might require approaches other than a knowledge-based educational approach to encourage them to seek help., Competing Interests: The authors have read the journal’s policy and have the following competing interests: The TOYOTA foundation provided financial support in the form of a Co-Creating New Society with Advanced Technologies grant. There are no patents, products in development or marketed products associated with this research to declare. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Background: Empathy, which involves understanding another person's experiences and concerns, is an important component for developing physicians' overall competence. This longitudinal study was designed to test the hypothesis that medical students' empathy can be enhanced and sustained by Humanitude Care Methodology, which focuses on perception, emotion and speech., Methods: This six-year longitudinal observational study examined 115 students who entered Okayama University Medical School in 2013. The study participants were exposed to two empathy-enhancing programs: (1) a communication skills training program (involving medical interviews) and (2) a Humanitude training program aimed at enhancing their empathy. They completed the Jefferson Scale of Empathy (JSE) seven times: when they entered medical school, before participation in the first program (medical interview), immediately after the first program, before the second program (Humanitude exercise), immediately after the second program, and in the 5th and 6th year (last year) of medical school. A total of 79 students (69% of the cohort) completed all seven test administrations of the JSE., Results: The mean JSE scores improved significantly after participation in the medical interview program (p < 0.01) and the Humanitude training program (p = 0.001). However, neither program showed a sustained effect., Conclusions: The Humanitude training program as well as medical interview training program, had significant short-term positive effects for improving empathy among medical students. Additional reinforcements may be necessary for a long-term sustained effect.

Aims: The purpose of this study was to retrospectively investigate care difficulties experienced by caregivers of people with schizophrenia during COVID-19 pandemic lockdowns in Japan (April 7-May 25, 2020) and examine associations between these care difficulties during lockdowns and daily caregiver burden., Methods: Data were collected from 132 participants of the LINE Schizophrenia Family Association using an online survey., Results: Caregivers were mostly concerned about who would care for people with schizophrenia if caregivers become infected with COVID-19. A significant association was found between higher daily caregiver burden and more difficult care experiences during COVID-19 pandemic lockdowns (B = 0.58, 95% confidence interval, 0.40-0.75, P < .01, adjusted R-squared = .34)., Conclusions: Further studies and supports for caregivers of people with schizophrenia are needed., (© 2021 The Authors. Neuropsychopharmacology Reports published by John Wiley & Sons Australia, Ltd on behalf of the Japanese Society of Neuropsychopharmacology.)

Background: The Japanese version of the individualized Supported Employment Fidelity scale (JiSEF) was developed by modifying the 25-item Individual Placement and Support Fidelity Scale (IPS-25). While a preliminary study partly confirmed the concurrent validity with vocational outcomes, this replication study aimed to examine the stability of the concurrent validity and the inter-rater reliability of the JiSEF and to test its convergent validity with IPS-25., Methods: Fidelity assessments were conducted in 2016 (n = 17), 2017 (n = 13), and 2018 (n = 18) to examine the employment rate and the fidelity scores at the agency level. We also evaluated the fidelity scores for the IPS-25 in 2018. We examined the associations between the fidelity scale scores and vocational outcomes for the concurrent validity and between the fidelity scales for convergent validity. The inter-rater reliability was examined in the 2016 and 2017 assessments., Results: High intraclass correlation coefficients (0.93 in 2016 and 0.92 in 2017) were obtained for the inter-rater reliability. The JiSEF score in each year was associated with the agency employment rate (r = 0.710, P = 0.001 in 2016; r = 0.722, P = 0.005 in 2017; and r = 0.665, P = 0.003 in 2018). A supplementary longitudinal data analysis also confirmed the association between the JiSEF score and the employment outcomes. Additionally, the JiSEF was significantly correlated with the IPS-25 (r = 0.760, P < 0.001)., Conclusions: This study stably replicated good inter-rater reliability and concurrent validity of the JiSEF. Additionally, the convergent validity was confirmed. Further studies with large samples are needed to confirm these findings., (© 2021 The Authors. Neuropsychopharmacology Reports published by John Wiley & Sons Australia, Ltd on behalf of the Japanese Society of Neuropsychopharmacology.)

