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Accurate diagnosis of retroflexed uterus in daily practice is essential because this condition is related to pelvic pain and deep endometriosis. Uterine flexion can be measured by transvaginal ultrasonography (TVUS), a cost-effective primary test, but the accuracy required for diagnosing retroflexed uterus is unclear. This study assessed the accuracy of TVUS for diagnosis of retroflexed uterus in patients with endometriosis and compared it with that of magnetic resonance imaging (MRI) -the gold standard for measuring the uterine axis.The study included 123 patients who underwent endometriosis surgery in our department between 2012 and 2017. Uterine flexion angles were measured by retrospectively examining TVUS and MRI images, and the correlation was analyzed. Analysis of anteverted and retroverted uterine subgroups identified aspects of diagnosing uterine flexion with TVUS.Uterine flexion angles on TVUS were strongly positively correlated (r = 0.86) with MRI results. Additionally, TVUS yielded no false-positive diagnoses and 28 false-negative diagnoses of retroflexion. All false-negative diagnoses occurred in patients with anteverted retroflexed uteruses.TVUS was generally accurate for measuring uterine flexion angle, as indicated by its strong correlation with MRI. Misdiagnosis of anteverted retroflexed uterus was a limitation of using TVUS for retroflexion diagnosis.

Supplementary Figure 1 from Blockade of B7-H1 and PD-1 by Monoclonal Antibodies Potentiates Cancer Therapeutic Immunity

Contemporary approaches for vaccination and immunotherapy are often capable of eliciting strong T-cell responses against tumor antigens. However, such responses are not parallel to clinical tumor regression. The development of evasion mechanisms within tumor microenvironment may be responsible for poor therapeutic responses. We report here that constitutive or inducible expression of B7-H1, a B7 family molecule widely expressed by cancers, confers resistance to therapeutic anti-CD137 antibody in mice with established tumors. The resistance is accompanied with failure of antigen-specific CD8+ CTLs to destroy tumor cells without impairment of CTL function. Blockade of B7-H1 or PD-1 by specific monoclonal antibodies could reverse this resistance and profoundly enhance therapeutic efficacy. Our findings support that B7-H1/PD-1 forms a molecular shield to prevent destruction by CTLs and implicate new approaches for immunotherapy of human cancers.

Background Laparoscopic sacrocolpopexy (LSC) is an increasingly popular treatment for pelvic organ prolapse (POP) because of its low recurrence rate and safety. Although LSC may improve the voiding function, it may also lead to de novo stress urinary incontinence. The detailed impact of LSC on voiding function and its mechanism remain unclear. Therefore, in this study, we evaluated the impact of LSC on voiding function prospectively by performing a pre- and post-operative urodynamic study in patients with stage 3 or greater POP. Methods Urinary status was evaluated before and 3 months after LSC. Pre- and post-operative evaluations included medical history, clinical examination, urodynamic studies, chain cystography, and residual urine volume measurement. Urinary symptoms were assessed using the International Prostate Symptom Score (IPSS) and the Overactive Bladder Symptom Score (OABSS). Results The non-recurrence rate at 3 months was 82.3%. All recurrences involved bladder prolapse. Apart from the fact that there was no significant change in the OABSS, the improvement in IPSS suggests that subjective voiding symptoms have improved. Although the maximum urinary flow rate did not change significantly, the bladder volume at first sensation increased, urinary storage function improved, and residual urine volume decreased. There were no perioperative complications, and none of the patients complained of post-operative difficulty in urination or urinary retention. The retrovesical angle significantly decreased. Conclusions The modified LSC in women with POP provides good functional outcomes in terms of IPSS, post void residual volume (PVR), and urinary storage function.

