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High scores on Harm Avoidance (HA) on Cloniger’s Temperament and Character Inventory (TCI) have been identified as a risk factor for depression. Group cognitive-behavioral therapy (GCBT) has been found effective in preventing depression and improving depressive symptoms among university students. However, no randomized controlled trials of GCBT have been conducted with university students with high HA. Although we initiated a randomized controlled trial in this study, some participants submitted incomplete questionnaires at baseline interfering with assured randomization; therefore, we report this study as a non-randomized controlled trial. We evaluated whether a GCBT intervention would be effective at reducing HA and, thereby, preventing depression in university students with high HA. We performed final analysis of data on 59 participants in the intervention group and 60 in a control group. We used scores on the Beck Depression Inventory-II (BDI-II) as the primary outcome measure and analysis of covariance to assess group differences on mean BDI-II change scores before the intervention and at six months and one year after the intervention. The intervention group had lower BDI-II scores than the control group at six months after the intervention. GCBT may have facilitated cognitive modification in individuals with high HA, or GCBT may have fostered mutual modeling by group participants. Thus, GCBT may contribute to reducing depressive symptoms in university students with high HA, and associated risk for developing depression.

Hyperhidrosis significantly reduces patients' quality of life, with many reporting feeling highly anxious. However, the relationship between hyperhidrosis and anxiety induced by sweating has not been examined in detail. The current study examined the relationship between: (1) the presence of hyperhidrosis symptoms, (2) hyperhidrosis severity, and (3) the sites of the most sweating and anxiety induced by sweating. A cross-sectional web-based survey was conducted among university students, and 1080 consenting participants (600 males and 480 females; mean age, 18.8 years) were included in the analysis. The survey items were: (1) diagnostic criteria for hyperhidrosis, (2) Hyperhidrosis Disease Severity Scale, (3) presence of anxiety induced by sweating, and (4) site of the most sweating. The results of multiple logistic regression analysis adjusted for sex and age showed that the odds ratio (OR) for anxiety induced by sweating was significantly higher in participants who screened positive for hyperhidrosis than in those who screened negative (OR, 9.72 [95% CI, 5.80-16.27]). The OR of anxiety induced by sweating was 7.11 (95% CI, 3.99-12.65) for mild/moderate hyperhidrosis and 23.46 (95% CI, 7.15-76.93) for severe hyperhidrosis, compared with those who screened negative for hyperhidrosis. Compared with those who screened negative for hyperhidrosis, the OR for anxiety induced by sweating in those with the palmar, plantar, axillary, and head/face as the site of the most sweating was 7.74 (95% CI, 3.91-15.33), 14.86 (95% CI, 1.83-120.58), 16.92 (95% CI, 5.95-48.14), and 5.38 (95% CI, 1.39-20.74), respectively. Our findings suggest that participants who screened positive for hyperhidrosis, mild/moderate or severe, are at a higher risk of anxiety induced by sweating than participants who screened negative for hyperhidrosis.

ObjectiveThis study aimed to evaluate whether a self-management program using the eHealth system could reduce symptom severity in patients with irritable bowel syndrome (IBS). Impact of the intervention on quality of life and gut microbiota were also examined.DesignThis study was designed as an open label, simple randomized controlled trial comparing an intervention group that attended an eHealth self-management program and a treatment as usual group. Participants were Japanese women between the ages of 18 and 36. Forty symptomatic IBS individuals who met the inclusion criteria were recruited and randomly assigned to the two groups. The eHealth group received 8 weeks of unlimited access to the self-management program containing a wide variety of e-learning content. Participants’ severity of IBS symptoms, the main outcome, was assessed using the irritable bowel syndrome-severity index (IBS-SI) at baseline and 8 weeks. The secondary outcomes of participants’ quality of life and gut bacteria were also assessed at baseline and week 8.ResultsThere was a significant difference in the net change in IBS severity index (IBS-SI) score between the eHealth and treatment as usual group (−50.1; 95% CI, −87.6 to -12.6; p = 0.010). The eHealth group had significantly lower IBS-SI scores following 8 weeks of intervention compared with the baseline scores (t = − 3.2, p < 0.01). The implementation of the eHealth program was accompanied by improvement of quality of life and decrease of phylum-level Cyanobacteria occupancy, respectively.ConclusionThe implementation of eHealth for IBS was shown to reduce IBS symptoms.Key MessagesWhat is already known on this topic –eHealth programs based on diet and probiotic use have shown good results in reducing IBS symptomsWhat this study adds– a self-management program with an e-learning component based on a successful self-help guidebook for IBSHow this study might affect research, practice or policy– The proposed eHealth model reduces symptoms and improves the quality of life of IBS patients, providing an efficient and cost-effective intervention option to be adopted in policy and practice, and creates scope for future research in food intake, exercise, and sleep management through eHealth for IBS.

