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Background: Tokyo, the capital of Japan, is a densely populated city of >13 million people, so the population is at high risk of epidemic severe acute respiratory coronavirus 2 (SARS-CoV-2) infection. A serologic survey of anti-SARS-CoV-2 IgG would provide valuable data for assessing the city's SARS-CoV-2 infection status. Therefore, this cross-sectional study estimated the anti-SARS-CoV-2 IgG seroprevalence in Tokyo., Methods: Leftover serum of 23,234 hospital visitors was tested for antibodies against SARS-CoV-2 using an iFlash 3000 chemiluminescence immunoassay analyzer (Shenzhen YHLO Biotech, Shenzhen, China) with an iFlash-SARS-CoV-2 IgG kit (YHLO) and iFlash-SARS-CoV-2 IgG-S1 kit (YHLO). Serum samples with a positive result (≥10 AU/mL) in either of these assays were considered seropositive for anti-SARS-CoV-2 IgG. Participants were randomly selected from patients visiting 14 Tokyo hospitals between September 1, 2020 and March 31, 2021. No participants were diagnosed with coronavirus disease 2019 (COVID-19), and none exhibited COVID-19-related symptoms at the time of blood collection., Results: The overall anti-SARS-CoV-2 IgG seroprevalence among all participants was 1.83% (95% confidence interval [CI], 1.66-2.01%). The seroprevalence in March 2021, the most recent month of this study, was 2.70% (95% CI, 2.16-3.34%). After adjusting for population age, sex, and region, the estimated seroprevalence in Tokyo was 3.40%, indicating that 470,778 individuals had a history of SARS-CoV-2 infection., Conclusions: The estimated number of individuals in Tokyo with a history of SARS-CoV-2 infection was 3.9-fold higher than the number of confirmed cases. Our study enhances understanding of the SARS-CoV-2 epidemic in Tokyo.

Several outbreaks of trench fever caused by Bartonella quintana occurred in soldiers during World Wars I and II. Although trench fever cases have been decreasing worldwide, the disease was reported among the homeless population in developing and developed countries. The current prevalence of B. quintana infection in Japan is unclear. Blood and body louse (Pediculus humanus humanus) samples were obtained from homeless inpatients with body lice during emergency hospitalization in Tokyo from January 2013 to March 2015. Patients were tested for B. quintana infections using the culture method, polymerase chain reaction, and indirect immunofluorescence assay (IFA). Among the 29 patients tested, the presence of Bartonella spp. was confirmed by genomic sequencing of DNA extracted from two samples from blood culture performed for 15 out of 29 patients and from body louse samples of 20 patients (69%). Immunoglobulin G against B. quintana was detected in 10 patients (34.5%) at a cut-off titer of 1:256 in IFA. B. quintana infection was detected in samples obtained between 2013 and 2015 in Tokyo and needs to be on the list of differential diagnoses performed for febrile homeless individuals.