Clinical and research interest is growing in mental health support for elite athletes, based on findings from epidemiological surveys conducted in Australia, the United States, and European countries. However, little is known about the mental health status of elite athletes in Asia, including Japan. In the current study, we examine the prevalence of mental health problems and suicidal ideation and its risk factors in Japan Rugby Top League players. We analyze anonymous web-based self-reported data from 251 currently competing Japan Rugby Top League male players. During the off-season from December 2019 to January 2020, data on anxiety and depression symptoms were collected using the Japanese version of the 6-item Kessler-6. Suicidal ideation was assessed using the Baron Depression Screener for Athletes. Among the players, 81 players (32.3%) had experienced symptoms of mild anxiety and depression during the previous 30 days, while 12 (4.8%) and 13 (5.2%) had suffered from moderate and severe symptoms, respectively. Nineteen athletes (7.6%) reported that they had experienced suicidal ideation during the previous 2 weeks. Players with mental health problems experienced more events in competitions and daily life, including reduced subjective performance, missing opportunities to play during the last season, changes in health condition, and thinking about a career after retirement, compared with players without such problems. Mental health issues in Japan Rugby Top League players, as elite athletes, may be common, and research and practice development is expected in the near future.

Aims: Since April 2020, the new Japanese mental health system has used the Intensive Case Management Screening Sheet (ICMSS) to identify patients' needs for case management services. This study aimed to examine the association between ICMSS score and service intensity and compare the magnitude of association between ICMSS score and service intensity with other scales., Methods: We recruited patients who received case management services from a staff member in a psychiatric outpatient service, psychiatric day-care program, or outreach team based at one psychiatric hospital. Case management service needs and functioning were assessed using ICMSS, Global Assessment Functioning (GAF), and Personal and Social Performance (PSP). The case manager also documented all services received by the participant for 2 months. The association between each scale and service duration was examined. Furthermore, the magnitude of the association between each scale and service intensity was compared., Results: Overall, 138 participants were included in the analysis. The most common diagnosis was schizophrenia. Mean total service duration was weakly but significantly correlated with ICMSS (Spearman's ρ = 0.320), GAF (ρ = -0.198), and PSP (ρ = -0.275) scores. Poisson's regression models and postestimation testing showed that the coefficient for ICMSS score (B = 0.144; 95% CI = 0.141, 0.148) was significantly larger than the coefficients for GAF (B = -0.017, 95% CI = -0.017, -0.016, χ 2  = 15.70, P < 0.001) and PSP (B=-0.016, 95% CI = -0.017, -0.016, χ 2  = 14.64, P < 0.001) scores., Conclusion: ICMSS may provide preliminary information on case management service needs, but the level of service should be based on the individual needs of each patient and shared decision-making between the patient and case manager., (© 2020 The Authors. Neuropsychopharmacology Reports published by John Wiley & Sons Australia, Ltd on behalf of the Japanese Society of NeuropsychoPharmacology.)

The Baron Depression Screener for Athletes (BDSA) is a brief, valid, and reliable athlete- specific assessment tool developed in the US to assess depressive symptoms in elite athletes. We examined the applicability and reliability of a Japanese version of the BDSA (BDSA-J) in a Japanese context, and further examined the construct validity of the BDSA-J. Web-based anonymous self-report data of 235 currently competing Japanese professional male rugby players (25-29 years = 123 [52.3%]) was analyzed. A two-stage process was conducted to validate the factor structure of the BDSA-J using exploratory factor analysis in a randomly partitioned calibration sample, and confirmatory factor analysis in a separate validation sample. Cronbach's alpha was used to assess internal consistency. Spearman's rank-order correlation coefficients were calculated to examine convergent validity with the Kessler-6. We identified a one-factor structure for BDSA-J. Confirmatory factor analysis supported this one-factor model, revealing good model fit indices. The standardized path coefficients for each of the items were β = 0.52 to 0.79 ( p < 0.001). A Cronbach's alpha of 0.71 was obtained for the BDSA-J. BDSA-J showed significant positive correlations with the Kessler-6. The BDSA-J is an appropriate and psychometrically robust measure for identifying depressive symptoms in Japanese male rugby players.

