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Semi-volatile organic compounds (SVOCs), such as phthalates and organophosphate flame retardants (OPFRs), are used in plastic products and electrical and electronic applications as plasticisers or flame retardants. There has been a growing concern that exposure to SVOCs can have an adverse impact on human health. Several large-scale epidemiological studies employ the sampling of house dust using household vacuum cleaners as the standard method. However, in this method, house dust samples might be contaminated by flame retardants and plasticisers because of the presence of these chemicals in the plastic materials of cleaners. Therefore, this study aimed to develop a low-cost, easy-to-distribute sampling method to collect house dust using a mop and analyse OPFRs, phthalate esters, and alternative plasticisers in house dust. Our findings show that the proposed mop sampling method can be easily distributable and lower contamination from a sampling tool. Moreover, the proposed house dust sampling method is extremely useful for a large-scale survey such as a cohort study.

Objective:Excessive salt intake raises blood pressure and increases the risk of non-communicable diseases (NCD), such as CVD, chronic kidney disease and stomach cancer. Reducing the Na content of food is an important public health measure to control the NCD. This study quantifies the amount of salt reduced by using umami substances, i.e. glutamate, inosinate and guanylate, for adults in the USA.Design:The secondary data analysis was performed using data of the US nationally representative cross-sectional dietary survey, the National Health and Nutrition Examination Survey (NHANES) 2017–2018. Per capita daily salt intake corresponding to the NHANES food groups was calculated in the four hypothetical scenarios of 0 %, 30 %, 60 % and 90 % market share of low-Na foods in the country. The salt reduction rates by using umami substances were estimated based on the previous study results.Setting:The USAParticipants:4139 individuals aged 20 years and older in the USAResults:Replacing salt with umami substances could help the US adults reduce salt intake by 7·31–13·53 % (7·50–13·61 % for women and 7·18–13·53 % for men), which is equivalent to 0·61–1·13 g/d (0·54–0·98 g/d for women and 0·69–1·30 g/d for men) without compromising the taste. Approximately, 21·21–26·04 % of the US adults could keep their salt intake below 5 g/d, the WHO’s recommendation in the scenario where there is no low-Na product on the market.Conclusions:This study provides essential information that the use of umami substances as a substitute for salt may help reduce the US adults’ salt intake.

In the COVID-19 era, movement restrictions are crucial to slow virus transmission and have been implemented in most parts of the world, including Japan. To find new insights on human mobility and movement restrictions encouraged (but not forced) by the emergency declaration in Japan, we analyzed mobility data at 35 major stations and downtown areas in Japan—each defined as an area overlaid by several 125-meter grids—from September 1, 2019 to March 19, 2021. Data on the total number of unique individuals per hour passing through each area were obtained from Yahoo Japan Corporation (i.e., more than 13,500 data points for each area). We examined the temporal trend in the ratio of the rolling seven-day daily average of the total population to a baseline on January 16, 2020, by ten-year age groups in five time frames. We demonstrated that the degree and trend of mobility decline after the declaration of a state of emergency varies across age groups and even at the subregional level. We demonstrated that monitoring dynamic geographic and temporal mobility information stratified by detailed population characteristics can help guide not only exit strategies from an ongoing emergency declaration, but also initial response strategies before the next possible resurgence. Combining such detailed data with data on vaccination coverage and COVID-19 incidence (including the status of the health care delivery system) can help governments and local authorities develop community-specific mobility restriction policies. This could include strengthening incentives to stay home and raising awareness of cognitive errors that weaken people's resolve to refrain from nonessential movement. Supplementary Information The online version contains supplementary material available at 10.1007/s11524-021-00566-7.