The majority of pediatric burns in Mongolia occur within the home, particularly in the spaces dedicated to cooking. This makes home environment modification a priority for injury prevention. Many of these injuries are caused by electric appliances used in traditional tent-like dwellings (called a ger). In the present study, we designed and provided a context appropriate kitchen rack to 50 households with children aged 0-3 years living in gers and investigated parental views on the acceptability of the rack and willingness-to-pay (WTP) through face-to-face structured individual and group interviews and the contingent valuation method. We used the DCchoice package of R to estimate the median WTP and its 95% confidence interval by the household income, previous experience of childhood burn injury, and the number of children in the household. There was a total of 89 children aged

Background Road traffic injury has long been regarded as a “time-dependent disease.” However, shortening the prehospital time might not improve the outcome in developing countries given the current quality of in-hospital care. We aimed to examine the relationship between the prehospital time and 24-h mortality among road traffic victims in Laos. Methods A prospective observational study was conducted using the trauma registry data on traffic-injured patients who were transported by ambulance to a trauma center in the capital city of Laos from May 2018 to April 2019. The analysis focused on patients with non-mild conditions, whose outcomes could be affected by the prehospital time. To examine the relationship between a prehospital time of Results Of 701 patients, 73% were men, 91% were riding 2- or 3-wheel motor vehicles during the crash, and 68% had a prehospital time of Conclusion A shorter prehospital time was not associated with the 24-h survival among road traffic victims in Laos.

Since 2011, commercial truck drivers have been required to take alcohol breath tests at the beginning and end of their working hours due to their employers' legal obligations. However, non-commercial truck drivers are not required to do so. We examined whether alcohol-related crashes had decreased after 2011 among commercial truck drivers.Using police data, we conducted a joinpoint regression analysis to examine the trend in the proportion of alcohol-related crashes from 1995 to 2020 caused by commercial truck drivers (who were subjected to alcohol breath testing) and non-commercial truck drivers (who were not subjected to testing). The annual percentage change in this trend was also estimated.During the 26-year study period, truck drivers caused 1,846,321 at-fault crashes, and 0.4% of the crashes involved intoxicated driving. A significant decreasing trend in the proportion of alcohol-related crashes was identified among both commercial and non-commercial truck drivers in the 2000s, during which several legal amendments were made against drunk driving. The annual percentage change was -13.5% from 2001 to 2012 among commercial truck drivers, and -14.9% from 2001 to 2011 among non-commercial truck drivers. No decreasing trend was observed afterwards, despite the introduction of mandatory alcohol breath testing in 2011.The effect of mandatory alcohol breath testing on reducing alcohol-related crashes among commercial truck drivers was not evident.

A 31-year-old nulliparous Japanese woman visited the clinic due to worsening dysmenorrhea. A cystic endometriotic lesion was found in the vesico-uterine pouch. Laparoscopic surgery was chosen due to the severe dysmenorrhea. Her first oocyte retrieval attempt was performed at in-vitro fertilization clinic before the planned surgery. However, she complained of abdominal pain on day 6 after the retrieval. We diagnosed her with peritonitis with an abscessed cystic endometriotic lesion in the vesico-uterine pouch. Conservative treatment was ineffective. Therefore, laparoscopic surgery was performed. The cysts in the vesico-uterine pouch were drained of pus. No adhesions or lesions of endometriosis in the uterus, bilateral adnexa, or pelvic peritoneum were found. Although cystic endometriotic lesions in the vesico-uterine pouch are rare, they can form abscesses after oocyte retrieval. The possibility of abscesses formation risk must be considered. Moreover, following the management of endometrioma, sufficient medication should be administered to prevent this formation.

Immigration policies in Japan and elsewhere have been toughened in recent years. To investigate the potential effects of parental detention on migrant children, psychosocial wellbeing of children from migrant families with and without parental detention was compared. In this cross-sectional study, adult asylum seekers and migrant workers with children staying in Japan were invited through non-governmental organizations to answer a self-administered anonymous questionnaire in June and July 2020. Children's psychosocial wellbeing was assessed based on the Strength and Difficulties Questionnaire. In the 49 participating families, including 28 where either parent had ever been detained in Japan, there were 85 children aged 4-17 years who were subject to the analyses. Psychosocial wellbeing of children in families with parental detention appeared to be worse than that of their counterparts, especially on the dimension of emotional problems. More attention should be paid to the wellbeing of migrant children in Japans immigration policy.