Objective: Little is known about the association between service intensity and fidelity scale score in supported employment programs. This study compares service contents and intensity in low- and high-fidelity programs and examines the validity of the Japanese version of the individualized Supported Employment Fidelity Scale., Methods: The vocational outcomes and service provision data for 51 individuals with schizophrenia in 13 supported employment programs were collected over a 12-month study period. Outcomes, service contents, and service intensity were compared between the low-fidelity group (seven programs; N=29) and the high-fidelity group (six programs; N=22)., Results: In both groups, 70% of the total services (hours) were provided in the first 6 months. The high-fidelity group, which was associated with better vocational outcomes than the low-fidelity group (employment rate, 68% versus 38%, respectively), made the greatest effort in job development outside of the agency, whereas the low-fidelity group spent more time on group services. In addition, before the client obtained a job, high-fidelity programs provided outreach services (B=7.2, p=0.043) and agency-based individual services (B=5.7, p<0.001) at greater intensity than did low-fidelity programs. However, no significant between-group difference was found in service intensity once clients were employed., Conclusions: Supported employment programs with a high fidelity score focus more intensely on providing individual services in and outside of the agency, particularly before clients obtain a job. However, clarification of the relationships among service quality at the structure level, amount of follow-up services, and individual needs in supported employment programs is a future issue.

Introduction: Development of a support system for families caring for people with schizophrenia in routine psychiatric care settings is an important issue worldwide. Regional mental health systems are inadequate for delivering effective services to such family members. Despite evidence that family psychoeducation (FPE) alleviates the burden of schizophrenia on families, its dissemination in routine clinical practice remains insufficient, suggesting the need for developing an effective and implementable intervention for family caregivers in the existing mental health system setting. In Japan, the visiting nurse service system would be a practical way of providing family services. Visiting nurses in local communities are involved in the everyday lives of people with schizophrenia and their families. Accordingly, visiting nurses understand their needs and are able to provide family support as a service covered by national health insurance. The purpose of this study is to discover whether a brief FPE programme provided by visiting nurses caring for people with schizophrenia will alleviate family burden through a cluster randomised controlled trial (cRCT)., Methods and Analysis: The study will be a two-arm, parallel-group (visiting nurse agency) cRCT. Forty-seven visiting nurse agencies will be randomly allocated to the brief FPE group (intervention group) or treatment as usual group (control group). Caregivers of people with schizophrenia will be recruited by visiting nurses using a randomly ordered list. The primary outcome will be caregiver burden, measured using the Japanese version of Zarit Burden Interview. Outcome assessments will be conducted at baseline, 1-month follow-up and 6-month follow-up. Multiple levels of three-way interactions in mixed models will be used to examine whether the brief FPE programme will alleviate the burden on caregivers relative to treatment as usual., Ethics and Dissemination: The Research Ethics Committee of the Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Japan (No 2019065NI) approved this study. The results will be published in a scientific peer-reviewed journal., Trial Registration Number: UMIN000038044., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Aims: In the past two decades, there has been growing interest in patient-doctor communication in psychiatry, and several treatment options have been established. This study aimed to develop the Interpersonal Processes of Care Survey-Japanese version (IPC-J), which measures multidimensional communication and the relationship between doctors and patients in Japanese psychiatry., Method: We conducted a cross-sectional questionnaire survey at one psychiatric hospital and two psychiatric clinics in Japan and investigated the factor validity, convergent validity, internal consistency, and test-retest reliability of the IPC-J., Result: Overall, 148 eligible patients participated in the study and were included in the analyses. Data from 16 participants were used to examine test-retest reliability. An exploratory factor analysis using 23 items from the IPC scale was performed to clarify the factor structure in a Japanese psychiatric setting. The final IPC-J contained 22 items and a two-factor structural model. High internal consistency (α > .8) and moderate test-retest reliability (interclass correlation > .65) were observed. Regarding convergent validity, the factor 1 "Doctor's communication-related attitudes and skills" was significantly correlated with service satisfaction, empowerment, and medication adherence, whereas the factor 2 "Consideration for the patient's to promote own treatment decisions" was correlated with service satisfaction and medication adherence., Conclusion: The IPC-J appears to be a useful tool for assessing patient views on interpersonal communication with doctors in a Japanese psychiatric setting. While the analysis suggested utilizing an IPC-J with 22 items, the full IPC-J can be used in cross-cultural studies., (© 2020 The Authors. Neuropsychopharmacology Reports published by John Wiley & Sons Australia, Ltd on behalf of the Japanese Society of NeuropsychoPharmacology.)

