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The aim of this prospective study was to clarify the associations of psychological status in the early postpartum period with resumption of menstruation and degree of menstruation-related symptoms. This study was conducted from February in 2017 to July in 2018 in Japan. We conducted self-administered questionnaire surveys for 229 postpartum women at 3 days postpartum, 2 weeks postpartum, one month postpartum, 3 months postpartum and 6 months postpartum. The proportion of women who resumed menstruation in the period up to 6 months postpartum was 38.8%. The Edinburgh Postnatal Depression Scale (EPDS) score at 6 months postpartum in women who resumed menstruation in the period up to 6 months postpartum was significantly higher than that in women who did not resume menstruation. EPDS scores during the postpartum period in women in whom menstruation-related symptoms became worse than those before pregnancy were significantly higher than those in women in whom menstruation-related symptoms did not change compared to those before pregnancy. In multiple regression analysis, there was no significant difference between EPDS score at 6 months postpartum and degree of menstruation-related symptoms. Additional research is needed to clarify the association of psychological condition during the postpartum period with resumption of menstruation. Impact Statement

Advanced midwives are expected to be candidates for middle managers in the next generation. Higher levels of management skills than the current levels may be required for middle managers in the future due to the progress of perinatal medicine. The aim of this study was to compare levels of management skills that are currently required for middle managers and levels of management skills that will be important in the next 10-20 years in advanced midwives. A self-administered questionnaire survey was conducted for 1652 advanced midwives in hospitals that have more than 300 beds in Japan. The scores for all management skills that will be required in the next generation were significantly higher than those for currently required management skills. Currently required management skills that were given high scores, including communication ability, ability to perform safety management and problem-solving ability, were also given high scores for middle managers in the next generation. Advanced midwives believed that management skills including the ability to participate in social activity, ability to use information and communication technology, and ability to participate in management in which these scores are low at present are needed for middle managers in the next generation. Advanced midwives consider that management skills for middle managers will change in the future. By acquisition of high levels of management skills, middle managers will be able to perform management of perinatal medicine and nursing. Key words: Advanced midwives, nursing middle managers, next generation, management skills.

Introduction Associations of luteinizing hormone (LH) with androgens during the menopausal transition and associations between follicle-stimulating hormone (FSH) levels and various diseases related to reproductive hormones in postmenopause have received much attention. LH and FSH are also known to be associated with activities of enzymes related to reproductive hormones. We examined the associations of LH and FSH with androgens and estrogens in each stage of the menopausal transition according to a classification from menopausal transition to postmenopause. Methods This study was a cross-sectional design. We basically used the Stage of Reproductive Aging Workshop (STRAW) + 10. We divided the 173 subjects into 6 groups according to menstrual regularity and follicle-stimulating hormone level: mid reproductive stage (Group A), late reproductive stage (Group B), early menopausal transition (Group C), late menopausal transition (Group D), very early postmenopause (Group E) and early postmenopause (Group F). Levels of LH, FSH, dehydroepiandrosterone sulfate (DHEAS), estradiol, estrone, testosterone (T), free T, androstenedione and androstenediol were measured. Results In Group A, LH showed significant positive correlations with androstenedione and estrone. In Group D, LH was positively associated with T and free T and was negatively associated with estradiol. In Groups B, C, D and F, LH showed significant positive correlations with FSH, and there was a tendency for an association between LH and FSH in Group E. FSH was associated with estradiol but not with estrone in Groups C and D. Conclusion The associations of LH and FSH with reproductive hormones are different depending on the stage of the menopausal transition. Trial registration Trial registration number 2356-1; Date of registration: 18/02/2018, retrospectively registered.