This study aimed to examine how the associations between surrendering driving licence and changes in self-rated health and social interactions among older adults differ by the years elapsed since surrendering and the number of public transportation systems (PTS) in the neighbourhood. We used the 2013 and 2016 survey data from the Japan Gerontological Evaluation Study targeting residents aged ≥65 years in 30 municipalities in Japan. Two-waves longitudinal data from 4894 older adults were evaluated. Based on the difference-in-differences method, the interaction terms of respondents' driving status, which was the categorical exposure variable representing respondents' driving status for three years during the study period, and a dummy variable of year (2016) were used as explanatory variables in logistic regression analyses to examine changes in outcomes (poor self-rated health and infrequent meeting with friends) between 2013 and 2016 by driving status during this period. Analyses were stratified based on neighbourhood PTS ('more PTS' and 'fewer PTS' groups). We found that, while surrendering licence within three years was associated with increased probability of poor self-rated health in more PTS group, the confidence interval was large. Although surrendering licence within three years was associated with decreased social interactions, this association weakened if licence was surrendered more than three years ago. These associations were not markedly affected by neighbourhood PTS. Our findings suggested that, regardless of neighbourhood PTS, support and care to promote social interactions at or shortly after surrendering licence may be beneficial to the well-being of older adults who lost their driving licence.

Background: Population ageing and stringent licensing policies will increase the number of older drivers who stop driving. Adverse health outcomes owing to driving cessation and their prevention are emerging concerns. Therefore, we longitudinally examined the impact of driving cessation and alternative transportation use after cessation on the risk of functional limitations in a cohort of community-dwelling people (65 years and older) in Japan. Methods: Using cohort data of those who drove as of 2006/07, we compared the risk of functional limitations between 2,704 current drivers and 140 former drivers (who stopped driving by 2010). Of the former drivers, 77 did not use public transportation or bicycles after driving cessation (thus losing independent mobility). We calculated the hazard ratios (HRs) for the incidence of functional limitations with 95% confidence intervals (CIs) based on the Cox proportional hazards model with the covariates influencing the functional limitations. Results: From 2010 through 2016, 645 people had functional limitations, which included 38, 82, and 119 per 1,000 person-years among current drivers, former drivers who used public transportation or bicycles, and former drivers who were only driven by others, respectively (HR 1.69; 95% CI, 1.15–2.49 and HR 2.16; 95% CI, 1.51–3.10, relative to current drivers). Conclusion: Driving cessation is associated with an increased risk of functional limitations among older adults, but this risk might be alleviated if they are able to maintain independent mobility using public transportation or bicycles after driving cessation.

We report a rare case of an ovarian steroid cell tumor with a diagnosis prompted by heart failure symptoms. A 28-year-old Japanese nulligravida/nullipara with a chief complaint of respiratory discomfort during physical exertion and exhibiting heart failure symptoms was referred to our hospital. She also had signs of virilization, including secondary menorrhea since the age of 20, hirsutism and balding. Cushing's syndrome was suspected, and further examinations showed hypertestosteronemia and right ovarian tumor. Symptomatic treatment for heart failure with diuretics and antihypertensives was followed by abdominal right adnexectomy performed due to the androgen-producing ovarian tumor. The tumor was solid and larger than a fist, and confirmed as a steroid cell tumor through postoperative histopathology. Serum total testosterone levels normalized at day 3 postoperatively, and menstruation resumed 2 months later. Our case was diagnosed due to heart failure symptoms, and its treatment resulted in improvement in virilization signs.