Background: In intensive case management (ICM), users receive a wide variety of services of varying content, which makes it difficult to understand the global features of ICM programs., Aims: The aim of this study was to examine the features of ICM programs using network analysis., Methods: A total of 233 ICM users in two Japanese medical institutions were recruited to participate. All received services were recorded for 2 months. In the network analysis, nodes represented types of ICM services and edges between two nodes depicted when over 5% of participants received both types of services., Results: We found high centrality values for 'H5. Hospital-based counseling', 'O13. Outreach support for mental health medications', 'H13. Hospital-based support for mental health medication', 'T5. Counseling via telecommunication', 'H3. Hospital-based coordination of services in the medical institution' and 'T2. Coordination of services with other institutions via telecommunication'. These results indicated that these services were associated with various other types of services. Social functioning was related to 'O13. Outreach support for mental health medication', whereas need for ICM was related to 'H13. Hospital-based support for mental health medications', 'T5. Counseling via telecommunication' and 'T2. Coordination of services with other institutions via telecommunication'., Conclusion: Based on these findings, we speculated that there are at least five types of core services in ICM: regular face-to-face contact, outreach services, hospital-based services, easy contacts and coordination. These findings clarified the features of ICM programs, which may help improve the understanding of case managers' practice.

Purpose: This study assessed the symptoms, treatment, social systems use, and perception of living conditions of patients with young-onset Parkinson's disease (YOPD), and investigated the support needed by them., Method: Among the 252 people who completed our questionnaire, we defined YOPD patients as those diagnosed as young onset or those with onset at ≤40 years. The data were compared with others., Results: There were 24 patients with YOPD (9.5%) (average age: 61.7 years), with an average disease duration 6.4 years longer (p < 0.01) and time until diagnosis 0.7 years longer (p < 0.1) than those of other patients. This group took 1.6 times more types of medicines, and time to their next appointment was 8.6 days shorter than that of other patients (p < 0.05). Patients with YOPD had more pulsive walking and more sweating (p < 0.05), and more motor fluctuation (p < 0.1). More patients with YOPD had a physical disability certificate but felt they were not obtaining the required services (p < 0.05). 45.0% of the YOPD group wanted to work more, more used information and communication equipment (p < 0.05), and more felt their medications were adequate (p < 0.1)., Conclusions: Increased awareness of YOPD is needed. YOPD patients have motor fluctuation because of the longer disease duration. Thus, the support of doctors and nurses, and frequent examination visits, are indispensable for controlling symptoms to achieve middle age developmental tasks. Increased support for care-giving, leisure-time activities, and work is also necessary and may help maintain the desire to work in this group.

Concern about mental health issues and the treatment of mentally disordered offenders attracts considerable public attention. This study aimed to gather the experiences and opinions of people who have experienced admission to a psychiatric ward in order to grasp their reaction to, and understanding of, the legislation behind the involuntary admission of psychiatric patients. A web-based questionnaire survey was conducted with a total of 379 participants, using a cross-sectional, exploratory design. The data were analyzed using a chi-squared test, Fisher's exact test, and a logistic regression analysis. According to the results, many patients were satisfied with their treatment during psychiatric admission; however, only few participants said that they had been given an adequate explanation for their involuntary treatment. Most participants expected qualified assistance after discharge, although the prospect of a regular visit from an official was not entirely supported by the participants. Patient satisfaction was relevant to the discussion of their needs after discharge and in developing a crisis plan during admission. These findings suggest that psychiatric patients accept inpatient treatment as long as they receive an adequate explanation. More qualified care such as relapse prevention would be expected to lead to better satisfaction. For them to welcome regular visits from an official, patients may need more information and discussion., Competing Interests: The authors declare no potential conflicts of interest concerning the research, authorship, and publication of this article.

Aim: Constipation is a serious problem for persons with mental and physical disabilities in Japan. However, prophylaxis is extremely difficult because the major causes of constipation in these individuals are related to their mental and physical disabilities. Constipation can be successfully treated with glycerol enemas (GEs) and other aperients. As constipation is a lifetime issue for these persons, dietary regimens to prevent constipation can be important., Methods: This study evaluated the probiotic effects of kefir-fermented milk for preventing constipation in 42 persons with mental and physical disabilities. The participants were administered 2 g of lyophilized kefir with each meal for 12 weeks and their bowel movements, the administration of GE and other aperients, and stool shape were recorded., Results: The intake of kefir significantly reduced constipation, compared with the baseline status. Some individuals showed complete relief of constipation, whereas others showed no effect., Conclusion: Despite individual variations, consuming kefir daily could prevent constipation., (© 2017 Japan Academy of Nursing Science.)