Takumi Kurabayashi,1 Yuki Ideno,2 Kazue Nagai,3 Naho Maruoka,3 Kiyoshi Takamatsu,4 Toshiyuki Yasui,5 Kunihiko Hayashi3 1Department of Obstetrics and Gynecology, Niigata City General Hospital, Niigata, Japan; 2Gunma University Center for Mathematics and Data Science, Maebashi, Gunma, Japan; 3Department of International/Community Health Laboratory Sciences, Graduate School of Health Sciences, Gunma University, Maebashi, Gunma, Japan; 4Department of Obstetrics and Gynecology, Tokyo Dental College Ichikawa General Hospital, Chiba, Japan; 5Department of Reproductive and Menopausal Medicine, Institute of Biomedical Science, Tokushima University Graduate School, Tokushima, JapanCorrespondence: Takumi KurabayashiDepartment of Obstetrics & Gynecology, Niigata City General Hospital, 463-7, Shumoku, Chuo-ku, Niigata City, Niigata Prefecture, 950-1197, JapanTel +81-25-281-5151Fax +81-25-281-5169Email takumi@hosp.niigata.niigata.jpPurpose: Although the validity of self-reported osteoporosis is often questioned, validation studies are lacking. This study was performed to investigate how well self-reported diagnoses of osteoporosis agreed with validated clinical information in young and middle-aged women in the Japan Nurses’ Health Study (JNHS), a nationwide prospective cohort study of nursing professionals.Patients and Methods: Data were reviewed for 15,717 subjects from the combined cohorts of the JNHS and a preceding pilot study (Gunma Nurses’ Health Study). The subjects’ mean age at the baseline (BL) survey was 41.6 ± 8.3 years, and the mean follow-up period was 11.5 ± 4.4 years. Participating nurses were mailed a follow-up questionnaire every 2 years. Respondents who self-reported a positive osteoporosis diagnosis during the study period were sent an additional confirmation questionnaire to corroborate the details.Results: The number (proportion) of women with osteoporosis was 884 (5.6%) [primary osteoporosis, 812 (5.2%); secondary osteoporosis, 72 (0.5%)]. The cumulative incidence of osteoporosis at the age of 40, 50, 60, 70, and 80 years was estimated to be 0.1% (95% confidence interval, 0.1– 0.2), 1.1% (0.9– 1.3), 7.7% (7.0– 8.4), 23.6% (21.6– 25.7), and 54.2% (40.2– 68.1), respectively. For BL and regular follow-up + expert review versus BL and regular follow-up + confirmation questionnaire + expert review, the positive predictive value (PPV) was 61.3% versus 85.6% and the negative predictive value (NPV) was 98.9% versus 98.2%, respectively.Conclusion: Self-reporting was associated with a high NPV for the incidence of osteoporosis. Although the PPV was slightly lower, additional corroborations by confirmation questionnaire might improve the PPV.Keywords: validation, self-reported diagnosis, osteoporosis, prospective cohort study, Japan Nurses’ Health Study

Sensitivity to cold, which is a popular symptom in Japanese women, is associated with various symptoms such as shoulder stiffness and general fatigue. However, an association of sensitivity to cold with muscle strength has not been reported. The aim of the study was to clarify the associations of sensitivity to cold with handgrip strength and with menstruation-related symptoms in female university students in Japan. We recruited 278 female university students in Japan. Sensitivity to cold and menstruation-related symptoms including physical and psychological symptoms were assessed by using a self-administered questionnaire that we designed. Handgrip strength was measured by using a handgrip strength dynamometer. We received responses from 269 students. The prevalence rate of sensitivity to cold in the subjects was 54.3%. The students who had sensitivity to cold had a lower handgrip strength level (25.5 ± 3.8 kg) than did the students who did not have sensitivity to cold (26.7 ± 3.9 kg) (p = 0.017). Sensitivity to cold was associated with low body mass index. In addition, the students who had sensitivity to cold tended to have low back pain and constipation during menstruation. In conclusion, sensitivity to cold is an important symptom associated with muscle strength as well as menstruation-related symptoms for young women.

The aim of this study was to clarify the relationship between maternal mental status and social supports during pregnancy and until one month after childbirth in order to evaluate the actual situation in a local city. A survey was conducted on 78 pregnant women who completed the CES-D (depression score), STAI (anxiety score) and Social Support Scale. Data were collected four times : during the second trimester, the third trimester, postpartum hospitalization, and 1 month after childbirth. The CES-D and STAI scores were initially high during pregnancy and decreased during the postpartum period. The Social Support Scale score, however, was initially low during pregnancy and increased during the postpartum period. The CES-D and STAI scores was significantly and negatively correlated with The Social Support Scale score during all four time periods. Participants ≧ 35 years of age scored lower on The Social Support Scale than did participants < 35 years of age in the second trimester, third trimester, and 1 month after childbirth. These findings should assist with the implementation of a comprehensive support center and may be useful for a local city in Japan. J. Med. Invest. 68 : 265-270, August, 2021.

