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Key topics related to risk communication and food safety were investigated by three different expert groups. In this study, the Delphi method was used to systematically and iteratively aggregate experts' opinions, and the topics to be communicated to consumers were expressed and prioritized. The opinions of three groups, consisting of 26 members of the expert committee (EC) from the Food Safety Commission of Japan (FSCJ), 29 local government officials (LGOs) from their respective food safety departments, and 25 food safety monitors (FSM) appointed by the FSCJ, were obtained in the period of June through September 2017. "Safety and security concept" was identified and ranked high in all groups. This topic identified "Zero-risk" demand of consumers without understanding risks as the reverse side of safety. The EC group prioritized additional issues, such as "concept of risk" and "safety costs and relevant risk management". The LGO and FSM groups prioritized specific hazard items for food poisoning and preventive measures. With regard to the so-called "health foods", the EC and LGO groups indicated insufficient transmission of scientific evidence from the government to consumers, and the FSM group indicated insufficient understanding by consumers of the food labeling system for health and nutrition. Because consumers do not fully understand all concepts of food safety, governments are encouraged to disseminate the probability of risk and the knowledge of risk reduction directly to the consumers by using simple and easy-to-understand terms.

To afford the future agenda of risk communication through an evaluation of the past, we examined the changes in risk perception in the food safety sector over the 15 years (2004–2018) since the establishment of the Food Safety Commission of Japan (FSCJ) in 2003 by analyzing the data of the food safety monitor survey. Hazards such as contaminants including cadmium, methylmercury and arsenic, and pesticide residues caused high levels of concern among the public in 2004. In contrast, hazards such as food poisoning by harmful microorganisms and so-called “Health foods” have been ranked high among concerns since 2008 and 2014, respectively. Scoring of concern levels showed that concern related to food additives and pesticide residues intentionally added to foods and controlled has gradually decreased in a time-dependent manner. These concern scores were considerably lower in male monitors than in female ones; the scores were also lower for individuals with professional experience in the food sector than without the experience. The concern scores for contaminants were lower for males with professional experience. The concern scores related to food poisoning and health foods were not decreased and were remained high in recent years. These scores did not show clear dependence on job experience or gender of the monitors. A gap between food specialists and other attributes in the basic recognition of risk seems to make it difficult to communicate effectively and constructively among various interested individuals. To improve the quality of risk communication in the food safety field, it will be necessary to provide scientific knowledge and information regarding food safety management mechanisms for individuals without professional experience in the food sector, taking into account the changes in information media and influence on risk perception.

This study used questionnaires to evaluate knowledge levels of risk management of raw-consumption of oysters and of norovirus as health hazards among monitors signed up for Food Safety Commission of Japan (FSCJ) having work experiences in food fields. The mean scores of monitors on norovirus knowledge were relatively high (79%), but on oyster raw-consumption were low (64%). Scores varied depending on occupational experiences; highest among administrative officials, high among researchers in food companies, and low among medical workers and educators. The higher scores with more practical experiences for risk management of oyster raw-consumption and norovirus were observed among the monitors. These monitors were expected better to recognize the risks, wheres only few monitors among the opinion-leaders replied correctly to all the questions. These results suggest the need of improvement on the management system for oyster raw-consumption, from the current complicated to the more precise and reinforced for consumers. To efficiently manage the risk associated with the consumption of raw oysters, the government should provide more relevant information of risk management to persons having interest, particularly influencers, in order to disseminate information and to improve knowledge among cooks and consumers.

Background The U.S. Food and Drug Administration (FDA) and European Medicines Agency (EMA) have published guidelines on the use of cancer treatments in young people of reproductive potential. However, no such guideline is available in Japan. Therefore, this project aimed to gather relevant data and draft a respective guidance paper. Methods From April 2019 to March 2021, the Study Group for Providing Information on the Proper Use of Pharmaceuticals in Patients with Reproductive Potential at the Japan Agency for Medical Research and Development gathered opinions from experts in reproductive medicine, toxicology, and drug safety measures. The group considered these opinions, the FDA and EMA guidelines, and relevant Japanese guidelines and prepared a guidance paper, which they sent to 19 related organizations for comment. Results By November 2020, the draft guidance paper was completed and sent to the related organizations, 17 of which provided a total of 156 comments. The study group finalized the guidance paper in March 2021. Conclusions The “Guidance on the Need for Contraception Related to Use of Pharmaceuticals” (The report of the Study Group for Providing Information on the Proper Use of Pharmaceuticals in Patients with Reproductive Potential, Research on Regulatory Science of Pharmaceuticals and Medical Devices, Japan Agency for Medical Research and Development: JP20mk0101139) is expected to help Japanese healthcare professionals provide fertility-related care and advice to adolescents, and young adults with cancer and their families.