Objective . The aim of this study was to evaluate the relationships between the composition of free fatty acids (FFAs) and metabolic parameters, including body fat distribution, in Japanese. Methods . The study subjects were 111 Japanese patients (54 males, 57 females). Metabolic parameters and visceral and subcutaneous fat areas as determined by CT scanning at the umbilical level were measured. Glucose tolerance test (GTT) was performed by administering 75 g glucose orally. Results . The percentage of linoleic acid (C18:2), the greatest constituent among FFAs, was negatively correlated with visceral fat area ( r = -0.411, p < 0.0001), fasting glucose ( r = -0.330, p < 0.0001), HbA1c ( r = -0.231, p = 0.0146), and systolic blood pressure ( r = -0.224, p = 0.0184). Linoleic acid percentage was also significantly negatively correlated with HOMA-IR ( r = -0.416, p < 0.0001) by simple correlation. Based on the findings of OGTT, the 111 subjects were classified into three groups: 33 with normal glucose tolerance, 71 with impaired glucose tolerance (IGT), and 7 diabetic subjects. The percentage of serum linoleic acid in diabetic subjects was significantly lower than that in normal subjects. Conclusion . We conclude that serum linoleic acid level is negatively correlated with the accumulation of visceral fat in relation to a reduction of insulin resistance in Japanese subjects.

The purpose of this study was to determine safe techniques of performing blood collection using an evacuated tube system, particularly with regard to manipulation of the equipment and at the puncture site. Careful observation of the procedure was used to collect data for evaluating the various venepuncture techniques. Nurses were digitally videotaped performing simulated venepuncture. A self-administered questionnaire and unstructured observation of a videotaped recording were evaluated, and valid responses were analyzed from participants who performed venepuncture using various techniques. The participants who changed hands during the procedure were older than those who did not change hands. Needle movements during puncture and insertion, including rotation and insertion in a wave-like trajectory, were observed. Appropriate training, including recommendations for maintaining the stability of the needle tip, is important to ensure safety when performing venepuncture. Movement of the needle should not place too much pressure on the puncture site., (© 2013 Wiley Publishing Asia Pty Ltd.)

The aim of this study is to clarify the health behavior of elderly people engaged in agriculture and information communication technology (ICT). The participants were 61 people engaged in agriculture in conjunction with ICT systems (group A), and 49 people not engaged in this (group B) from among the people aged 65 years or over in village C, both living located in a mountain areas. Data were collected from August 2009 to June 2011 in two stages: interviews to members of group A through home visits, and a group survey of groups A and B through questionnaires. The results of the study were as follows: 1) members of group A lived with feelings of attachment to the land to which they were accustomed and showed gratitude to their ancestors; 2) in group A, the desire of participants to continue their life was sufficient motivation to look after their own health and maintain independence; and 3) they provided a new challenge and a sense of achievement. The results suggest that the health behavior in group A was behavior adopted voluntarily in order to maintain an independent lifestyle supported by working, and it is likely to be linked to the preservation of health.

Following the March 11, 2011 Great Japan East Earthquake and the Fukushima Daiichi Nuclear Power Plant accident, disaster workers have been working day and night for recovery efforts. A large part of disaster workers, i.e., Self-Defense Force, police, fire department, and coast guard personnel, were highly acknowledged by the Japanese public for searching nearly 19,000 dead or missing victims. This recognition will be beneficial for their psychological recovery. On the other hand, dentists and government employees also took a large role in these mortuary missions, but their work was hardly known to the people. Furthermore, local government employees became victims of public criticisms. Similar phenomenon has been seen among Fukushima nuclear plant workers. These workers have experienced a whole array of traumatic stress, including near-death work experiences, irradiation fear, loss of their properties and their loved ones. The electric company has been blamed by the public for their disaster responses, so the public portrays these employees as disaster perpetrators. However, this trend is leading to serious discriminations and harassments, and adversely affecting their mental health. We all hope the recovery efforts to complete as soon as possible. However, when people criticize these workers, their burden of psychological trauma will continue to grow, and their recovery process will be impeded. It is crucial for the society to recognize these hard-working people and to show appreciation and support for their dedications.