Background: Coronavirus infections are spreading rapidly worldwide, and primary and middle schools are closed in many countries. After the state of emergency was lifted in Japan, schools have reopened, and teachers are conducting face-to-face classes while maintaining safety precautions. This study aimed to assess the factors contributing to infection-related anxiety and educational anxiety among teachers conducting face-to-face classes during the COVID-19 pandemic after schools reopened., Methods: This questionnaire-based cross-sectional study was conducted with 263 primary and middle school teachers in the Shinagawa area of Tokyo (October 10-30, 2020). The questionnaire assessed the type of school (primary or middle school), sex, age, and factors contributing to infection-related anxiety and educational anxiety that arose from the pandemic. The levels of anxiety and the factors contributing to anxiety were assessed using a 5-point Likert scale ranging from 1 (not at all) to 5 (very anxious)., Results: In an analysis of the data of 237 participants excluding the missing data, many teachers reported feeling infection- and education-related anxiety. A majority of the participants were women (n = 152, 64.1%), and the mean age of the participants was 39.8 ± 11.3 years. A stepwise multiple regression analysis identified six factors for infection-related anxiety as significant (R 2  = 0.61, p < 0.001). Among these variables, the largest partial regression coefficient value was reported for the following reason: "I feel anxious because we cannot ensure the safety of teachers themselves or of their families" (β = 0.37, p < 0.001). For educational anxiety, four of six reasons were identified as significant (R 2  = 0.64, p < 0.001). Among these, "anxiety about the students' home situations" (β = 0.41, p < 0.001) and "delay in education (students' side)" (β = 0.27, p < 0.001) had stronger associations with anxiety compared to the others., Conclusion: In-person education during the COVID-19 pandemic has caused teachers to experience anxiety. This report provides useful information by highlighting the reasons for infection-related anxiety and educational anxiety that teachers experience in face-to-face classes during a pandemic. Even if the coverage of a COVID-19 vaccine becomes widespread worldwide, we will still be combating COVID-19 infections for at least a few years. Given concerns regarding such infections, to ensure students' right to education, it is essential to understand why teachers feel anxious and to determine appropriate measures to decrease such anxiety.

Healthcare workers (HCWs) are highly exposed to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The actual coronavirus disease (COVID-19) situation, especially in regions that are less affected, has not yet been determined. This study aimed to assess the seroprevalence of SARS-CoV-2 in HCWs working in a frontline hospital in Tokyo, Japan. In this cross-sectional observational study, screening was performed on consented HCWs, including medical, nursing, and other workers, as part of a mandatory health checkup. The screening test results and clinical characteristics of the participants were recorded. The antibody seroprevalence rate among the 4147 participants screened between July 6 and August 21, 2020, was 0.34% (14/4147). There was no significant difference in the seroprevalence rate between frontline HCWs with a high exposure risk and HCWs working in other settings with a low exposure risk. Of those seropositive for SARS-CoV-2, 64% (9/14) were not aware of any symptoms and had not previously been diagnosed with COVID-19. In conclusion, this study provides insights into the extent of infection and immune status in HCWs in Japan, which has a relatively low prevalence of COVID-19. Our findings aid in formulating public health policies to control virus spread in regions with low-intensity COVID-19.

Objective: We test the proposition that both social orientation and cognitive style are constructs consisting of loosely related attributes. Thus, measures of each construct should weakly correlate among themselves, forming intraindividually stable profiles across measures over time., Method: Study 1 tested diverse samples of Americans (N = 233) and Japanese (N = 433) with a wide range of measures of social orientation and cognitive style to explore correlations among these measures in a cross-cultural context, using demographically heterogeneous samples. Study 2 recruited a new sample of 485 Americans and Canadians and examined their profiles on measures of social orientation and cognitive style twice, one month apart, to assess the stability of individual profiles using these variables., Results: Despite finding typical cross-cultural differences, Study 1 demonstrated negligible correlations both among measures of social orientation and among measures of cognitive style. Study 2 demonstrated stable intraindividual behavioral profiles across measures capturing idiosyncratic patters of social orientation and cognitive style, despite negligible correlations among the same measures., Conclusion: The results provide support for the behavioral profile approach to conceptualizing social orientation and cognitive style, highlighting the need to assess intraindividual stability of psychological constructs in cross-cultural research., (© 2019 Wiley Periodicals, Inc.)

We conducted a comprehensive radiation hazard assessment of the Tokyo Olympic Games (Tokyo 2020, postponed to 2021). Our combined experimental and literature study focused on both external and internal exposure to ionizing radiation for athletes and visitors of the Games. The effective dose for a visit of 2 weeks ranges from 57 to 310 μSv (including flight dose). The main contributors to the dose are cosmic radiation during the flights (approximately 10-81%), inhalation of natural radon (approximately 9-47%), and external exposure (approximately 8-42%). In this complex exposure, anthropogenic radionuclides from the Fukushima nuclear accident (2011) always play a minor role and have not caused a significant increase of the radiological risk compared to pre-Fukushima Japan. Significantly elevated air dose rates were not measured at any of the Tokyo Olympic venues. The average air dose rates at the Tokyo 2020 sites were below the average air dose rates at the sites of previous Olympic Games. The level of radiological safety of foods and water is very high in Japan, even for athletes with increased water and caloric demands, respectively.