Background: Osteoporosis and related fractures, a worldwide public health issue of growing concern, is characterized by compromised bone strength and an increased risk of fracture. Here we show an association between self-reported walking speed and bone mass among community-dwelling postmenopausal Japanese women aged 50 years and older. Design; cross-sectional study: Setting and Participants; The survey population included 1008 postmenopausal women 50?92 years of age residing in rural communities. Methods: Self-reported walking speed was ascertained by asking the participants: “Is your walking speed faster than others of the same age and sex?” to which participants responded “yes (faster)” or “no (moderate/slower).” Calcaneal stiffness index was measured. Results: Women with a faster self-reported walking speed were younger and had a lower BMI, higher stiffness index, and higher grip strength than women with a slower walking speed. Multiple linear regression analysis adjusted for age, BMI, grip strength, comorbidity, current smoking, and alcohol drinking status showed a significant association between faster self-reported walking speed and higher calcaneal stiffness index (p < 0.001). Conclusions: Our findings suggest that questionnaires of walking speed may be useful for predicting bone mass and that a fast self-reported walking may benefit bone health in postmenopausal women., BMC Geriatrics, 20(1), art.no.466; 2020

After the accident at the Fukushima Daiichi Nuclear Power Station, food products from the areas affected by the accident suffered reputational damage worldwide. Therefore, the present study aimed to identify the factors associated with people refraining from purchasing foods produced in affected areas to avoid radioactive materials. The study also aimed to clarify the time trends for the avoidance of foods produced in Fukushima Prefecture. We used data from “A survey on consumer awareness of reputational damages” conducted by the Japanese Consumers Customer Agency and implemented statistical analysis. Even if the year since the accident differed, “living with children”, “knowing detailed information about food inspections”, and “not being able to accept radiation risk even if the level is below the standard” were commonly associated. Not only did this study reveal that some people’s risk perceptions are fixed even when new knowledge is provided, but it also suggests that the implementation of food inspection can promote reputational damage. Additionally, the avoidance of Fukushima food products was found to decrease as time passed after the Fukushima accident. The results of this study may help develop countermeasures against reputational damage to food products after future nuclear disasters.

Background: Osteoporosis in women is a serious health problem. The relationships between biochemical markers of bone turnover and bone mineral density (BMD) in women have been reported, but no study has examined relationships between tartrate-resistant acid phosphatase-5b (TRACP-5b) or bone-specific alkaline phosphatase (BAP) and bone mass measured by quantitative ultrasound (QUS) in Japanese post-menopausal women. Aim: To investigate the serum TRACP-5b and BAP levels and to determine their associations with the heel stiffness index measured by QUS in post-menopausal women. Subjects and methods: The subjects were 510 post-menopausal women who were invited to participate in periodic health examinations in 2011-2013 (the Unzen Study). The heel stiffness index (bone mass) was measured by QUS. Serum samples were collected and TRACP-5b and BAP levels were measured. Results: Multiple regression analysis showed that a higher log (TRACP-5b) was correlated with a lower stiffness index (p = 0.014) and log (BAP) was not correlated with stiffness index after adjusting for covariates (p = 0.136). Conclusion: Higher rates of bone resorption are associated with a lower stiffness index in Japanese post-menopausal women. These results may indicate that high bone resorption affects bone mass more than bone formation, resulting in a low bone mass.

Aim The purposes of the present study were to investigate risk factors for incident disability in activities of daily living (ADL) among middle-aged and older women, and to determine whether there are differences in risk factors according to age groups. Methods The participants were 264 Japanese women aged 40 years and older. A self-administered questionnaire was used to survey participants about difficulty in carrying out selected basic and instrumental ADL at baseline and at follow up. ADL disability was defined as difficulty carrying out three or more ADL. Information on knee joint or back pain and comorbidities (heart disease, lung disease, stroke or diabetes mellitus) was obtained using a self-administered questionnaire at baseline. Physical performance measurements (grip strength, chair stand time, rapid walking speed and functional reach) were also carried out at baseline. Results The prevalence of incident ADL disability was 44 (27.5%) in women aged 40–64 years, and 57 (54.8%) in women aged ≥65 years (P

The aim of the present study was to investigate the age-related patterns and the relationships between serum levels of tartrate-resistant acid phosphatase-5b (TRACP-5b) or bone-specific alkaline phosphatase (BAP), and the heel stiffness index measured by quantitative ultrasound (QUS) in 429 Japanese men, with special emphasis on 2 age groups (40-59 years and 60 years or over). The heel stiffness index (bone mass) was measured by QUS. Serum samples were collected, and TRACP-5b and BAP levels were measured. The stiffness index was significantly decreased with age. Log (TRACP-5b) was significantly increased with age, but Log (BAP) was stable. Generalized linear models showed that higher levels of Log (TRACP-5b) and Log (BAP) were correlated with a lower stiffness index after adjusting for covariates in men aged 60 years or over, but not in men aged 40 to 59 years. In conclusion, higher rates of bone turnover markers were associated with a lower stiffness index only in elderly men. These results may indicate a different mechanism of low bone mass among different age groups of men., Medicine (United States), 97(8), e9962; 2018