The change in appetite and food cravings before, during and after menstruation and the relationships between each premenstrual symptom and change in appetite and type of food with increased intake were investigated. This study was conducted by a self-administered questionnaire in 311 female students of health sciences. It was found that the proportion of students who increased the appetite was 70.4% during the menstruation cycle, and the highest period was before menstruation (85.8%). Sweets had the highest intake in all menstrual phases followed by junk food. It was found that increased appetite was significantly associated with depression and sleepiness. Moreover, increased intake of sweets was associated with depression, anger and sleepiness, while intake of junk food was associated with irritability and depression. In conclusion, the relationships between increased appetite for sweets and junk food and premenstrual symptoms indicate the need for promoting proper menstruation-related eating habits. Key words: Premenstrual symptoms, change in appetite, food craving, sweets, junk food.

Hot flashes and night sweats commonly occur during menopausal transition period due to estrogen deficiency, but these conditions can also occur during postpartum period in which there are marked hormonal fluctuations. This study determined the prevalence and examined factors related to hot flashes and night sweats among the Japanese women in the postpartum period. The design of this study was a longitudinal investigation and the population of the postpartum women recruited was 229. A self-administered questionnaire that adapted Edinburgh Postnatal Depression Scale (EPDS) of measurement was used to collect data at 3 days postpartum, 2 weeks postpartum and one month postpartum. There was a significant association between transient night sweats and anxiety regarding family finances. Women who complained of hot flashes was 22.8% at 3 days postpartum and it decreased thereafter, while women who complained of night sweats were 58.6% at 3 days postpartum, 33.1% at 2 weeks postpartum and 15.2% at one month postpartum. In conclusion, hot flashes and night sweats among Japanese women in the postpartum period was associated with psychological and social factors. Key words: Hot flashes, night sweats, postpartum women.

Introduction: Some somatic and psychological disorders have been associated with handgrip strength, which is an easy, inexpensive and noninvasive method for assessment of muscle strength. We conducted a cross-sectional study to clarify the relationship of handgrip strength and menstruation-related symptoms. Material and Methods: Handgrip strength was measured and a self-administered questionnaire was performed in female university students in Japan. Results: Handgrip strength did not significantly differ among the menstrual phases. The mean handgrip strength level (n = 260) was 26.0 ± 3.9 kg. We divided the subjects into three groups according to the handgrip strength level. Handgrip strength was associated with degrees of depression and anxiety during menstruation. Conclusion: This can be used as fundamental data in further clarifying the relationship between muscle strength and menstruation-related symptoms.

Background: Depressive symptoms and anxiety symptoms during the postpartum period affect physical health and child rearing and that these effects are important social issues. Objective: The aims of this study were to clarify the differences in the transition of depressive symptoms and anxiety symptoms according to parity during a 6-month postpartum period and to clarify the differences in associations of depressive symptoms and anxiety symptoms with feelings for involvement with newborn infants in primiparous and multiparous postpartum women. Methods: The design of this study was a longitudinal investigation. This study was conducted from February 2017 to July 2018 in Japan. By using self-administered questionnaires that included questions on psychological symptoms in a standard climacteric scale and questions on feelings for involvement with newborn infants, we collected data at 3 days postpartum, 2 weeks postpartum, one month postpartum, 3 months postpartum and 6 months postpartum. Results: Responses to all of the questionnaires were obtained from 121 (52.8%) of 229 women. The score for depressive symptoms in primiparous women was significantly higher than that in multiparous women at 3 days postpartum. Depressive symptoms and anxiety symptoms showed peaks at 2 weeks postpartum in both primiparous women and multiparous women, but depressive symptoms reoccurred from 3 months postpartum to 6 months postpartum in primiparous women and anxiety symptoms reoccurred from one month to 3 months postpartum in multiparous women. Depressive symptoms and anxiety symptoms were associated with negative feelings for involvement with newborn infants and with mother’s sleeping time. Conclusion: Changes in depressive symptoms and anxiety symptoms were different in primiparous women and multiparous women during a 6-month postpartum period. In addition, depressive symptoms and anxiety symptoms were associated with negative feelings for involvement with newborn infants and with sleeping time in postpartum women.