Background: Residual dried blood spots (DBS) remaining after routine newborn screening (NBS) tests are candidate specimens for extended uses such as quality assurance and the development of new technology. A trial of NBS using tandem mass-spectrometry was launched in 2004 in Japan. The aim of the present study was to analyze the attitudes of the public, patient families, and medical professionals toward the extended use and long-term storage of residual DBS, and to construct a standardized informational brochure., Methods: A questionnaire was sent to randomly selected members of the public, members of the Japanese Phenylketonuria (PKU) Association, medical staff of a general hospital, staff of a children's hospital, obstetricians and gynecologists, pediatricians and NBS personnel. Associated responses, which were given in a free comment format, were analyzed by text mining., Results: The awareness ratio of NBS was low in the public (26.6%), but despite this, when a brief explanatory note on NBS was provided, 71.7% of them recognized the necessity of NBS. They were less positive than medical professionals and PKU patient families regarding the extended use of DBS for forensic investigation, for the study of health problems, or long-term storage of residual DBS, regardless of whether these factors affected them personally or not. Among the medical professionals, obstetricians and pediatricians exhibited a higher ratio of negative responses toward the extended use and long-term storage of DBS than others., Conclusion: The general public is more conservative than PKU patients and their families or medical professionals about the extended use or long-term storage of residual DBS. Presentation to the public, particularly to couples of childbearing age, of appropriate explanatory information on NBS itself, or the extended use or long-term storage of residual DBS, is recommended.

The results of previous studies on the relationship between leptin and blood pressure are discordant. We investigated to what extent the serum leptin level was related to blood pressure independent of the degree of insulin resistance. The subjects were 1916 men aged 34-69 years whose mean body mass index (BMI) was 23.0 kg/m2. Blood pressure was regressed by leptin concentrations with adjustments for age, BMI, insulin resistance, triglyceride, high density lipoprotein cholesterol, low density lipoprotein cholesterol, physical activity, drinking habits and smoking status. Leptin was associated with diastolic blood pressure (DBP) (standardized beta: 0.092, p = 0.003), but not with systolic blood pressure (SBP) (standardized beta: 0.035, p = 0.25), although insulin resistance was positively associated with both SBP and DBP (standardized beta: 0.175 for SBP, p < 0.001 and 0.114 for DBP, p < 0.001) among all subjects. After subjects were divided into those with normal blood pressure (SBP <130 mmHg and DBP <85 mmHg) and those with higher blood pressure, leptin was positively and significantly associated with DBP (standardized beta: 0.106, p = 0.012) independent of the degree of insulin resistance, but not with SBP (standardized beta: 0.064, p = 0.13) among subjects in the normal blood pressure range. Among the subjects with higher blood pressure, however, neither the association of leptin with SBP nor that of leptin with DBP was statistically significant. These findings suggest that leptin may maintain and increase arterial tone, resulting in the elevation of DBP only within normal blood pressure range. It is also likely that leptin is a physiological mediator--or at least a marker--of some degree of DBP elevation in obesity.

Objective: This study aimed at evaluating two emergency medical service systems, one in which emergency life-saving technicians (ELSTs) are allowed to administer epinephrine (adrenaline) to patients with out-of-hospital cardiac arrest and one in which ELSTs are allowed to administer epinephrine, lidocaine, and atropine., Methods: A modified, prospective community health trial was conducted from April 1 to October 31, 2003. Areas served by physician-manned ambulances, where out-of-hospital cardiopulmonary resuscitation (CPR) was performed with resuscitative drugs (experimental areas), were compared to areas served by ELST-manned ambulances, where resuscitative drugs were not administered outside the hospital (reference areas). The sequence of emergency procedures performed in the experimental areas was divided into three phases. Phase I included administration of epinephrine, which simulated administration of epinephrine by ELSTs. Phase II started with the use of lidocaine or atropine. Phases I and II simulated administration of epinephrine, lidocaine, and atropine by ELSTs. Phase III began with administration of another drug. Outcomes, resuscitation rates and 1-month survival rates were determined, and differences between the two types of areas were analyzed., Results: For non-traumatic cardiac arrest, outcomes through phase II in the experimental areas were significantly better than those in the reference areas. Phase I-only outcomes in the experimental areas were better, but not significantly better, than those in the reference areas., Conclusion: Use of resuscitative drugs for non-traumatic prehospital CPR appears to be effective in terms of resuscitation rates and 1-month survival rates.