Aim Determining gait speed as a measure of physical performance is recommended in diagnosing sarcopenia. Gait speed measurements require a certain amount of space (e.g. a 6-m course), and might not be feasible in clinical settings or heath checkup examination sites. We developed a formula to estimate chair stand time based on gait speed, and examined the validity (sensitivity and specificity) of using the estimated chair stand time cut-off point as a surrogate for the recommended gait speed cut-off point. Methods Chair stand time was defined as the time it took to stand up from a standard chair five times. Gait speed was calculated from the time required for participants to walk a 6-m course at their usual pace. Results Simple regression analysis showed a significant negative relationship between chair stand time and gait speed (P

Study objectives Poor or short sleep and the presence of snoring indicative of sleep-disordered breathing (SDB) have been associated with behavioral problems in school-aged children. We examined the relationship between SDB, sleep duration, obesity risk, and behavioral characteristics in Japanese elementary school students using a large-scale survey. Methods We conducted a cross-sectional study of children enrolled in all 46 public primary schools in Matsuyama city, Japan. The children's parents or guardians completed a questionnaire that covered sleep habits, presence of SDB risk, and behavioral characteristics. Results In total, 24 296 responses were received (90% response rate). After excluding incomplete responses, we analyzed complete datasets for 17 769 children. Mean sleep duration decreased with age, as did the prevalence of pediatric SDB. We found an increased risk for the presence of SDB and short sleep among overweight/obese children. With SDB or short sleep, we observed significantly increased odds of restless behaviors, fidgety behaviors, and poor concentration in school. Conclusions Shorter sleep duration was associated with increased risk of obesity, and in turn, obesity increased SDB risk. Both short sleep duration and SDB risk were significantly associated with behavioral problems in school.

Background To investigate if the prevalence of bipolar disorder in epidemiologic studies is an underestimate, as suggested by clinical studies. Methods We analyzed data from 8 countries that participated in the World Mental Health Survey Initiative ( n =47,552). We identified 6.8% and 18.9% of the sample who we think were screened out inappropriately (SCI) from the euphoric and irritable bipolar sections respectively. We compared them to those who were allowed to continue the section (CONT, 2.6% of the sample for euphoric; 1.0% for irritable) and to the reference group (REF, 69.5% of the sample). Results The SCI group had consistently higher rates of major depression (29.1% vs. 6.4%), earlier age of onset (24.3 y vs. 32.4 y), more suicide attempts (13.3% vs. 5.9%), and more episodes (4.2 vs. 2.7) than the REF for the euphoric group. Similar findings exist for the irritable group. Also, comorbidity with anxiety, disruptive behavior disorders and substance use were much higher than the REF. Limitations As with all epidemiologic studies, recall bias cannot be ruled out. Conclusions The findings above suggest that a number of the SCI subjects belong to the bipolar group. A revision of instruments used in epidemiologic research will probably prove what clinical studies have been showing that bipolar disorder is more common than has been reported.

BACKGROUND: Previous single country research has raised concerns that: (1) the DSM-IV diagnosis of alcohol abuse (AA) is met primarily through the hazardous use criterion related to drinking and driving and (2) that the hazardous use and social consequences AA criteria primarily reflect varying socioeconomic and cultural factors rather than psychiatric disorder. METHODS: Using representative cross-national data from the 21 countries in the World Mental Health surveys, adults meeting DSM-IV lifetime criteria for AA but not dependence from 10 developed (n = 46,071) and 11 developing (n = 49,761) countries were assessed as meeting AA with the hazardous use or the social consequences criteria. RESULTS: Between 29.3% (developed) and 16.2% (developing) of respondents with AA met only the hazardous use criterion. AA cases with and without hazardous use were similar in age-of-onset, course, predictors, and psychopathological consequences in both developed and developing countries. DISCUSSION AND CONCLUSIONS: Despite some associations of the AA criteria with socioeconomic factors, the hazardous use and social consequences criteria were significantly associated with psychiatric predictors and sequelae. The findings indicate that these criteria reflect psychiatric disorder and are appropriate for inclusion as DSM-5 Alcohol Use Disorder criteria. SCIENTIFIC SIGNIFICANCE: These findings support a psychiatric rather than a sociocultural view of the hazardous use and social consequences symptoms and provide evidence that they are appropriate diagnostic criteria cross-nationally with utility in a wide range of socioeconomic environments. This suggests consideration for their adoption by ICD-11. Further research is needed on the implications of these results for prevention and treatment. (Am J Addict 2014;23:145-155). Language: en