Background: There are various health problems in rotating shift workers. There have been few studies on the associations of male climacteric symptoms with duration of working and lifestyle. Objective: The aim of this study was to determine the differences in male climacteric symptoms depending on the number of working years and to determine whether lifestyle habits differ depending on the number of working years in rotating shift workers. Methods: We collected participant’s data from the manufacturing companies in Japan during the period from March to May in 2017. We conducted a self-administered questionnaire survey in 1561 male rotating night shift workers. Male climacteric symptoms were evaluated by using the Aging Males’ Symptoms (AMS) rating scale. We analyzed 636 rotating shift workers aged over 40 years old whose all AMS data was collected. Results: A significant difference in psychological AMS score was found between men who had worked for 10 - 19 years (9.4 ± 3.9) and men who had worked for more than 40 years (7.6 ± 3.0) (p = 0.011). Sexual functional AMS score significantly differed depending on the number of working years (less than 10 years: 8.1 ± 3.9, 10 - 19 years: 9.8 ± 4.1, 20 - 29 years: 7.9 ± 3.3, 30 - 39 years: 9.3 ± 3.5, more than 40 years: 9.3 ± 3.5) (p < 0.001). The proportion of workers with a balanced meal intake was significantly lower in men who had worked for less than 10 years and the proportions of such workers were significantly higher in men who had worked for 10 - 19 years and for more than 40 years. The proportions of men who did not drink alcohol were high in men who had worked for less than 10 years and 20 - 29 years and low in men who had worked more than 30 years. Conclusion: Psychological AMS score and sexual functional AMS score are significantly different among the 5 groups according to the number of working years on rotating shift. In addition, well-balanced diet on day shift and reduction of alcohol drinking is a related-factor for long-term rotating night shift workers.

Smartphones use for a long period of time can cause health problems including physical condition, psychological condition and sleeping status. In addition, smartphones use may affect menstruation related symptoms. This study was conducted using a self-administered questionnaire between June and November in 2016 to clarify the differences in physical and psychological condition, sleeping status and menstruation-related symptoms before and after starting to use smartphones in female university students in Japan. We recruited 273 female nursing students and the response rate was 95.2%. We found significant changes after starting to use smartphones regarding eyestrain (p < 0.001), posture (p = 0.002), stiffness of neck, back and shoulders (p < 0.001), level of outdoor activity (p < 0.001), difficulty concentrating (p < 0.001), lack of motivation (p < 0.001), and sensitivity to stress (p = 0.005). Moreover, we also found that fatigue before menstruation and headache/low back pain during menstruation were higher after starting to use smartphones. The proportions of students with irritability and depressive feeling as emotional premenstrual symptoms appeared higher after starting to use smartphones. These results imply that young women should refrain from using smartphones if they have visual display terminal-related symptoms, disturbance of sleep pattern and menstruation-related symptoms before and during menstruation.

This study was conducted using a self-administered questionnaire to clarify the differences in menopausal symptoms between smokers and non-smokers in Japanese nurses and the relationship between job-related stress and smoking. The proportion of smokers was 10.3%. Smokers are more likely than non-smokers to have menopausal symptoms such as heart beating quickly or strongly, difficulty in sleeping, loss of interested in most things and night sweat. The scores for anxiety and vasomotor factors in smokers were significantly higher than non-smokers in the postmenopausal stage. Support to stop smoking should be provided before menopausal transition.

Mothers and family members of young female students play important roles for guiding their self-care strategies for menstruation-related symptoms; which often affect their daily life and academic life. The aim of this study is to clarify the differences in menstruation-related symptoms before and during menstruation in university students living alone and university students living with their family in Japan. We conducted a cross-sectional online survey to assess menstruation-related symptoms before and during menstruation using the menstrual distress questionnaire (MDQ). Among 135 students; the proportion of students living alone was 60.7% and the proportion of students living with their family was 39.3%. Before menstruation; the MDQ total score and the scores for negative affect and behavior change were significantly higher in students living alone than in students living with their family. During menstruation; scores for negative affect and impaired concentration were also significantly higher in students living alone. In addition; before menstruation; scores for an increase in appetite and craving for sweets were significantly higher in students living alone. Thus; living alone affected the psychological aspects of menstruation-related symptoms in young women. The results suggest that university students who live alone should be aware of the importance of talking about their menstruation problems with family members and seeking their advice