To investigate the extent to which long-term care facilities used ambulances for low-acuity conditions. A large number of instances of ambulance use for low-acuity conditions corresponded to long-term care facilities. Intervention in long-term care facilities may reduce ambulance use for low-acuity conditions, which will help facilitate the timely transportation of patients. Increased ambulance calls affect the timely transportation of patients. Recently, ambulance uses from long-term care facilities (LTCFs) for older adults has been increasing. The aim of this study was to investigate to what extent LTCFs used ambulances for low-acuity conditions. Ambulance records from the fire department of Misato City were used. The participants were patients aged 65 years or older transported from all types of LTCFs (including public nursing homes, geriatric health services facilities, private nursing homes, and group homes) and homes. The proportions of ambulance use for low-acuity conditions and their 95% confidence intervals (CI) were calculated and compared by time (daytime and night-time) and day (weekdays and holidays) of ambulance use for each type of residence. Of 12,494 participants, 1336 (11%) were transported from LTCFs, and 326 (2.6%) for low-acuity conditions. Of 326 patients with low-acuity conditions, 69% were transported from LTCFs. The proportion of low-acuity conditions was 17% among those transported from LTCFs, while it was only 1% among those from homes. The proportion of low-acuity conditions was significantly greater during night-time than daytime among those from public nursing homes, geriatric health services facilities, and group homes, while this proportion was greater on weekdays than holidays among those from geriatric health services facilities. This study found a large number of instances of ambulance use for low-acuity conditions by LTCFs. To reduce unnecessary ambulance use for low-acuity conditions efficiently, LTCFs should be assisted in making proper assessments of both patients’ conditions and appropriate ambulance use.

Objectives. To quantify the impact of the “Zone 30” policy introduced in September 2011 on the incidence of cyclist and pedestrian injuries in Japan. Methods. This was an interrupted time-series study. We used the data of cyclist and pedestrian injuries recorded by the Japanese police between 2005 and 2016. We evaluated the monthly number of deaths and serious injuries per person-time on narrow roads (width Results. There were 266 939 deaths and serious injuries. By 2016, the cumulative changes in the rate ratio spanned from −0.26 to −0.046, depending on sex and age, and an estimated number of 1704 (95% confidence interval = 1293, 2198) injuries were prevented. Conclusions. The policy had a large preventive impact on cyclist and pedestrian deaths and serious injuries at the national level.

Aim To investigate the accuracy and clinical value of an adhesion scoring system using transvaginal ultrasonography for endometriotic adhesion. Methods In this prospective observational study, we included 131 patients with endometriosis who underwent surgery. Before surgery, transvaginal ultrasonography and adhesion mapping were performed to determine the presence or absence of adhesions at 10 sites of the pelvis. Mapping accuracy was determined by comparing the mapping findings with the surgical findings. To determine the severity of pelvic adhesions, we developed an adhesion score (0-10). With the adhesion score, we assessed the effect of surgical adhesiolysis and evaluated the relationship between postoperative adhesions and infertility. Results Of the 10 sites assessed for adhesions, the most frequent site of adhesions was the site between the left ovary and the uterus (70.5%). The overall sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio and accuracy of adhesion mapping were 80.4%, 86.1%, 78.8%, 87.2%, 5.79, 0.23 and 83.9%, respectively. The adhesion score in this system was significantly correlated with the adhesion-related score in the revised American Society for Reproductive Medicine classification (R2 = 0.734). Surgical adhesiolysis yielded only about 30% improvement postoperatively. The adhesion score 1 month after surgery in the non-in vitro fertilization (IVF) pregnancy group was significantly lower than that in the IVF pregnancy group (3.45 vs 5.21; P = 0.02). Conclusion Our adhesion scoring system allowed an accurate prediction of the pelvic adhesion status and may potentially be an indicator of postoperative adhesions and infertility.