Vaccine hesitancy is a global public health threat. We present unique data that characterises those who experienced reversals of COVID-19 vaccination hesitancy in Japan.We administered a questionnaire on vaccination intention among 30053 Japanese adults aged 20 years or older before the COVID-19 vaccination was available to the general population (first survey) and conducted a follow-up survey on vaccination status one year later in February 2022 (second survey). Those who responded in the first survey that they did not intend to be vaccinated or were unsure and then responded in the second survey that they were vaccinated or intend to be vaccinated were asked about the reasons for their change of heart. Based on previous literature and expert opinion, 31 reasons for changing vaccination intention were compiled and respondents were asked to choose which among them applied to themselves, with multiple responses possible. Based on the results of those responses, each individual was then clustered using the Uniform Manifold Approximation and Projection (UMAP) dimensionality reduction technique and Ordering Points To Identify the Clustering Structure (OPTICS) algorithm. We then identified unique characteristics among each of the sub-populations (clusters).In the second survey we received 19195 responses (response rate 63.9%), of which 8077 responded 'no' or 'not sure' in the first survey regarding their intention to be vaccinated. Of these, 5861 responded having received or intending to receive the vaccine (72.6%). We detected six and five sub-populations (clusters) among the 'no' group and 'not sure' group, respectively. The clusters were characterized by perceived benefits of vaccination, including the COVID-19 vaccine, awareness of the COVID-19 vaccination status of those close to them, recognition of the social significance of COVID-19 vaccination for the spread of infection, and dispelled concerns about short-term adverse reactions and the safety of the COVID-19 vaccine. Work and personal relationship reasons were also found to be a unique overarching reason for vaccination changes of heart only among those who did not intend to vaccinate.Those who changed their intention to accept COVID-19 vaccination as well as their unique characteristics as detailed in this study will be important entry points when discussing how to promote vaccination to those who are hesitant to vaccinate in the future.The present work was supported in part by a grant from the Kanagawa Prefectural Government of Japan and by AIST government subsidies.

The COVID-19 pandemic has disrupted health care access around the world, both for inpatients and outpatients. We applied a quasi-Poisson regression to national, monthly data on the number of outpatients, number of inpatients, length of average hospital stay, and the number of new hospitalizations from March 2015 to October 2021 to assess how these outcomes changed between June 2020 to October 2021. The number of outpatient visits were lower-than-predicted during the early phases of the pandemic but normalized by the fall of 2021. The number of inpatients and new hospitalizations were lower-than-predicted throughout the pandemic, and deficits in reporting continued to be observed in late 2021. The length of hospital stays was within the predicted range for all beds, but when stratified by bed type, was higher than predicted for psychiatric beds, lower-than-predicted for tuberculosis beds, and showed variable changes in long-term care insurance beds. Health care access in Japan was impacted by the COVID-19 pandemic.

Objectives The Japanese prime minister declared a state of emergency on April 7 2020 to combat the outbreak of coronavirus disease 2019 (COVID-19). This declaration was unique in the sense that it was essentially driven by the voluntary restraint of the residents. We examined the change of the infection route by investigating contact experiences with COVID-19–positive cases. Study design This study is a population-level questionnaire-based study using a social networking service (SNS). Methods To assess the impact of the declaration, this study used population-level questionnaire data collected from an SNS with 121,375 respondents (between March 27 and May 5) to assess the change in transmission routes over the study period, which was measured by investigating the association between COVID-19–related symptoms and (self-reported) contact with COVID-19–infected individuals. Results The results of this study show that the declaration prevented infections in the workplace, but increased domestic infections as people stayed at home. However, after April 24, workplace infections started to increase again, driven by the increase in community-acquired infections. Conclusions While careful interpretation is necessary because our data are self-reported from voluntary SNS users, these findings indicate the impact of the declaration on the change in transmission routes of COVID-19 over time in Japan., Highlights • After a weak lockdown, the transmission route of coronavirus disease 2019 (COVID-19)–related symptoms changed. • COVID-19 monitoring responses from more than 120,000 social networking service users in Japan were used for analysis. • The emergency declaration prevented infections in the workplace and increased domestic infections. • Even lockdown with limited enforcement may prevent the spread of infection.