Background Tension-type headaches and migraines are prevalent conditions; however, no reliable biological markers have been identified for screening. A validated screening tool for epidemiological studies would aid in carrying out large-scale epidemiological studies. Therefore, there is a need to develop a screening tool in the Japanese language based on the International Classification of Headache Criteria, which can be used in epidemiological studies. In this study, we aimed to develop a Japanese-language tool that can be used to screen patients for migraine, tension-type headaches, and mixed migraine/tension-type headaches. Consequently, our objective was to develop a questionnaire based on the 3rd edition of the International Classification of Headache Disorders (ICHD-3) using screening items for each type of headache and to examine its validity. Methods The questionnaire consisted of 29 questions based on the ICHD-3 diagnostic criteria. It comprised 10 screening items for migraine, eight for tension-type headache, and five for mixed migraine/tension-type headache. The screening results of the questionnaire were compared with the diagnoses of three neurologists, which were used as the gold standard reference. Results The study population comprised 69 patients (mean age ± standard deviation, 55.0 ± 18.7 years) aged 19–89 years who were visiting the Tominaga Hospital of the Kotobukai Social Medical Corporation. According to the neurologists’ diagnoses, twenty-two patients had migraine, 30 had tension-type headaches, and 17 had mixed migraine/tension-type headaches. The sensitivity and specificity were as follows: migraine, 72.7% and 86.7%; tension-type headache, 50.0% and 86.4%; and mixed migraine/tension-type headache, 70.6% and 67.3%, respectively. Conclusions The screening tool developed in this study has sufficient validity except for tension-type headache. The questionnaire developed in this study is a rapid and sensitive tool for determining migraine, tension-type headache, and mixed migraine/tension-type headache in persons with headache symptoms.

Young adults with irritable bowel syndrome (IBS) occasionally exhibit specific abdominal symptoms, including abdominal pain associated with brain activity patterns. Decoded neural feedback (DecNef) is a biofeedback exercise that allows symptomatic people to exercise self-control over their brain activity patterns relative to those without symptoms. Thus, DecNef can be used to self-control abdominal pain in patients with IBS. To establish a DecNef practice for IBS, it is necessary to develop a classifier that can distinguish the electroencephalography (EEG) patterns (EEG signatures) of IBS between symptomatic and healthy people. Additionally, the accuracy of the "classifier" must be evaluated.This study analyzed EEG data obtained from symptomatic and asymptomatic young adults with IBS to develop a support vector machine-based IBS classifier and verify its usefulness. EEG data were recorded for 28 university students with IBS and 24 without IBS. EEG data were frequency-analyzed by fast Fourier transform analysis, and IBS classifiers were created by supervised learning using a support vector machine.The diagnostic accuracy of IBS symptoms was verified for the whole brain and the frontal, parietal, and occipital regions. We estimated90% accuracy of the IBS classifier in the whole brain and frontal region.The results of this study suggest that EEG data can be used to determine the presence or absence of IBS symptoms. With the IBS classifier, EEG may help provide feedback regarding the presence or absence of symptoms to patients, which is the basis for developing self-management strategies for IBS.