The metabolic effects of androgens and their underlying mechanisms in females have been revealed by recent studies. An excess of androgens can have adverse effects on feeding behavior and metabolic functions and induce metabolic disorders / diseases, such as obesity, insulin resistance, and diabetes, in women and experimental animals of reproductive age. Interestingly, these effects of androgens are not observed in ovariectomized animals, indicating that their effects might be dependent on the estrogen milieu. Central and peripheral mechanisms, such as alterations in the activity of hypothalamic factors, reductions in energy expenditure, skeletal muscle insulin resistance, and β-cell dysfunction, might be related to these androgens' effects. J. Med. Invest. 68 : 228-231, August, 2021.

The mental health of fathers influences the development of children and the functioning of families significantly. However, there is no useful scale for the mental health screening of childrearing fathers. This study developed a Mental Health Scale for Childrearing Fathers (MSCF) and determined its reliability and validity. Childrearing fathers are working fathers who co-parent with their spouses. This survey was conducted in two stages: a pilot study and a main survey. Data were obtained from 98 fathers raising preschoolers in the pilot study and 306 fathers in the main survey. The collected data were used to confirm the construct validity, criterion-related validity, convergent validity, and internal consistency reliability. The final MSCF consisted of 25 items comprising four factors: peaceful familial connection, healthy mind and body, satisfying paternal alliances, and leading a meaningful life as a parent. The internal consistency reliability estimated using Cronbach’s alpha coefficient for the total scale was 0.918. The validity of the MSCF was logically secured using a confirmatory factor analysis. The MSCF can be an effective tool for mental health screening among fathers in relation to the burden of childrearing during regular infant health checks.

Objective We aimed to investigate whether hypertensive disorders of pregnancy are associated with problematic hot flashes in Japanese women. Methods In this study, we included participants in the Japan Nurses' Health Study who were women aged 41 to 55 years at baseline, parous, and complete a 4-year follow-up questionnaire. The main outcome was self-reported problematic hot flashes. At the 4-year follow-up survey, we investigated hot flashes using the Climacteric Symptom Checklist for Japanese Women, which was developed by a subcommittee of the Japan Society of Obstetrics and Gynecology. Results At the baseline survey, of the 4,627 women included in the analysis, 610 (13.2%) reported a history of hypertensive disorders of pregnancy. At the 4-year follow-up survey, 394 women (8.5%) reported problematic hot flashes, 529 (11.4%) were diagnosed with premenopausal hypertension, and 2,389 (51.5%) were postmenopausal. Multivariable logistic regression analysis revealed a multivariable-adjusted odds ratio (95% confidence interval) of problematic hot flashes for women with a history of hypertensive disorders of pregnancy of 1.42 (1.04-1.94), compared with women without this history. Among women without premenopausal hypertension, the odds ratio increased to 1.55 (1.10-2.19) among women with hypertensive disorders of pregnancy as compared with those without these disorders. Conclusions In this prospective study, we found that women with a history of hypertensive disorders of pregnancy have a significantly increased risk of problematic hot flashes, compared with their counterparts without a history of hypertensive disorders of pregnancy.

Background Many women experience various symptoms during the period of menopausal transition, including complaints of reduced cognitive functioning. However, these complaints are not necessarily recognized as core menopausal symptoms. In this study, we sought to characterize subjective complaints of reduced cognitive functioning by analyzing cross-sectional data from the Japan Nurses’ Health Study (JNHS). Methods The JNHS 4-year follow-up questionnaire containing a 21-item climacteric symptom checklist, which included a question about “poor memory or forgetfulness”, was mailed between 2005 and 2011 to all JNHS participants, regardless of their age at the time of the survey. We estimated the prevalence of slight and severe complaints in 5-year age-groups. We used principal component analysis to explore the underlying factors among the 21 symptoms during the menopausal transition period in women aged 45–54 years at the time of the survey. We also examined risk factors for complaints using multivariable modified Poisson regression analysis. Results In total, 12,507 women responded to the 4-year survey. The mean age at the time of the 4-year survey was 46.5 years (range 27–82). “Poor memory or forgetfulness” showed a peak prevalence of 81.7% (severe 27.9%; slight 53.8%) at 50–54 years, and gradually decreased after 55 years. Principal component analysis indicated that “poor memory or forgetfulness” belonged to somatic symptoms and was close to psychological symptoms in women aged 45–54 years. In women aged 45–54 years, the complaint was also significantly associated with hot flashes and sweats. Multivariable modified Poisson regression analysis showed that menopausal status (uncertain and postmenopausal), less sleep (sleep of Conclusions We found that prevalence of “poor memory or forgetfulness” was highest during the menopausal transition period and among perimenopausal women. This subjective complaint was associated with somatic, psychological complaints and VMS. It may be useful for women with cognitive problems in the transition period to consider management of comorbid menopausal symptoms.