To estimate the effect of airline travel restrictions on the risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) importation.We extracted passenger volume data for the entire global airline network, as well as the dates of the implementation of travel restrictions and the observation of the first case of coronavirus disease (COVID-19) in each country or territory, from publicly available sources. We calculated effective distance between every airport and the city of Wuhan, China. We modelled the risk of SARS-CoV-2 importation by estimating survival probability, expressing median time of importation as a function of effective distance. We calculated the relative change in importation risk under three different hypothetical scenarios that all resulted in different passenger volumes.We identified 28 countries with imported cases of COVID-19 as at 26 February 2020. The arrival time of the virus at these countries ranged from 39 to 80 days since identification of the first case in Wuhan. Our analysis of relative change in risk indicated that strategies of reducing global passenger volume and imposing travel restrictions at a further 10 hub airports would be equally effective in reducing the risk of importation of SARS-CoV-2; however, this reduction is very limited with a close-to-zero median relative change in risk.The hypothetical variations in observed travel restrictions were not sufficient to prevent the global spread of SARS-CoV-2; further research should also consider travel by land and sea. Our study highlights the importance of strengthening local capacities for disease monitoring and control.Évaluer les effets des restrictions de voyage par voie aérienne sur le risque d'importer le coronavirus 2 du syndrome respiratoire aigu sévère (SARS-CoV-2).Nous avons prélevé les données sur le volume de passagers pour l'ensemble du réseau aérien dans le monde, ainsi que les dates de mise en œuvre des restrictions de voyage et l'observation du premier cas de maladie à coronavirus (COVID-19) dans chaque pays ou territoire, à partir de sources accessibles au public. Nous avons calculé la distance réelle entre chaque aéroport et la ville de Wuhan, en Chine. Nous avons modélisé le risque d'importation du SARS-CoV-2 en estimant sa probabilité de survie, la période médiane d'importation étant exprimée en fonction de la distance réelle. Nous avons déterminé l'évolution relative du risque d'importation selon trois scénarios hypothétiques, qui ont tous débouché sur différents volumes de passagers.Nous avons identifié 28 pays ayant importé des cas de COVID-19 au 26 février 2020. La date d'arrivée du virus dans ces pays s'est étalée sur une période de 39 à 80 jours depuis la détection du premier cas à Wuhan. Notre analyse de l'évolution relative du risque a indiqué que les stratégies de réduction du nombre global de passagers et de restriction des voyages dans 10 aéroports de première catégorie auraient eu le même niveau d'efficacité dans la diminution du risque d'importation du SARS-CoV-2. Néanmoins, cette diminution est très limitée, avec une évolution relative médiane du risque proche de zéro.Les variations hypothétiques présentes dans les restrictions de voyage observées n'étaient pas suffisantes pour éviter la propagation du SARS-CoV-2 aux quatre coins de la planète. Les futures recherches à ce propos devraient également tenir compte des déplacements par voie terrestre et maritime. Notre étude souligne l'importance de renforcer les capacités locales de surveillance et de contrôle des maladies.Estimar el efecto de las restricciones a los viajes en avión sobre el riesgo de importación del coronavirus tipo 2 del síndrome respiratorio agudo grave (SARS-CoV-2).Se obtuvieron los datos sobre el volumen de pasajeros de toda la red global de aerolíneas, así como las fechas en las que se implementaron las restricciones de viaje y la observación del primer caso de la enfermedad del coronavirus (COVID-19) en cada país o territorio, a partir de fuentes a disposición del público. Se calculó la distancia efectiva entre cada aeropuerto y la ciudad de Wuhan, China. Se diseñó un modelo del riesgo de importación del SARS-CoV-2 al estimar la probabilidad de supervivencia, que indica el tiempo medio de importación en función de la distancia efectiva. Se calculó el cambio relativo en el riesgo de importación bajo tres escenarios hipotéticos diferentes que arrojaron valores distintos sobre el volumen de pasajeros.Se identificaron 28 países con casos importados de la COVID-19 al 26 de febrero de 2020. El tiempo de llegada del virus a estos países osciló