Objective: To analyze the longitudinal changes in the treatment of out-of-hospital cardiac arrests. These analyses have focused on the time interval from the receipt of call until defibrillation of patients with ventricular fibrillation., Design: Population-based, prospective longitudinal study according to the Utstein style., Setting: Osaka Prefecture (population 8, 800, 000), served by 36 municipal fire and emergency departments., Patients: Consecutive, out-of-hospital cardiac arrests occurring between May 1998 and April 2001., Main Outcome Measures: Change in the interval to defibrillation, and one-year survival from cardiac arrest., Results: Of the 15,211 cases of confirmed cardiac arrests during the three years, resuscitation was attempted in 14,609 subjects. Of the 2957 cases of cardiac origin and witnessed by bystanders, 90 cases (3.0%) were alive 1 year following the episode. In 383 cases of defibrillation, the interval from receipt of call to defibrillation was evaluated annually. This interval decreased significantly during the three year course (14.5, 13.0, and 11.5 min expressed by the median), suggesting that this project to report the data of out-of-hospital arrests was an effective campaign for EMT. However, the outcome did not improve significantly during this period (3.0%, 2.6%, and 3.6% alive 1 year in witnessed arrests with cardiac etiology). This may be because the third year median duration of 11.5 min, is still insufficient to indicate a significant improvement in the outcome., Conclusions: This project to report the data of out-of-hospital cardiac arrest might have contributed to the reduction of the interval for defibrillation, as a campaign for the EMTs; although the decrease in this interval was still insufficient to result in a significant increase in the number of cases who are alive one year later.

Purpose: The authors focused on preventing lifestyle-related diseases among schoolchildren on the basis of health surveys with blood examinations and questionnaires on lifestyle in collaboration with parents, YOGO teachers, and public health nurses. The present study purposed to evaluate this approach using the PRECEDE-PROCEED Model., Method: The authors inquired of schoolchildren's parents their awareness of their children's health through health surveys of their children. Additionally, changes in the role of YOGO teachers and public health nurses before and after our attempt were assessed. The significance and problems with our approach were then evaluated based on the PRECEDE-PROCEED Model., Results: Based on the PRECEDE-PROCEED Model, it was clarified that, for prevention of lifestyle-related diseases among schoolchildren, health surveys with blood examinations and questionnaires on lifestyle increased parents' interest in their children's health. On the basis of the results of health examinations, the role of YOGO teachers changed from leading figure for general health education to supporters of health promotion for individuals, with provision of health education classes in schools for this purpose. The role of public health nurses also changed from providing health education at the request of schools to supporting families to improve their lifestyle, including that of their children., Conclusions: In collaboration with children's parents, YOGO teachers and public health nurses, the present approach to prevent lifestyle-related diseases of schoolchildren on the basis of health surveys has advantages for increasing interest in schoolchildren's health, and should be useful for health promotion.

Recent evidence has shown the association of increased plasma fibrinogen levels with subsequent coronary heart disease or stroke. Fibrinogen is an acute-phase inflammatory reactant as well as a clotting factor. The authors investigated an association between fibrinogen levels and cardiovascular risk factors in apparently healthy Japanese subjects, while considering C-reactive protein (CRP) levels, a marker of the inflammatory status. Plasma fibrinogen and serum CRP from 2 706 participants in an annual mass screening examination, held in Matsukawa, Nagano, Japan were measured. A total of 2 355 subjects (816 men and 1 539 women) were analyzed after excluding individuals with a history of diabetes mellitus, heart disease, or stroke. Plasma fibrinogen was strongly correlated with CRP levels. After adjusting the CRP levels, fibrinogen was positively associated with age, smoking status, total cholesterol, and hemoglobin A(1c) (HbA(1c)) in men, and with age, total cholesterol, and HbA(1c) in women. On the other hand, high-density lipoprotein (HDL) cholesterol was a strong negative correlate of fibrinogen in both genders. Fibrinogen levels also tended to be associated positively with body mass index in both genders and negatively with exercise habits in men. The present multiple regression analysis has shown that plasma fibrinogen levels are correlated with conventional cardiovascular risk factors even after adjusting for the CRP levels. Persons with cardiovascular risk factors tended to have higher fibrinogen levels, suggesting that all elevated plasma fibrinogen concentration in those with risk factors may further increase the risk of the development of atherothrombosis and subsequent cardiovascular disease through the blood coagulation system.