PURPOSE: The study aimed to determine the differences between stress levels in day shift workers and night shift workers by measurements of hair cortisol concentration (HCC) and by using self-administered questionnaires. METHODS: HCC was measured by using liquid chromatography-mass spectrometry. The subjective stress level was evaluated by a brief job stress questionnaire, stress response scale-18 (SRS-18), and visual analog scale (VAS). RESULTS: Mean (± standard deviation: SD) HCC in the 16 subjects was 17.28 ± 7.39 pg/mg. There was no significant difference between HCCs in day shift workers (17.98 ± 3.03 pg/mg) and rotating night shift workers (16.37 ± 1.86 pg/mg). There were also no significant differences in SRS-18 scores, job-related stress scale scores, and VAS scores between day shift workers and rotating night shift workers. There was a significant difference in HCC between the group in which the stress condition was weak or normal and the group in which the stress condition was slightly strong or definitely strong according to the SRS-18 level (p = 0.030). CONCLUSIONS: Day shift workers and rotating night shift workers have similar HCCs and similar degrees of job-related stress. In rotating shift workers who feel strong stress, acquirement of resilience due to stress coping for medium- to long-term stress may be involved in low HCC.

Objective We aimed to establish correlations for the levels of follicle-stimulating hormone (FSH), estrone (E1) and estradiol (E2) between urine and serum in premenopausal and postmenopausal women using immunoassays. Methods In this study of 92 women (61 postmenopausal, 31 premenopausal), both urine and blood specimens were collected on the same day and stored at 4 °C for analysis by chemiluminescent immunoassay, radioimmunoassay and/or electrochemiluminescent immunoassay. Results There were correlations in the levels of FSH, E1 and E2 between urine and serum in both postmenopausal (r = 0.96 for FSH, r = 0.91 for E1, r = 0.80 for E2) and premenopausal (r = 0.98 for FSH, r = 0.92 for E1, r = 0.90 for E2) women. It is indicated that the correlations were stronger in the premenopausal group compared with the postmenopausal group, especially for FSH. Conclusion The levels of FSH, E1 and E2 in urine correlated with those in the serum in premenopausal and postmenopausal women. Urine samples could be used instead of serum samples to measure hormone levels, which would reduce the difficulty of conducting large survey studies.

The aim of this study was to clarify the actual status of male climacteric symptoms in rotating night shift workers and how to cope with the symptoms.We planned a self-administered questionnaire survey in male rotating night shift workers. Male climacteric symptoms were evaluated by using the Aging Males' Symptoms (AMS) scale.Of 1891 questionnaires that were sent, 1561 were collected. There were significant differences in total AMS scores among the age groups. In all age groups, there were high proportions of men with increased need for sleep and often feeling tired (64.9%) and decrease in muscular strength (60.7%). There were significant differences in AMS scores for somatic symptoms between men in their 20 s and those in their 40 s or 50 s and between men in their 30 s and those in their 50 s and in AMS scores for sexual symptoms between men in their 20 s and those in their 30 s, 40 s, 50 s or 60 s, between men in their 30 s and those in their 40 s, 50 s or 60 s and between men in their 40 s and those in their 50 s or 60 s.Significant age-dependent differences are found in somatic symptoms and sexual symptoms in rotating night shift workers.