entre 39 y 80 días desde la identificación del primer caso en Wuhan. El análisis que se expone aquí sobre el cambio relativo del riesgo indicó que las estrategias orientadas a reducir el volumen de pasajeros a nivel mundial y a imponer restricciones a los viajes en otros 10 aeropuertos centrales serían igualmente efectivas para reducir el riesgo de importación del SARS-CoV-2; sin embargo, esta reducción es muy limitada si se tiene en cuenta que el cambio relativo medio del riesgo es casi nulo.Las variaciones hipotéticas de las restricciones de viaje que se observaron no fueron suficientes para impedir la propagación global del SRAS-CoV-2; además, se debería analizar la posibilidad de viajar por tierra y por mar en las investigaciones futuras. Este estudio destaca la importancia de fortalecer la capacidad local para monitorear y controlar la enfermedad.الغرض تقييم تأثير فرض قيود للسفر عبر الخطوط الجوية، على خطر جلب فيروس المتلازمة التنفسية الحادة الشديدة المعروفة باسم كورونا فيروس 2 (سارس كوف 2). الطريقة قمنا باستخراج بيانات حجم الركاب لشبكة الخطوط الجوية العالمية بالكامل، بالإضافة إلى تواريخ تنفيذ قيود السفر، وملاحظة الحالة الأولى لمرض فيروس كورونا (كوفيد 19) في كل بلد أو إقليم، من المصادر المتاحة للجمهور. قمنا بحساب المسافة الفعالة بين كل مطار ومدينة ووهان، في الصين. وقمنا بوضع نموذج لخطر جلب سارس كوف 2 من خلال تقدير احتمالية البقاء، مع التعبير عن متوسط ​​وقت الجلب كدالة للمسافة الفعالة. واحتسبنا التغيير النسبي في مخاطر الجلب في ظل ثلاثة سيناريوهات افتراضية مختلفة أدت جميعها إلى أحجام مختلفة للركاب. النتائج حددنا 28 دولة بها حالات تم جلبها من كوفيد 19 حتى 26 فبراير/شباط 2020. تراوح وقت وصول الفيروس في هذه البلدان من 39 إلى 80 يوماً منذ تحديد الحالة الأولى في ووهان. أشار تحليلنا للتغيير النسبي في المخاطر، إلى أن استراتيجيات الحد من حجم الركاب العالمي، وفرض قيود السفر في 10 مطارات مركزية أخرى، ستكون فعالة بنفس القدر في الحد من خطر جلب فيروس سارس كوف 2؛ إلا أن هذا الانخفاض في المخاطر محدود للغاية مع متوسط للتغيير النسبي يقترب من الصفر. الاستنتاج لم تكن الاختلافات الافتراضية في قيود السفر الملحوظة كافية للحيلولة دون الانتشار العالمي لسارس كوف 2؛ ويجب أن تعتني المزيد من الأبحاث أيضا بالسفر البري وعبر البحر. تركز الدراسة الخاصة بنا على أهمية تعزيز القدرات المحلية لمكافحة المرض والسيطرة عليه.旨在评估航空出行限制对严重急性呼吸综合征冠状病毒 2 (SARS-CoV-2) 输入风险的影响。.我们从公开来源中提取了全球所有航空公司网络的客运量数据，以及各个国家或地区实施出行限制的日期和观察到首例 2019 冠状病毒病 (COVID-19) 患者的日期。我们计算了每个机场和中国武汉之间的有效距离。我们通过估计存活概率来模拟严重急性呼吸综合征冠状病毒 2 (SARS-CoV-2) 的输入风险，将输入时间的中位数用一个含有效距离的函数式来表示。我们计算了三种不同假设情境下输入风险的相对变化，这三种情境下的客运量均不相同。.截至 2020 年 2 月 26 日，我们确定了 28 个 2019 冠状病毒病输入病例国家。自武汉确诊首例患者以来，病毒传播至这些国家的时间从 39 天到 80 天不等。我们对风险相对变化的分析表明，减少全球客运量和在另外 10 个枢纽机场实施出行限制的策略在降低严重急性呼吸综合征冠状病毒 2 (SARS-CoV-2) 输入风险方面有着同样的效果；然而，这种减少是非常有限的，因为风险的相对变化中值接近于零。.所观察到的出行限制的假设变化不足以防止严重急性呼吸综合征冠状病毒 2 (SARS-CoV-2) 在全球的传播；未来的研究还应该考虑陆路和海路出行。此项研究突出强调加强地方疾病监测和控制能力的重要性。.Оценить влияние ограничения воздушного сообщения на риск завоза тяжелого острого коронавирусного респираторного синдрома (SARS-CoV-2).Авторы взяли из общедоступных источников данные об объеме пассажирских перевозок для всей международной сети авиалиний, а также датах ввода ограничений на путешествия и сроках выявления первых случаев коронавирусной болезни (COVID-19) в каждой отдельной стране или территории. Было рассчитано эффективное расстояние между каждым аэропортом и городом Ухань в Китае. Авторы смоделировали риск завоза вируса SARS-CoV-2 посредством оценки вероятности выживания, выразив медианное время завоза как функцию эффективного расстояния. Было рассчитано относительное изменение риска завоза инфекции для трех различных гипотетических сценариев, все из которых привели к разному объему пассажирского потока.По состоянию на 26 февраля 2020 года было выявлено 28 стран, в которые была завезена инфекция, вызывающая COVID-19. Срок попадания вируса в эти страны составлял от 39 до 80 дней с момента выявления первого случая заболевания в Ухане. Анализ относительного изменения риска указывает на то, что стратегии сокращения глобального объема пассажирских перевозок и наложения ограничений на перелеты в 10 дополнительных крупных узловых аэропортах были бы так же эффективны для снижения риска завоза вируса SARS-CoV-2, однако такое снижение риска очень ограниченно и имеет близкое к нулю медианное значение относительного изменения риска.Гипотетические вариации наблюдаемых ограничений воздушного сообщения не были достаточны для предотвращения глобального распространения SARS-CoV-2. В последующих исследованиях следует также учитывать поездки наземным транспортом и по морю. Исследование подчеркивает важность укрепления потенциала для мониторинга и контроля заболеваний на местах.