Background: The Cognitive Attentional Syndrome Scale 1 Revised (CAS-1R) is a 10-item self-report measure designed to assess dysfunctional metacognition, which is a transdiagnostic predictor of psychological disorders. Dysfunctional metacognition can be broadly classified into “cognitive attentional syndrome” and “metacognitive beliefs.” In the present study, the CAS-1R was translated into Japanese, and the reliability and validity of the Japanese version of the CAS-1R (CAS-1R-J) were examined in a Japanese community sample. Methods: We recruited 552 Japanese residents via the Internet and received responses from 552 individuals for Time 1 (275 men and 277 women, M age = 39.81, SD = 11.06) and 112 individuals for Time 2. Of these, the data of 87 individuals (46 men and 41 women, M age = 40.31, SD = 10.62) were used to examine test-retest reliability.Results: The results of confirmatory factor analysis indicated that the factor structure (three-factor model) of the CAS-1R-J was appropriate for the data. Each of the subscales of the CAS-1R-J showed good internal consistency. In addition, there was a theoretical relationship between the CAS-1R-J and Metacognition Questionnaire-30, Penn State Worry Questionnaire, Generalized Anxiety Disorder-7 Scale, and Patient Health Questionnaire-9 Scale. Furthermore, the results of the hierarchical logistic regression analysis showed that the CAS-1R-J has discriminant and incremental validity for clinical symptoms. Conclusions: These results indicate that the CAS-1R-J is a valid instrument for assessing state cognitive attentional syndrome and metacognitive beliefs in Japanese individuals.

This study assessed whether a combined intervention of omega-3 polyunsaturated fatty acids (PUFAs) and psychoeducation better improved mild to moderate depression in workers compared to psychoeducation alone.This study was a double-blinded, parallel group, randomized controlled trial that compared the intervention group, receiving omega-3 fatty acids, with a control group, receiving a placebo supplement. Participants receiving omega-3 fatty acids took 15 × 300 mg capsules per day for 12 weeks. The total daily dose of omega-3 PUFAs was 500 mg docosahexaenoic acid and 1000 mg eicosapentaenoic acid (EPA). The Beck Depression Inventory®-II (BDI-II) was used to assess the severity of depression after treatment.After 12 weeks of treatment, BDI-II scores were significantly lower in the placebo and omega-3 group, when compared to their respective baseline scores (Placebo: t = - 4.6, p 0.01; Omega-3: t = - 7.3, p 0.01). However, after 12 weeks of treatment, we found no significant difference between both groups with respect to changes in the BDI-II scores (0.7; 95% CI, - 0.7 to 2.1; p = 0.30).This study did not measure blood omega-3 fatty acid concentration and presented a high-dropout rate. Moreover, our results may not be generalizable to other regions.The results show that a combination of omega-3 fatty acids and psychoeducation and psychoeducation alone can contribute to an improvement in symptoms in people with mild to moderate depression. However, there is no difference between the interventions in ameliorating symptoms of depression.

Objectives This study comprised a randomized controlled trial to examine the effect of internet‐based attention bias modification (iABM) on reducing workers' anxiety. Methods In total, 300 eligible participants were randomized according to sex and age; 180 were assigned to the intervention group and 120 to the control group. The word stimuli used in the iABM included eight positive words and eight neutral words. Participants were instructed to indicate the positive word's position as quickly and accurately as possible by tapping one of the two directions on display. The intervention included five sessions per participant over 1 month, resulting in a total of 600 trials. The main outcome measure was the total state anxiety score of the State‐Trait Anxiety Inventory (STAI). Results There was no significant difference in the net change in STAI scores between the intervention and control groups. The mean reaction time of the fifth session was significantly shorter than the mean reaction time of the first session. Furthermore, although there was no effect on the index of effect size Δ, the paired t‐test showed a significant decrease in the anxiety score. Conclusions The iABM intervention in this study did not enhance the amelioration of workers' anxiety when compared with the control condition.

Post-stroke depression increases the likelihood of adverse physical symptoms. Attentional bias (AB) for negative stimuli is important in depression onset, maintenance, and remission. Stroke is more likely in older adults, who can have reduced cognitive function. Individuals with mild cognitive impairment (MCI) can have delayed reaction times (RTs). We hypothesized that RT to select neutral facial expression is affected by depressive symptoms and cognitive function in patients with stroke. This study analyzed 61 patients with stroke. Beck Depression Inventory-Second Edition (BDI-II) and Profile of Mood States (short version) scores were determined. Task stimuli comprised eight pairs of facial expressions containing affective (angry) and neutral faces. AB was measured as the RT to select the neutral face in two simultaneously presented images using attention bias modification (ABM) software. Patients were grouped according to depressive symptoms using BDI-II scores. Between-subject factors of depressive symptoms and cognitive function were determined by ANCOVA. No significant interaction was found between depressive symptoms and cognitive function on RT. There was a main effect of cognitive function, but not depressive symptoms. In patients with hemiparesis and depressive symptoms, RT was significantly shorter in patients without MCI compared with patients with MCI. People with stroke and elevated depression symptoms with hemiparesis but without MCI quickly selected neutral facial expressions from neutral and aversive expressions, and thus do not need ABM to escape aversive stimuli. ABM in response to aversive stimuli may be useful in evaluating negative emotions in individuals with post-stroke depression without MCI.