The measurement of radioactivity in food and agricultural ecosystems is an essential task for keeping the population safe after a nuclear emergency. Prior to the Tokyo Electric Power Company's Fukushima Dai-ichi Nuclear Power Plant (FDNPP) accident in 2011, the probability of such an accident, combining complex effects of natural and technical factors, was not reflected in detail in national emergency preparedness guidelines. The lack of such guidelines resulted in a limited efficiency response to the Fukushima accident in agriculture. This outcome showed a need for the preparation of such guidelines as a part of emergency preparedness for nuclear and radiological emergences. This paper provides information and generic, non-country-specific guidance on approaches to sampling food. The paper is intended for scientists, policy makers and decision makers involved in nuclear emergency preparedness and responses, particularly on large scales and at different stages of nuclear emergency based on lessons learned from the FDNPP accident., 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 paper., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Aim: Nurses are expected to have a role in the transition of care from pediatric to adult medical practices for adolescents and young adults with childhood-onset chronic diseases. This study compares the experience, knowledge, and perceptions regarding the ideal care among adult unit and pediatric nurses regarding the transition to adult care for those with childhood-onset chronic diseases., Methods: A cross-sectional study using self-report questionnaires was conducted with nurses in a tertiary hospital in Tokyo. Questions were generated based on a literature review and expert discussion. Data from 1,064 participants were analyzed (adult unit nurses: n = 959, 90.1%; pediatric nurses: n = 105, 9.9%)., Results: Among 623 adult unit nurses who had care experience for adult patients with a childhood-onset chronic disease, 458 nurses (73.6%) were unaware of the concept of transitional care. As the obstructive factors for transition, pediatric nurses recognized problems in healthcare providers' attitudes and lack of transitional care coordinators, while the adult unit nurses emphasized the patients' wishes to continue to receive pediatric healthcare. Most adult unit nurses expected pediatric nurses to function as transitional care coordinators., Conclusion: Adult unit and pediatric nurses had different perceptions of the barriers in transitioning children with chronic diseases to adult care. It is important to have educational programs focusing on transitional care for all nurses, both to enable pediatric nurses to improve transition readiness of children with chronic diseases and to offer adult patients with a childhood-onset chronic disease continuing support through adult unit nurses., (© 2020 Japan Academy of Nursing Science.)

Background and Aim: A missense variant of the nucleoside diphosphate-linked moiety X-type motif 15 (NUDT15) gene (R139C) predisposes Asian patients with inflammatory bowel disease (IBD) to thiopurine-induced leukopenia. This study evaluates the long-term effect of NUDT15 R139C heterozygosity on hematological parameters during thiopurine administration., Methods: We enrolled 83 Japanese IBD patients who were on anti-tumor necrosis factor-α agents and had used thiopurine. NUDT15 R139C was genotyped by polymerase chain reaction. We retrospectively reviewed patient clinical charts to collect data on white blood cell (WBC) count, mean corpuscular volume (MCV), hemoglobin, and platelet count during the 24 months following thiopurine initiation., Results: The included patients had either Crohn's disease (54; 65.1%) or ulcerative colitis (29; 34.9%). Genotyping of NUDT15 R139C identified 62 patients (74.7%) of genotype C/C and 21 (25.3%) of genotype C/T. The median dose of thiopurine was lower in the C/T group than in the C/C group after starting thiopurine. At 6 months, the mean WBC count of the C/T group became significantly lower than that of the C/C group (P = 0.008) and remained lower through the 24 months. The C/T group developed grade 2-4 leukopenia by 6 months, which persisted through 12-24 months. The mean MCV in the C/T group became higher than that of the C/C group after 3 months., Conclusions: NUDT15 R139C heterozygosity affected the WBC count and MCV for 24 months after thiopurine administration. Our results indicate that careful monitoring of leukopenia and dose adjustment are necessary throughout treatment in IBD patients heterozygous for the NUDT15 R139C., (© 2019 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.)