The change in follicle-stimulating hormone (FSH) during the menopausal transition and associations of FSH with various diseases have been assessed by using blood samples. We examined cross-sectionally the variation of FSH levels, associations of estrone and estradiol with FSH, and associations of BMI with these hormones by using urinary samples from peri- and postmenopausal women in Japan. Of 4472 participants in the Urinary Isoflavone Concentration Survey of the Japan Nurses' Health Study, we analyzed urinary levels of estrone, estradiol and FSH in 547 women aged from 45 to 54 years. Urinary FSH levels varied widely in postmenopausal women and the pattern of change in urinary FSH levels seems to be similar to that in blood FSH levels in previous studies. There were no significant differences in age, body mass index (BMI), estradiol, estrone and estradiol/estrone ratio among three groups according to the tertile of FSH. In postmenopausal women, there were significant associations of BMI with levels of estrone and estradiol, but there was no significant association of BMI with FSH. Studies using urinary samples will allow us to establish a study project as a large-scale population-based study to determine associations between FSH and various diseases after menopause. J. Med. Invest. 66 : 297-302, August, 2019.

The purpose of this study was to compare digit lengths and proximal phalanx lengths in newborn infants by using ultrasonography (USG) and to examine sex differences between the ratio of the second digit (2D) and fourth digit (4D) of digit length and that of proximal phalanx length and the associations of digit length and proximal phalanx length with birth weight and birth height. Sixty newborn infants (28 males and 32 females) were recruited. Digit lengths were measured by using a transparent ruler and proximal phalanx lengths were measured by using USG. There were significant correlations between digit length and proximal phalanx length in the left and right hands. There was no significant correlation between 2D:4D ratios of digit lengths and 2D:4D ratios of proximal phalanx lengths measured by using USG. In males, birth height was significantly associated with right fourth proximal phalanx length and with left second and fourth proximal phalanx lengths. Birth weight was significantly associated with proximal phalanx length in males. Proximal phalanx length measured by using USG was significantly associated with digit length in newborn infants. Hormonal exposure before birth may be involved in the associations of proximal phalanx length with birth weight and height in males.Impact statement

This chapter analyses knowledge creation in Sumida Ward’s industrial cluster in Tokyo and shows the possibility of creating design-driven innovation and new industries. It uses and expands the design-driven innovation theory applied to cases of horizontal and co-creative network of SMEs. Malmberg and Maskell (1999) argue that spatial clusters are important for knowledge creation, in addition to the importance of knowledge creation in forming innovation. Sumida Ward was selected in this research because the concentration of SMEs in industrial clusters is the highest in Japan and the spatial clusters are remarkable. As a survey method, it uses text mining from the interview survey in the small and medium-sized manufacturing industry of Sumida Ward, Tokyo. The results show that development through dialogue between various stakeholders provides an opportunity to give products new “meanings†and create new industries.

The coronavirus disease 2019 (COVID-19) pandemic affected the daily lifestyle of people, including many aspects affecting young women. Subsequent to the COVID-19 pandemic stress and anxiety have been reported related to menstrual disorders (Takmaz, Gundogmus, Okten, & Gunduz, 2021). The purpose of this study was to investigate the intensity and to compare menstruation-related symptoms before and during menstruation among university students in Japan. We conducted an online cross-sectional study from May to July 2021 using a menstrual distress questionnaire (MDQ) to assess symptoms experienced before and during menstruation. Our results showed that of 141 students, five students (3.5%) did not report any symptoms before menstruation and one student (0.7%) had no symptoms during menstruation. We found that the most frequently experienced symptoms before menstruation were skin blemishes or disorder, mood swings, irritability, swelling, cramps, fatigue, take naps, stay in bed, feeling sad or blue, weight gain and difficulty concentrating. The most frequently experienced symptoms during menstruation were cramps, fatigue, irritability, mood swings, take naps, stay in bed, feeling sad or blue, backache, swelling, skin blemish or disorder, and poor school/work performance. The total MDQ score was significantly higher during menstruation than before menstruation. Among the MDQ eight scales, the scores of five scales including pain, autonomic reaction, impaired concentration, behavior change, and control were significantly higher during menstruation than before menstruation. The prevalence of increased appetite and craving for sweets were higher than MDQ symptoms before menstruation. The prolonged exposure to pandemic may have more effect on psychological symptoms than on physical symptoms.