Objective: To ascertain important factors in the improvement of out-of-hospital cardiac arrest survival rates through analysis of data for Osaka Prefecture with the focus on time factors., Design: Prospective cohort study according to the Utstein style., Setting: Osaka Prefecture (population 8,830,000) served by a single emergency medical services system., Patients: Consecutive prehospital cardiac arrests occurring between May 1998 and April 1999., Main Outcome Measures: One-year survival from cardiac arrest, and time factors., Result: Of the 5047 cases of confirmed cardiac arrests, resuscitation was attempted in 4871 subjects. Of the 982 cases of cardiac origin and witnessed by bystanders, 31 (3.2%) were still alive, and of the 576 cases of non-cardiac origin and witnessed by bystanders, ten (1.7%) were still alive at the 1 year follow-up. The median time from receipt of the emergency call until ambulance arrival was 5 min and that from receipt of the call until the start of cardiopulmonary resuscitation (CPR) was 7 min. For the 214 patients for whom defibrillation was attempted, the median time from receipt of the call until the first shock was 15 min. The median time from receipt of the call until departure of the ambulance from the scene was 16 min and that until arrival of the ambulance at a hospital was 22 min., Conclusions: This study using the standardized format according to the Utstein style clearly elucidates the specific delay of the start of defibrillation by paramedics and also indicates the inappropriate rule for this procedure in Japan.

A retrospective study of 6 patients with obturator hernia diagnosed before surgery by X-ray and computed tomography (CT) was conducted between 1993 and 2000. The initial CT of the abdomen including the pelvic area revealed incarcerated bowel in the obturator foramen of all 6 patients. All patients underwent laparotomy as soon as possible after CT scans were obtained. Resection of the small bowel was performed in 3 patients, and release of the small bowel was performed in the remaining 3 patients. There were no perioperative deaths. In elderly women who show evidence of small bowel obstruction by abdominal plain x-ray studies, we recommend performing CT scans of the abdomen including the pelvic area for detection of obturator hernia.

Background: Human mitochondrial aldehyde dehydrogenase (ALDH2) is a major enzyme responsible for the oxidation of acetaldehyde derived from ethanol metabolism. The human ALDH2 gene shows genetic polymorphism at position 1510 with a G to A transition in exon 12. This mutation leads to ALDH2 enzyme deficiency and protection against alcoholism. As yet, no polymorphism for the promoter region of the ALDH2 gene has been reported., Methods: We analyzed 600 nucleotides of the promoter region in addition to exon 12 from 571 Japanese, 68 Chinese, 80 Myanmar, 60 Mongolians, and 82 North-American Caucasians using single-strand conformational change polymorphism (SSCP) analysis and the polymerase chain reaction (PCR). PCR products that showed an aberrant banding pattern detected by the SSCP analysis were subjected to PCR direct sequencing., Results: A novel polymorphism at -357 with a G to A substitution was found in all the population groups, including North-American Caucasians. In addition, the polymorphic status in the promoter and exon 12 suggested linkage disequilibrium between the two loci, which indicated that among Japanese, the ALDH2*2 allele is linked to the G promoter allele, and theALDH2*1 allele is linked to the A allele. A total of 206 healthy male controls and 185 alcoholic male patients with the homozygous ALDH2*1 genotype were analyzed for the polymorphism in the promoter. Genotypic frequencies of GG, GA, and AA for alcoholics were 54.1%, 44.3%, and 1.6%, and those for controls were 52.9%, 40.3%, and 6.8%, respectively. The A allele frequencies for alcoholics and controls were 0.24 and 0.27, respectively. A chi2 test for the entire 3 x 2 table indicated significant variations in the three genotypes (chi2 = 6.40, p < 0.05). However, no significant difference in allelic frequencies between the two groups was observed., Conclusion: This new polymorphism in the ALDH2 promoter is present in all populations studied. Further analysis in other ethnic groups is necessary to establish this as an additional risk factor for alcoholism.

Bovine herpesvirus 1 (BHV-1) isolates from respiratory tract and from vagina of bovine in Japan were analyzed by SDS-polyacrylamide gel electrophoresis (SDS-PAGE) and the DNA restriction endonuclease cleavage pattern, and compared with European BHV-1 strains. Both protein profile and DNA cleavaged pattern of BHV-1 isolates from respiratory tract were the same as those of European infectious bovine rhinotracheitis (IBR) virus, whereas the protein profile and DNA cleavage patterns of one isolate (M1) from vagina was the same as those of the European infectious pustular vulvovaginitis (IPV) virus. The facts indicate that IPV virus has existed in Japan.

Recurrent intestinal obstruction for which no underlying cause can be found has been termed "chronic idiopathic intestinal pseudoobstruction (CIIP)" by Maldonado et al. Some clinical features of CIIP have been pointed out in literatures. More often than not, CIIP often shows hereditary occurrence. The authors have summed up twenty-one cases of CIIP reported till 1984 in Japan, In these cases, only one familial occurrence has been reported excluding our own. Our cases were a young woman and her father and they showed clinical features of CIIP and they might have hereditary factors.