ObjectiveTo evaluate the effects of child burn prevention campaigns on medically attended burn injuries in Ulaanbaatar, Mongolia.MethodsWe conducted an interrupted time-series analysis using data on patients agedResultsDuring the 10-year study period, there were 23 459 patients, of whom 18 433 (79%) were treated for scald injuries, including 6920 severe injuries. The monthly rate of overall scald injuries started to decrease after the first campaign, with a relative change of −32% at the end of the intervention. However, the rate started increasing before the initiation of the second campaign; this trend continued during and after the campaign. The rate of severe scald injuries did not show any significant changes throughout the study period. The results were consistent for both sexes.ConclusionsThe nationwide burn prevention campaign was effective in reducing non-severe burn injuries among young children. Since the campaign was primarily aimed at increasing public awareness of child burn injury risks, further interventions should be considered with passive measures to prevent severe burn injuries.

Background: To scale up the services for first-episode schizophrenia in Thailand, it is essential to understand to what extent health care-seeking is delayed, and how much the delay affects the treatment outcome. Objectives: To investigate the duration of untreated psychosis (DUP) and its impact on remission in first-episode schizophrenia across the country. Methods: 276 outpatients with a first-episode schizophrenia were followed for 6 months and assessed whether they fulfilled the criteria for remission at the follow-up. The proportion of those achieving remission was compared by the DUP. The impact of DUP on remission was estimated in multivariate analyses. Results: At the follow-up, 83% (71/86) of patients who had met the criteria for symptomatic remission at the baseline achieved enduring remission, whereas 63% (119/190) of patients who had not met the criteria for symptomatic remission at baseline met it at the follow-up. The shorter the DUP, the higher the proportion of those who achieved symptomatic or enduring remission at the follow-up. The impact of DUP on symptomatic remission appeared to be significant after controlling for other factors influencing remission. Conclusion: Since the DUP would influence remission of patients with schizophrenia, early detection and intervention services should be provided in Thailand.

Child burn injuries in Mongolia are often caused by electric cooking appliances used on the floor or low table in traditional tent-like dwellings (called a ger) which have no separate kitchen. To prevent these injuries, we developed a context-specific kitchen rack to make electric appliances inaccessible to children, and the rack was provided to 50 families with children aged 0-3 years living in gers for a pilot test. In the present study, we investigated their opinions about the rack after they used it for about 10 months through semi-structured interviews, their willingness-to-pay (WTP) for the rack using a contingent valuation method, and their preference for potential modifications of the rack using best-worst scaling. The estimated median WTP was about USD 40 (which was higher than USD 37 at the baseline when they started to use the rack). The highest priority of modifications of the rack was to enclose the lower section of the rack with doors (which was originally open without doors to reduce the production cost). A few families did not use the rack in winter because they used heating stoves instead of electric appliances for cooking, but we found a unanimous view that the rack reduces burn injuries to children, which may be reflected in their increased WTP for the rack. These findings would guide us to make our burn prevention efforts more relevant to real-life situations and socially acceptable in Mongolia.