The purposes of the present study were to investigate risk factors for incident disability in activities of daily living (ADL) among middle-aged and older women, and to determine whether there are differences in risk factors according to age groups.The participants were 264 Japanese women aged 40 years and older. A self-administered questionnaire was used to survey participants about difficulty in carrying out selected basic and instrumental ADL at baseline and at follow up. ADL disability was defined as difficulty carrying out three or more ADL. Information on knee joint or back pain and comorbidities (heart disease, lung disease, stroke or diabetes mellitus) was obtained using a self-administered questionnaire at baseline. Physical performance measurements (grip strength, chair stand time, rapid walking speed and functional reach) were also carried out at baseline.The prevalence of incident ADL disability was 44 (27.5%) in women aged 40-64 years, and 57 (54.8%) in women aged ≥65 years (P 0.001). Multiple logistic regression analysis showed that decreased grip strength and having pain were significantly associated with a higher risk for incident ADL disability among women aged 40-64 years. For women aged ≥65 years, decreased rapid walking speed, having a comorbidity and having pain were associated with incident ADL disability.The present study showed that a different set of risk factors was associated with incident ADL disability among women aged 40-64 years and women aged ≥65 years. Age-specific screening and intervention strategies are necessary for effective prevention of incident ADL disability. Geriatr Gerontol Int 2017; 17: 1096-1101.

Objective: This study examined Japanese mothers’ satisfaction with food-safety education in primary schools, compared the characteristics of mothers who were not satisfied, and identified topics that should be included in food-safety education, according to mothers. Design: An online survey was conducted in March 2011 in Japan. The questionnaire included topics related to food-safety education and satisfaction regarding food-safety education. Setting: Japanese mothers with children attending primary school were asked to complete an online questionnaire. Method: A total of 1,300 mothers completed questionnaires. The sample was divided into two groups according to median scores for satisfaction with food-safety education, and chi-square tests were used to compare data related to other questions. The numbers of mothers who selected each topic for inclusion in food-safety education were calculated. Results: Participants were divided into two groups; high satisfaction ( n = 796, 61.2%) and low satisfaction ( n = 504, 38.8%). The low-satisfaction group consisted of mothers who described government action related to the food-safety problem as ‘inadequate’ ( n = 305, 60.5%) and who disagreed with the notion that food items can be 100% safe ( n = 146, 29.0%). More than half of the mothers endorsed ‘judging freshness’, ‘reading food labels’, and ‘food additives’ as important topics to include in food-safety education. Conclusion: Japanese mothers who were not satisfied with food-safety education were more likely to consider government actions inadequate and to disagree with the notion that food items can be 100% safe. Mothers wanted schools to teach not only the prevention of food-borne illnesses but also other topics related to food safety.

PURPOSE The BCG immunization has long been performed in Japan. Although the BCG immunization service is the responsibility of the municipality, the manner in which the BCG immunization is delivered differs from municipality to municipality. The purpose of this study was to clarify how the different manner of the BCG immunization delivery systems influenced the BCG immunization coverage. METHODS The study of BCG immunization coverage was conducted in the Tama area located in the western suburbs of Tokyo in 2004. The birth data and the immunization history by the age of 3 years were collected in the three-year-old health check-up from a total of 2,341 children residing in the Tama area. Based on the age at immunization for each child, the BCG immunization coverage was calculated according to the types of the BCG immunization delivery system. The immunization types were defined as follows; the BCG immunization given on the occasion of the mass health check-up (Group 1); the exclusive mass BCG immunization in a monthly service (Group 2); the exclusive mass BCG immunization in a bimonthly service (Group 3); the exclusive mass BCG immunization in services of fewer than every two months (Group 4); and the immunization given on an individual basis by a general practitioner (Group 5). A univariate analysis was performed to examine the relationship between the BCG immunization coverage by the age of 6 months and the difference among the BCG immunization delivery systems, followed by a multivariate regression analysis to adjust for the factors related to the demography, health care services and the socio-economic status of the municipalities. RESULTS Unadjusted odds ratios and adjusted odds ratios for BCG unimmunized children under the age of 6 months by the BCG immunization delivery manner groups were OR 1 reference, adj. OR 1 reference in Group 1; OR 1.42 CI 0.87-2.29, adj. OR 4.01 CI 2.24-7.11 in Group 2; OR 4.96 CI 3.66-6.82, adj. OR 15.59 CI 10.10-24.49 in Group 3;OR 18.60 CI 13.77-25.49, adj. OR 48.17 CI 29.62-79.75 in Group 4; and OR 4.24 CI 2.86-6.31, adj. OR 15.61 CI 9.05-27.26 in Group 5. The univariate analysis and multivariate regression analysis revealed an influence of the BCG immunization delivery manner on the BCG immunization coverage. CONCLUSION The choice of BCG immunization delivery manner is very important to raise the BCG immunization coverage. The BCG immunization given on the occasion of the mass health check-up and the high-frequent immunization service are thought to improve the BCG immunization coverage.