Purpose: Patients with cancer often experience general nutritional problems as the disease progresses. We aimed to examine if there is a need and demand for nutritional counselling among cancer outpatients, and explore relevant psychological factors pertaining to eating and nutrition., Methods: A survey was conducted among adult patients receiving outpatient chemotherapy at the Tokyo Medical and Dental University Hospital. The participants completed self-report questionnaires, which included questions on their nutritional state (Patient-Generated Subjective Global Assessment Short Form), experience of eating-related distress and quality of life (QOL) (European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-C30)., Results: Of the 151 (median age, 66.5 years) participants, 42 had a demand for nutritional counselling. Patients' experience of eating-related distress and demand for nutritional counselling were significantly associated, particularly in regard to 'conflicts over food between patients and the people surrounding them' (p = 0.005), 'concerns about food' (p = 0.007) and 'self-motivated effect related to nutrition' (p = 0.018). A significant association was also observed between the demand for nutritional counselling and global health status (p = 0.028), emotional functioning (p = 0.022), cognitive functioning (p = 0.028) and social functioning (p = 0.040) in terms of QOL. Patients with a low QOL tended to demand nutritional counselling., Conclusions: The demand for nutritional counselling was associated with QOL and eating-related distress. Therefore, medical staff caring for patients with cancer, such as attending physicians, dietitians, nurses, clinical psycho-oncologists, social workers and psychiatric oncologists, should collaborate and share information to provide nutritional counselling.

In 2011 the east coast of Japan experienced a massive earthquake which triggered a devastating tsunami destroying many towns and killing over 15 000 people. The work presented in this paper is a personal account that outlines the relief efforts of the Humanitarian Medical Assistance team and describes the efforts to provide medical assistance to evacuees. The towns most affected had a large proportion of older people who were more likely to have chronic conditions and required medication to sustain their health. Since personal property was destroyed in the tsunami many older people were left without medication and also did not remember which type of medication they were taking. Some evacuees had brought a list of their medication with them, this assisted relief teams in obtaining the required medication for these people. The more successful evacuation centers had small numbers of evacuees who were given tasks to administer the center that kept them occupied and active., (© 2013 Wiley Publishing Asia Pty Ltd.)

People from different cultures vary in the ways they approach social conflicts, with Japanese being more motivated to maintain interpersonal harmony and avoid conflicts than Americans are. Such cultural differences have developmental consequences for reasoning about social conflict. In the study reported here, we interviewed random samples of Americans from the Midwest United States and Japanese from the larger Tokyo area about their reactions to stories of intergroup and interpersonal conflicts. Responses showed that wisdom (e.g., recognition of multiple perspectives, the limits of personal knowledge, and the importance of compromise) increased with increasing age among Americans, but older age was not associated with wiser responses among Japanese. Younger and middle-aged Japanese showed greater use of wise-reasoning strategies than younger and middle-aged Americans did. This cultural difference was weaker for older participants' reactions to interpersonal conflicts and was actually reversed for intergroup conflicts. This research has important implications for the study of aging, cultural psychology, and wisdom.