An emergency care system is an important aspect for healthcare organisations in low- and middle-income countries (LMICs) with a growing burden from emergency disease conditions. Evaluations of emergency care systems in LMICs in broader contexts are lacking. Thus, this study aimed to develop a comprehensive emergency medical system model appropriate for resource-constrained settings, based on expert opinions.We used the Delphi method, in which questionnaire surveys were administered three times to an expert panel (both emergency medical care providers and healthcare service researchers), from which opinions on the model's components were compiled. The panel members were mostly from Asian countries. In the first round, the questionnaire drew a list of model components developed through a literature review; the panel members then proposed new components to create a more comprehensive list. In the second and third rounds, the panel members rated the listed components to achieve consensus, as well as to remove components with low ratings. Finally, we rearranged the list to improve its usability.In total, 32 experts from 12 countries participated. The final model totalled 177 components, categorised into 8 domains (leadership, community-based actions, emergency medical services, upward referral, definitive care, rehabilitation, downward referral, and evaluation and research). No components needed removal.We developed a comprehensive emergency care system model, which could provide a basis to evaluate emergency care systems in resource-constrained LMICs; however, field-testing and validation of this system model remain to be done.Un système de soins d'urgence est un aspect important pour les organisations de soins de santé dans les pays à revenu faible ou intermédiaire (PRFI), qui subissent une charge croissante d'affections de maladie d'urgence. Les évaluations des systèmes de soins d'urgence dans les PRFI dans des contextes plus larges font défaut. Cette étude visait donc à élaborer un modèle de système médical d'urgence complet, adapté aux contextes à ressources limitées, sur la base d'opinions d'experts. MÉTHODES: Nous avons utilisé la méthode Delphi, dans laquelle des enquêtes par questionnaire avaient été administrées à trois reprises à un groupe d'experts (prestataires de soins médicaux d'urgence et chercheurs en services de santé), à partir desquelles des avis sur les composants du modèle ont été compilés. Les membres du panel venaient principalement de pays asiatiques. Lors du premier tour, le questionnaire a dressé une liste des composants du modèle développés à travers une revue de la littérature; les membres du panel ont ensuite proposé de nouveaux composants pour créer une liste plus complète. Lors des deuxième et troisième tours, les membres du panel ont évalué les composants énumérés afin de parvenir à un consensus et d’éliminer les composants faiblement cotés. Enfin, nous avons réorganisé la liste pour en améliorer la convivialité. RÉSULTATS: Au total, 32 experts de 12 pays ont participé. Le modèle final comprenait 177 composants, classés en 8 domaines (leadership, actions communautaires, services médicaux d'urgence, référence ascendante, soins définitifs, suivi, référence postérieure, évaluation et recherche). Aucun composant ne nécessitait d’être exclus.Nous avons élaboré un modèle complet de système de soins d'urgence qui pourrait servir de base à l’évaluation des systèmes de soins d'urgence dans les PRFI aux ressources limitées. Cependant, les essais sur le terrain et la validation de ce modèle de système restent à faire.

Primary healthcare (PHC) principles provide a framework for strengthening the healthcare system to tackle increasing and diversifying health needs in low- and middle-income countries (LMICs). Currently, PHC systems in LMICs require expanded care capabilities in order to deal with noncommunicable diseases and injuries, including emergency conditions. In this article, we discuss the possibility of applying PHC principles to emergency care in LMICs and integrating emergency care into PHC; such principles include providing first points of contact with healthcare through nonprofessional providers close to communities in order to improve accessibility, providing high-quality (i.e., comprehensive, coordinated, and continuous) primary care, and addressing primary causes of ill-health through community empowerment. These principles are applicable to emergency care, which has the same attributes: it also requires increasing first points of contact through layperson first aid and the ambulance system, and it also provides comprehensive care for diverse diseases and injuries, with various facilities and personnel involved in its coordinated and continuous delivery; collective community actions also develop and strengthen the emergency care system, particularly through components outside the health sector (e.g., transport, communication, and mutual aid). Integrating emergency care into PHC could enhance the general health system and is more efficient than having separate systems.

ObjectiveTo evaluate the effect of adding a cognitive test to a license renewal procedure for drivers aged 75 years or older in reducing their motor vehicle collisions (MVCs). The test has been obligatory since June 2009.MethodsUsing monthly police-reported national data on MVCs from January 2005 through December 2016, we calculated the rates of MVCs per licensed driver-year by sex and age group (70–74, 75–79, 80–84 and 85 years or older) for each month together with the ratios of MVC rates of drivers in the three oldest age groups (which are subject to the test) to those of the 70–74 years group (not subject to the test) to control for extraneous factors affecting MVCs over the study period. Then, we conducted an interrupted time-series analysis by regressing the rate ratio stratified by sex and age group on the number of months from January 2005, June 2009 (when the cognitive test was introduced to a license renewal procedure) and June 2012 (when all drivers subject to the test have taken it at least once).ResultsThe rates showed a longitudinal decrease in male and female drivers over the study period without any apparent effects of the introduction of the cognitive test while no significant decrease was observed in the rate ratios after the introduction of the cognitive test.ConclusionsThere were no clear safety benefits of the cognitive test for drivers aged 75 years or older to reduce their MVCs.