[This corrects the article DOI: 10.1371/journal.pone.0234089.].

Irritable bowel syndrome (IBS) is a common bowel disorder that manifests as unexplained abdominal pain or discomfort and bowel habit changes in the form of diarrhea, constipation, or alternating patterns of the two. Some evidences demonstrate that increased physical activity improves IBS symptoms. Hence, daily exercise is recommended in these patients. In this study, we aimed to investigate the relationship between physical activity and gastrointestinal symptoms in 101 university students (female = 78) with IBS. Participants were examined by Gastrointestinal Symptoms Rating Scale (GSRS), and gait steps were measured for 1 week using a pedometer. The association between the GSRS score and pedometer counts was determined by ordinal logistic modeling analysis. The ordinal logistic regression model for GSRS and locomotor activity showed a significant stepwise fit (z = -3.05, p = 0.002). The logistic curve separated GSRS score of 5 points (moderately severe discomfort) from 2 points (minor discomfort) by locomotor activity. The probability for daily locomotor activity to discriminate between 5 and 4 points of GSRS (i.e., likely to have reverse symptoms) decreased in accordance with increment of steps per day: 78% probability for 4000 steps, 70% probability for 6000 steps, 59% probability for 8000 steps, and 48% probability for 10000 steps. This study demonstrated that the severity of GSRS is associated with the amount of walking in younger people with IBS. These results may be used as a measure to determine the daily step count to reduce the severity of gastrointestinal symptoms in individuals with IBS.

In industrialized countries, the turnover rate of preschool workers is extremely high and now represents a social problem. Consequently, it has become important to promote stable early care and educational environments for this population. Several factors related to working environments are known to affect turnover intention; however, the specific factors related to turnover intention among preschool workers have not yet been identified. Considering this, the objective of the present study was to determine factors associated with preschool workers’ willingness to continue working.The participants of this study were 1137 preschool workers based in Nagasaki Prefecture, Japan. Multivariate logistic regression analysis was used to analyze the participants’ data,with willingness to continue working for 5 years or more set as the dependent variable.Analysis of the results for all subjects clearly showed that male sex, older age, good mental health, high number of social supports, and good work engagement have a positive effect on willingness to continue working. Further, stratifying the participants in terms of age revealed that for preschool workers under 39 years, male sex,good mental health, high number of social supports, and good work engagement act positively in regard to willingness to continue working. Meanwhile, for those over 40 years, it was found that permanent employment and good work engagement act positively in this regard. Thus, work engagement was the only common factor between preschool workers under 39 and over 40.The findings of this cross-sectional study demonstrate that the factors associated with willingness to continue working among preschool workers differ between younger and older professionals. These findings underline the importance of considering age categories when attempting to maximize such professionals’ willingness to continue working., Medicine, 97(49), e13530; 2018

High harm avoidance (HA) scores on the temperament and character inventory appear to be a risk factor for depressive disorders and suicide. Since 2012, we have conducted group cognitive behavioral therapy (G-CBT) interventions for students at Nagasaki University with high HA and without depressive disorders, with the aim of preventing depression. Here, we report on the effects of the G-CBT at 1-year follow-up for the 2012 to 2015 period. Forty-two participants with high HA were included in the final analysis. Outcomes were measured with the Beck Depression Inventory II, Manifest Anxiety Scale, 28-item General Health Questionnaire, and Brief Core Schema Scales at baseline, and at 6-month, and 1-year follow-ups. Repeated-measures analyses of variance revealed a significant decrease in mean depressive symptom scores at the 6-month follow-up point; this decrease was maintained at 1 year. Improvements in cognitive schemas were also seen at 6 months and 1 year. We observed improvements in cognitive schemas associated with depression as a result of the G-CBT intervention, with effects maintained at 1 year post-intervention. This intervention may be effective in positively modifying the cognitions of students with HA and preventing future depression.