To investigate the effects of sleep hygiene education for workers of an information technology (IT) company, we conducted a controlled clinical trial providing 581 workers one-hour sleep hygiene education. The contents of the sleep hygiene education program were a review of sleep habits, provide sleep hygiene education, and the establishment of sleep habit goals. A self-report questionnaire was used to measure outcomes including the Pittsburgh Sleep Quality Index (PSQI), Karolinska Sleepiness Scale (KSS), Checklist Individual Strength (CIS), Center for Epidemiologic Studies for Depression (CES-D), and mean sleep duration on weekdays before and 4 wk after the intervention. A total of 391 participants were included in the analysis, with 214 participants in the sleep hygiene education group and 177 in the waiting list group. KSS score at 2 P.M. decreased by 0.42 points in the sleep hygiene education group, but increased by 0.08 points in the waiting list group, showing a significant effect size of 0.50 (95%CI, -0.97 to -0.04, p<0.05). PSQI score also improved, but the inter-group difference was not statically significant. The present study provides preliminary evidence that brief sleep hygiene education may improve afternoon sleepiness at work, but not sleep at night for IT workers.

This study was carried out to investigate whether the personal advocacy of influenza vaccination by community pharmacists to people aged 65 years and above affected the vaccination rate and number of influenza patients. A cluster randomized controlled trial was conducted with the cooperation of 84 community pharmacies in the wards of Suginami and Nerima, Tokyo. Participants were aged 65 years and above living in Suginami and Nerima wards, Tokyo, receiving dispensing services in their community pharmacies. The intervention was that pharmacists in the intervention pharmacy group provided information on the risk of influenza and benefits of influenza vaccination. Main outcome measures were the self-reported influenza vaccination rate in January 2004, and the number of participants with influenza, as confirmed by inspection of their prescriptions from January to May 2004. The vaccination rate in the intervention pharmacy group (81.6%) was significantly higher than that in the control pharmacy group (64.9%). The number of participants with influenza among the intervention group (2/881) was significantly lower than that among the control group (11/895). The personal advocacy of influenza vaccination by community pharmacists among people aged 65 years and above increases the vaccination rate and decreases the number of influenza patients.

Improving an unhealthy lifestyle decreases risk of incidence and death of lifestyle-related diseases. Consultation about a healthy lifestyle to recipients of health checkups conducted by public health nurses is one method for such improvement. The objective in the present study was to investigate the difference between consciousness of intervention by (1) the public health nurses who conducted consultations with recipients of health checkups and (2) the recipients who were consulted by the public health nurses. Data on 1,370 male white collar workers who underwent health checks were analyzed. When public health nurses determined that recipients required health consultation regarding lifestyle from the health checkup, they consulted with the recipients regarding improvement of lifestyle. The consultation regarding lifestyle included abstinence from smoking, drinking in moderation, exercise, and eating. The results of the analysis regarding difference in consciousness of the intervention by the public health nurses and the recipients show that (1) most drinkers did not think they were being discouraged to drink despite intervention by the public health nurses and (2) the smokers and the subjects with no habitual physical exercise tend to think that they were being consulted even though the public health nurses did not intervene regarding smoking and exercise.

We have developed an adverse drug reaction (ADR) reporting system integrating it with Hospital Information System (HIS) of the University of Tokyo Hospital. Since this system is designed with JAVA, it is portable without re-compiling to any operating systems on which JAVA virtual machines work. In this system, we implemented an automatic data filling function using XML-based (extended Markup Language) files generated by HIS. This new specification would decrease the time needed for physicians and pharmacists to fill the spontaneous ADR reports. By clicking a button, the report is sent to the text database through Simple Mail Transfer Protocol (SMTP) electronic mails. The destination of the report mail can be changed arbitrarily by administrators, which adds this system more flexibility for practical operation. Although we tried our best to use the SGML-based (Standard Generalized Markup Language) ICH M2 guideline to follow the global standard of the case report, we eventually adopted XML as the output report format. This is because we found some problems in handling two bytes characters with ICH guideline and XML has a lot of useful features. According to our pilot survey conducted at the University of Tokyo Hospital, many physicians answered that our idea, integrating ADR reporting system to HIS, would increase the ADR reporting numbers.