We developed a prediction model to distinguish between malignant and nonmalignant lymphadenopathies. We first analyzed clinical features of 222 patients with lymphadenopathy (161 malignant and 61 nonmalignant) in the derivation group. Through logistic regression analysis we identified 6 covariates that independently predict malignancy: age (X1), abdominal lymphadenopathy (X2), lymphadenopathy of the other sites (X3), number of enlarged lymph node regions (X4), absence of fever (X5), and largest lymph node size (X6). We determined the formula as follows: predictive score=-2.3+x1+2.8x2+1.3x3+1.6x4-2.2x5+1.8x6.A higher score correlated with increased likelihood of malignancy. With the cutoff value of 0.4, the sensitivity and specificity of the model were 91.9% and 77.0%, respectively. The validation study using 117 cases (82 malignant and 35 nonmalignant) yielded 90.2% sensitivity and 68.6% specificity. A maximum lymph node size of less than 2.0 cm on systemic computed tomography (CT) scanning indicated a low probability of malignant lymphadenopathy. In this model, 4 of the 6 covariates were obtained by CT scanning, which strongly indicates the usefulness of initial evaluation with systemic CT scanning in the detection of malignant lymphadenopathy.

Objective To identify whether university students who have both food-safety knowledge and beliefs perform risk-reduction behaviors. Design Cross-sectional research using a questionnaire that included food-safety knowledge, perceptions, risk-reduction behavior, stages for the selection of safer food based on the Transtheoretical Model, and demographic characteristics. Setting Four universities in eastern Japan and 2 universities in western Japan. Participants University students (n = 799). Main Outcome Measures Food-safety knowledge, beliefs, and risk-reduction behaviors. Analysis Answers on measures assessing risk perception and food-safety knowledge were combined to form 4 groups of participants. Relationships among demographic characteristics, the 4 groups, risk-reduction behaviors, stage of change, and severity and susceptibility were assessed. Results The proportion of students who had more knowledge of food safety and a belief that “there are no 100% safe food items” was high in the group that frequently performed risk-reduction behaviors, as it was in the group who had taken a basic class about food or health care and who had, or were working toward, a food or nutrition qualification. Conclusions and Implications University students who thought that there were no 100% safe food items and who had more knowledge about food safety were more likely to confirm food-safety information when selecting food.

Objectives The purpose of this study was to determine which zoonoses should the general population be more aware of. Methods We conducted qualitative research (Delphi method) on thirty veterinarians who were selected from the whole country. Results Twenty-four diseases were selected. The reasons for their selection were classified into three categories: "Amount of knowledge, attitude and behavior", "Clinicoepidemiologic characteristics" and "Social characteristics". More than half of the top ten zoonoses are those that are not transmitted from humans to humans, with rabies in the first place, avian influenza (with its high pathogenicity) in the second place and psittacosis in the third place. Conclusions From the top ten diseases, it is considered that the prevention of animal-to-human transmission should be emphasized. In addition, from the reasons for the selection, it is suggested that it is necessary to review social characteristics, such as the inadequacy of quarantine and the insufficiencies of legal systems. As for the zoonoses that are transmitted from humans to humans, it will be indispensable in the future to widely spread information on zoonoses and enlighten the general population about them. It is thought that this survey can be a basis for selecting a zoonosis that should be given priority in enlightening the general population.

BackgroundSuicide is a leading cause of death worldwide, but the precise effect of childhood adversities as risk factors for the onset and persistence of suicidal behaviour (suicide ideation, plans and attempts) are not well understood.AimsTo examine the associations between childhood adversities as risk factors for the onset and persistence of suicidal behaviour across 21 countries worldwide.MethodRespondents from nationally representative samples (η = 55 299) were interviewed regarding childhood adversities that occurred before the age of 18 years and lifetime suicidal behaviour.ResultsChildhood adversities were associated with an increased risk of suicide attempt and ideation in both bivariate and multivariate models (odds ratio range 1.2–5.7). The risk increased with the number of adversities experienced, but at a decreasing rate. Sexual and physical abuse were consistently the strongest risk factors for both the onset and persistence of suicidal behaviour, especially during adolescence. Associations remained similar after additional adjustment for respondents' lifetime mental disorder status.ConclusionsChildhood adversities (especially intrusive or aggressive adversities) are powerful predictors of the onset and persistence of suicidal behaviours.