Background Modal shifts in transport may reduce overall road injuries. Cyclist junior high school students are at a high risk of road injuries while commuting in Japan, and injuries among junior high school students could be reduced if the cyclists switch to other transport modes. Methods We estimated the change in the incidence of road deaths and serious injuries while commuting in months with heavy snowfall, when cyclists are likely to switch to other transport modes. Using police data on the monthly number of road injuries while commuting among junior high school students in Japan between 2004 and 2013 and corresponding population statistics and snowfall data, we calculated the monthly injury rate (number of deaths and serious injuries divided by population) at the prefecture level. We conducted Poisson regression analysis to estimate the change in the rate in months with a snowfall of ≥100 cm, compared to months without snowfall. Results A total of 3164 deaths and serious injuries occurred during 2004 to 2013. The injury rate among cyclists was almost zero in months with a snowfall of ≥100 cm. That among cyclists and pedestrians in these months was reduced by 68% (95% confidence interval, 43-82%). Conclusions In months with heavy snowfall, road injuries while commuting were reduced due to the near-elimination of cycling injuries among junior high school students in Japan. Switching from cycling to other transport modes would reduce overall road injuries among this population, and inducing modal shifts can be an important tool for road safety.

BackgroundIn 1948, Japan started a short-term publicity and enforcement campaign for traffic safety nationwide, and since 1952, the campaign has been conducted twice a year for 10 days. We aimed to quantify the short-term effect of the spring sessions of the campaign, which were conducted in different months in different years, on road fatalities in Japan using data from 1949 to 2019.MethodsWe obtained national police data on the monthly number of road deaths and conducted a time series regression analysis with three steps: smoothing the long-term patterns with the natural cubic spline function, calculating the ratio of the monthly number of deaths to the corresponding smoothed value, and regressing the ratio on the number of months from January 1949 and the binary variable for the conduct of spring sessions. We repeated the analysis for four subperiods (1949–1964, 1965–1989, 1990–2004 and 2005–2019).ResultsDuring the study period, there were 632577 road deaths. Our analysis revealed that the spring sessions changed the number of deaths per day by −2.5% (95% CI −4.1% to −0.9%) in the months when they were conducted. In the four subperiods, the estimated changes were −4.5% (95% CI −8.9% to −0.1%), −2.6% (95% CI −5.0% to −0.1%), −0.1% (95% CI −2.9 to 2.7) and −3.5% (95% CI −7.9 to 0.9).ConclusionsRoad fatalities were reduced in the months when the spring sessions of the campaign were conducted, but the reduction was modest. The effect might have been somewhat larger until 1964, when Japan was a middle-income country.

To reduce delays in accessing services and providing early treatment for patients with first-episode psychosis requires an understanding of the causes of treatment delay. We investigated it among patients with the first-episode schizophrenia (FES) across the country. 302 outpatients with a FES were recruited in one psychiatric hospital, six general hospitals, one community hospital, and one university hospital from June 2017 to August 2018. Those who have the duration of untreated psychosis (DUP) 3 months or longer were considered as delayed treatment seekers. The relative influences of patients’ characteristics on the delay in treatment-seeking were estimated on logistic regression analyses. The mean and median DUP was 9 weeks (standard deviation: 12) and 4 weeks (interquartile range: 2–9), respectively. 24% of the enrolled patients were delayed treatment seekers. Those living 6–10 km away and those living more than 20 km away from the hospital tended to be delayed treatment seekers, while those who had a family history of mental disorders tended to have sought treatment timely. Since the distance to the hospitals was a potential barrier to seeking health care among patients with FES, providing outreach mental health services and transportation support may be considered to shorten treatment delay in Thailand.