Background Attention bias modification normalizes electroencephalographic abnormalities in alpha and beta power percentages related to attention in patients with irritable bowel syndrome (IBS). Yet, it is unknown whether ABM contributes to the normalization of event-related potentials (ERP) in these patients. We hypothesized that ERP related to attention deficit would be normalized after ABM implementation in individuals with IBS. Methods Thirteen patients with IBS and 10 control subjects completed a 2-month intervention that included five ABM sessions. Each session included 128 trials, resulting in a total of 640 trials during the study period. Event-related potentials were measured at the first and fifth sessions. As per the international 10-20 system for electroencephalographic electrode placement, right parietal P4 was evaluated to measure the attention component of facial expression processing. Key results A group comparison of P100 latency at P4 revealed that latencies were significantly different between groups in session 1 (IBS vs control, 108 ± 8 vs 97 ± 14; t = -2.51, P = .0203). This difference was absent in session 5 (94 ± 11 vs 93 ± 11, respectively; t = -0.397, P = .6954, r = .09), indicating an effect of ABM in the IBS group. Conclusions and inferences Attention bias modification may have clinical utility for normalizing brain function and specifically attentional abnormalities in patients with IBS.

We investigated the relationship between number of weekly working hours and the prevalence of diabetes in the urban Chinese population. Data regarding anthropometric measurements, fasting blood glucose level and number of hours worked per week were collected from 2228 workers in Shanghai, China (Mage = 44 years; 64% men). Participants were divided into three groups according to the number of hours worked per week (

Background This study was conducted to investigate the relationship between symptoms of gambling problems, gambling behaviours, and cognitive distortions among a university student population in Japan ages 20 to 29 years. We aimed to address the gap in knowledge of gambling disorders and treatment for this population. Methods Data were obtained from 1471 Japanese undergraduate students from 19 universities in Japan. Descriptive statistics and hierarchical multivariate regression analysis were used to investigate whether the factors of gambling cognitive distortions would have predictive effects on gambling disorder symptoms. Results Results indicated that 5.1% of the participants are classifiable as probable disordered gamblers. The bias of the gambling type to pachinko and pachislot was unique to gamblers in Japan. Of the students sampled, 342 self-reported gambling symptoms via the South Oaks Gambling Screen. Hierarchical multivariate regression analysis indicated that one domain of gambling cognitive distortions was associated significantly with gambling symptoms among the 342 symptomatic participants: gambling expectancy (β = 0.19, p Conclusion This study successfully contributed to the sparse research on university student gambling in Japan. Specifically, our results indicated a statistically significant relationship between gambling cognitive distortions and gambling disorder symptoms. These results can inform the development of preventive education and treatment for university students with gambling disorder in Japan. The report also describes needs for future research of university students with gambling disorder.

Background Helicobacter pylori (HP) infection is implicated in gastric and extra-gastric diseases. While gastritis-related chronic inflammation represents a known trigger of metabolic disturbances, whether metabolic syndrome (MetS) is affected by gastritis status remains unclear. We aimed to clarify the effect of HP-related gastritis on the risk of MetS. Materials and Methods We retrospectively enrolled patients undergoing screening for MetS between 2014 and 2015. Investigations included HP-specific immunoglobulin G (IgG) antibody assays to detect HP infection, and serum pepsinogen assays to evaluate atrophic gastritis status. The risk of MetS was evaluated via multiple logistic regression analyses with two covariates: serum HP infection status (IgG levels) and atrophic gastritis status (two criteria were applied; pepsinogen I/II ratio < 3 or both pepsinogen I levels ≤ 70 μg/L and pepsinogen I/II ratio < 3). Results Of 1,044 participants, 247 (23.7%) were HP seropositive, and 62 (6.0%) had MetS. HP seronegative and seropositive patients had similar risks of MetS. On the other hand, AG (defined in terms of serum PG I/II