本研究では，管理栄養士・栄養士が，消費者に必要と考える食の安全の知識を調査することを目的とした。全国の管理栄養士・栄養士30名に協力を依頼し，22名（73.3％）から同意が得られた。質的調査法であるデルファイ法を用いて，3回にわたる質問紙調査を実施した。調査対象者は，食の安全に関する様々な項目について，優先順位をつけた。3回の調査の回収率は，第1回調査から順に100％（22人），95.5％（21人），95.5％（21人）であった。3回の調査を経て，最終的には35項目が得点し，上位10項目のうち第1，4，10位は「残留農薬」に関する項目であった。上位10項目の選出理由では「消費者」の「内面」および「行動」を中心にして，「社会の抱える課題」「周囲の人」「専門家」「生産者」との関連がみられた。管理栄養士・栄養士は，消費者の感情や行動に影響を及ぼす事項が食の安全教育に必要だと考えている。またその理由には，消費者自身の内面や行動，および社会の課題が関係していることが示唆された。今後は，専門家あるいは消費者を対象としたさらなる調査を行い，消費者にとって必要な食の安全に関する知識を確認することが必要である。（オンラインのみ掲載）

Objective To identify specific infectious diseases about which the Japanese public should be informed. Materials and methods A Delphi survey was conducted, recruiting 26 physicians who are engaged in clinical practice of infectious diseases and working at designated medical institutions of infectious diseases in Japan. Results Following HIV/AIDS (first ranked), tuberculosis (second) and influenza (third), 24 diseases in total were identified based on "knowledge, awareness and behavior of inhabitants" or "social and clinico-epidemiological circumstances". Scores for the top three ranked diseases were more than two-folds of those for following diseases. Among the top 10 ranked diseases, 9 were in common with the previous survey result among public health physicians and veterinarians working for governmental agencies. Discussion Our findings of scores for specific diseases most likely reflect an importance of performing preventions and early diagnoses of severe diseases and promoting prophylaxis for travelers' diseases which tend to be factors for prioritizing infectious diseases among clinicians. The top-scored diseases among clinicians were consistent with those among public health officers, indicating the critical need to inform the public about these diseases. Nevertheless, both clinicians and public health experts have already attempted to promote preventions and/or treatment for these diseases in the previous time, and thus, the previous experience must be critically reviewed and reconsidered for improvements. In future, the similar surveys to ours should target specific subjects of experts and investigate more specific types of infectious diseases. Following such an expert survey, concrete action plans to inform the public about prioritized diseases are also called for.

Objectives: No public consensus exists yet on handling Biosafety Level 4 agents and no laboratory is operational at BSL4 in Japan. A discussion that includes neighboring residents and experts should be initiated to communicate risks. In this article, we present the current situation and prioritize problems we presently face. Methods: A three-stage Delphi survey was conducted. The subjects were twenty-two persons with extensive experience and knowledge of infectious diseases. Seven projections and issues were made with regard to the problems arising from the lack of an operational BSL4 laboratory. These were tabulated by the KJ method. The top seven projections were scored, such that the top received 7 points and the last received 1 point. Results: A total of 51 projections were obtained for the first part of the survey, 39 for the second, and 29 for the last. The projection with the highest score was that it is impossible to cope with newly emerging infectious diseases. The second was that complete diagnoses are impossible without a BSL4 laboratory. All projections and issues were divided into the following four main groups: issues for researchers and laboratory staff, clinical practice and research on BSL4 agents, domestic and global security, and Japan’s international position. Conclusion: We clarified possible problem arising from not having BSL4 laboratories in Japan. The identification of projections by the Delphi survey in this study should be considered as one of many attempts to develop effective risk communication strategies.

Objectives: The objective of this study is to gather statistical references on food safety education that encourages competence of food choice from the view-point of food safety. A survey on the involvement of the risk communication program on food safety in municipal governments and the attitude of local dietetics professionals towards the program was conducted. Methods: In November, 2006, self-reported questionnaires were mailed to 1990 local dietetics professionals who worked in municipal governments in Japan. Descriptive statistics and cross tables were used for data analysis. Results: 1162 questionnaires were mailed and 1130 available surveys were returned. Among the respondents, 41.5% answered that they inform the community about food safety, but 49.9% answered that they did not get information from the community. Most of the respondents answered that risk communication of food safety was important; 21.8% answered “extremely agree” and 62.3% answered “rather agree” on a scale of four from “extremely agree” to “do not agree”. More than one-half of the dietetics professionals answered that their confidence in conducting risk communication was low; 20.5% answered “no confidence” and 52.5% answered “hardly have confidence” on a scale of four from “without confidence” to “with confidence”. More than 80% of the respondents answered that they needed “professional knowledge” and “support from professional agencies”. Conclusion: This study suggests that educating local dietetics professionals about professional knowledge on food safety, and obtaining support from special agencies will be essential in the upgrade of risk communication program on food safety in a community.

The characteristics were studied of risk communication regarding food safety (i.e., two-way, one-way, or not in practice) by local public agencies. The staff in charge of nutrition at public agencies in Japan were surveyed in November 2006 by means of a questionnaire answered anonymously. Answers concerning risk communication practices with residents were classified into three groups: ‘two-way,’ ‘one-way,’ and ‘not in practice.’ A cross-sectional analysis and chi-square test were used to assess each characteristic and differences between the groups for the other questions.Responses on risk communication practices with residents showed 144 (12.4%) responses as ‘two-way,’ 371 (31.9%) as ‘one-way,’ and 613 (52.8%) as ‘not in practice.’ The percentage of the ‘two-way’ group was significantly (p

Objectives: We studied 1365 male workers at a Japanese computer worksite in 2004 to determine the relationship between employees' time management factor of visual display terminal (VDT) work and General Health Questionnaire (GHQ) score.Methods: We developed questionnaires concerning age, management factor of VDT work time (total daily VDT work time, duration of continuous work), other work-related conditions (commuting time, job rank, type of job, hours of monthly overtime), lifestyle (smoking, alcohol consumption, exercise, having breakfast, sleeping hours), and the Japanese version of 28-item General Health Questionnaire (GHQ). Multivariate logistic regression analyses were performed to estimate the odds ratios (ORs) of the high-GHQ groups (>6.0) associated with age and the time management factor of VDT work.Results: Multivariate logistic regression analyses indicated lower ORs for certain groups: workers older than 50 years old had significantly a lower OR than those younger than 30 years old; workers sleeping less than 6 h showed a lower OR than those sleeping more than 6 h. In contrast, significantly higher ORs were shown for workers with continuous work durations of more than 3 h compared with those with less than 1 h, those with more than 25 h/mo overtime compared with those with less, those doing VDT work of more than 7.5 h/day compared with those doing less than 4.5 h/day, and those with more than 25 h/mo of overtime compared with those with less.Conclusion: Male Japanese computer workers' GHQ scores are significantly associated with time management factors of VDT work.

The aim of the present study was to investigate the age-related patterns and the relationship between levels of urinary cross-linked N-telopeptide of type-I collagen (NTx) and heel stiffness index measured by quantitative ultrasound (QUS) in men with a special reference to age groups of aged 40 to 59 years and ≥60 years. A total of 379 men participated in this study. Heel stiffness index (bone mass) was measured by QUS. Spot urine samples were collected, and urinary NTx was measured. The values were corrected for creatinine (Cre) concentration. Stiffness index was significantly lower in men aged ≥60 years compared with men aged 40 to 59 years (P

In Japan, it has been thought that pain during labor develops maternal identity and there are cultural and psychological barriers to the use of epidural labor analgesia. The objective of this study was to examine epidemiologic data and psychological data about satisfaction with delivery and maternal identity with epidural labor analgesia.A web-based survey was randomly conducted in 1,000 women (ages, 20-40 years) with children under the age of 3 years. The questionnaire included the basic characteristics of the participants and children, their experiences with delivery and two scales to evaluate satisfaction of delivery and maternal identity.There were a total of 1,030 respondents and 50 (5.0%) respondents reported having epidural labor analgesia. Scores about self-evaluation scales for satisfaction of delivery and maternal identity among women of epidural labor analgesia were not significantly different with those among women of spontaneous delivery.Satisfaction with delivery and maternal identity are not influenced by chosing epidural labor analgesia.

We conducted focus group interviews to understand how residents of Japan feel about the transport of pathogens. Twelve randomly selected housewives, who had no special knowledge regarding the topic before the interview, expressed their opinions in 2 separate meetings regarding pathogen transport. The results of the interviews were analyzed by the KJ method. The analysis found that although the transport of pathogens is universally recognized to be necessary, there is not clear consensus on the exact methods of transport, the positive and/or negative value of such information, and how clearly and/or uniquely to label containers, packages, compartments, vehicles, and conditions used for such transportation. Further studies to improve the skills of both the providers and receivers of such information (a technique of risk communication) are necessary.

The BCG immunization has long been performed in Japan. Although the BCG immunization service is the responsibility of the municipality, the manner in which the BCG immunization is delivered differs from municipality to municipality. The purpose of this study was to clarify how the different manner of the BCG immunization delivery systems influenced the BCG immunization coverage.The study of BCG immunization coverage was conducted in the Tama area located in the western suburbs of Tokyo in 2004. The birth data and the immunization history by the age of 3 years were collected in the three-year-old health check-up from a total of 2,341 children residing in the Tama area. Based on the age at immunization for each child, the BCG immunization coverage was calculated according to the types of the BCG immunization delivery system. The immunization types were defined as follows; the BCG immunization given on the occasion of the mass health check-up (Group 1); the exclusive mass BCG immunization in a monthly service (Group 2); the exclusive mass BCG immunization in a bimonthly service (Group 3); the exclusive mass BCG immunization in services of fewer than every two months (Group 4); and the immunization given on an individual basis by a general practitioner (Group 5). A univariate analysis was performed to examine the relationship between the BCG immunization coverage by the age of 6 months and the difference among the BCG immunization delivery systems, followed by a multivariate regression analysis to adjust for the factors related to the demography, health care services and the socio-economic status of the municipalities.Unadjusted odds ratios and adjusted odds ratios for BCG unimmunized children under the age of 6 months by the BCG immunization delivery manner groups were OR 1 reference, adj. OR 1 reference in Group 1; OR 1.42 CI 0.87-2.29, adj. OR 4.01 CI 2.24-7.11 in Group 2; OR 4.96 CI 3.66-6.82, adj. OR 15.59 CI 10.10-24.49 in Group 3;OR 18.60 CI 13.77-25.49, adj. OR 48.17 CI 29.62-79.75 in Group 4; and OR 4.24 CI 2.86-6.31, adj. OR 15.61 CI 9.05-27.26 in Group 5. The univariate analysis and multivariate regression analysis revealed an influence of the BCG immunization delivery manner on the BCG immunization coverage.The choice of BCG immunization delivery manner is very important to raise the BCG immunization coverage. The BCG immunization given on the occasion of the mass health check-up and the high-frequent immunization service are thought to improve the BCG immunization coverage.

BackgroundAssociations between specific parent and offspring mental disorders are likely to have been overestimated in studies that have failed to control for parent comorbidity.AimsTo examine the associations of parent with respondent disorders.MethodData come from the World Health Organization (WHO) World Mental Health Surveys (n = 51 507). Respondent disorders were assessed with the Composite International Diagnostic Interview and parent disorders with informant-based Family History Research Diagnostic Criteria interviews.ResultsAlthough virtually all parent disorders examined (major depressive, generalised anxiety, panic, substance and antisocial behaviour disorders and suicidality) were significantly associated with offspring disorders in multivariate analyses, little specificity was found. Comorbid parent disorders had significant sub-additive associations with offspring disorders. Population-attributable risk proportions for parent disorders were 12.4% across all offspring disorders, generally higher in high- and upper-middle- than low-/lower-middle-income countries, and consistently higher for behaviour (11.0–19.9%) than other (7.1–14.0%) disorders.ConclusionsParent psychopathology is a robust non-specific predictor associated with a substantial proportion of offspring disorders.

The purpose of this study was to determine which zoonoses should the general population be more aware of.We conducted qualitative research (Delphi method) on thirty veterinarians who were selected from the whole country.Twenty-four diseases were selected. The reasons for their selection were classified into three categories: "Amount of knowledge, attitude and behavior", "Clinicoepidemiologic characteristics" and "Social characteristics". More than half of the top ten zoonoses are those that are not transmitted from humans to humans, with rabies in the first place, avian influenza (with its high pathogenicity) in the second place and psittacosis in the third place.From the top ten diseases, it is considered that the prevention of animal-to-human transmission should be emphasized. In addition, from the reasons for the selection, it is suggested that it is necessary to review social characteristics, such as the inadequacy of quarantine and the insufficiencies of legal systems. As for the zoonoses that are transmitted from humans to humans, it will be indispensable in the future to widely spread information on zoonoses and enlighten the general population about them. It is thought that this survey can be a basis for selecting a zoonosis that should be given priority in enlightening the general population.

Major depression is expected to become the leading contributor to disease burden worldwide by 2020. Previous studies have shown that the societal cost of depression is not less than that of other major illnesses, such as cardiovascular diseases or AIDS. Nevertheless, the cost of depression in Japan has never been examined. The goal of the present study was to estimate the total cost of depression in Japan and to clarify the characteristics of this burden.A prevalence-based approach was adopted to measure the total cost of depression. The total cost of depression was regarded as being comprised of the direct cost, morbidity cost and mortality cost. Diagnoses included in this study were depressive episodes and recurrent depressive disorder according to the ICD-10 or major depressive disorder according to the DSM-IV. Data were collected from publicly available statistics and the World Mental Health Japan Survey database.The total cost of depression among adults in Japan in 2005 was estimated to be ¥2.0 trillion. The direct cost was ¥0.18 trillion. The morbidity cost was ¥0.92 trillion, while the mortality cost was ¥0.88 trillion.The societal costs caused by depression in Japan are enormous, as in other developed countries. Low morbidity costs and extremely high mortality costs are characteristic in Japan. Effective interventions for preventing suicide could reduce the societal costs of depression.

Our aim was to explore the association of physical performance and pain with fear of falling among community-dwelling Japanese women. The subjects were 278 women aged 65 years and over. We collected information on fear of falling, painful joints, comorbidities, falls in the previous year, and cataracts. Walking time (distance of 6 m), chair stand time (5 times), grip strength, the timed up and go test (TUG), and functional reach were measured. The prevalence of fear of falling was 36.3%, and it increased with age, but it was not significant (P=0.081). Multivariate logistic regression analysis showed that poor physical performance (longer walking time, longer chair stand time, weaker grip strength, and longer TUG) and pain (low back, and upper and lower extremity pain) were significantly associated with fear of falling after adjusting for age, body mass index, comorbidities, falls in the previous year, and cataracts. Maintaining physical functioning and managing pain may be important for elderly women with fear of falling., Medicine, 94(35), e1449; 2015