The association between maternal antibiotic exposure during pregnancy and childhood obesity is still unclear.The study aimed to evaluate the association between prenatal exposure to antibiotics and obesity at age 3 years using data from a large Japanese birth cohort.The Japan Environment and Children's Study is a nationwide birth cohort study. In this study, singleton vaginal full-term births were included. Obesity was defined as body mass index ≥95th percentile according to child growth standards. Prenatal antibiotic exposure was defined as antimicrobial agent use during pregnancy and was collected from maternal interviews and medical record transcripts. Logistic regression analysis was performed to evaluate the association of prenatal antibiotic exposure with child obesity at 3 years.In the crude and adjusted models with all children, maternal antibiotic exposure during pregnancy showed a marginal relationship with child obesity at 3 years. In the analyses according to exposure period and sex, exposure to antibiotics during the second/third trimester was significantly associated with obesity at the age of 3 years in female infants, but not in male infants, although the exposure during the first trimester was not in both sexes.Maternal antibiotic exposure during mid/late pregnancy may result in child obesity.

Maternal exposure to polychlorinated biphenyls (PCBs) during pregnancy is associated with a low birth weight; however, the congener-specific effects of PCB congeners are not well defined. In this study, we used maternal serum samples from the Chiba Study of Mother and Child Health (C-MACH) cohort, collected at 32 weeks of gestational age, to analyze the effects of PCB congener exposure on birth weight by examining the relationship between newborn birth weight and individual PCB congener levels in maternal serum (n = 291). The median total PCB level in the serum of mothers of male and female newborns at approximately 32 weeks of gestation was 39 and 37 ng g−1 lipid wt, respectively. The effect of the total PCB levels and the effects of PCB congener mixtures were analyzed using a linear regression model and a generalized weighted quantile sum regression model (gWQS). The birth weight of newborns was significantly associated with maternal exposure to PCB mixtures in the gWQS model. The results suggest that exposure to PCB mixtures results in low newborn birth weight. However, specific impacts of individual PCB congeners could not be related to newborn birth weight.

Lead poisoning is often considered a traditional disease; however, the specific mechanism of toxicity remains unclear. The study of Pb-induced alterations in cellular metabolic pathways is important to understand the biological response and disorders associated with environmental exposure to lead. Metabolomics studies have recently been paid considerable attention to understand in detail the biological response to lead exposure and the associated toxicity mechanisms. In the present study, wild rodents collected from an area contaminated with lead (N = 18) and a control area (N = 10) were investigated. This was the first ever experimental metabolomic study of wildlife exposed to lead in the field. While the levels of plasma phenylalanine and isoleucine were significantly higher in a lead-contaminated area versus the control area, hydroxybutyric acid was marginally significantly higher in the contaminated area, suggesting the possibility of enhancement of lipid metabolism. In the interregional least-absolute shrinkage and selection operator (lasso) regression model analysis, phenylalanine and isoleucine were identified as possible biomarkers, which is in agreement with the random forest model. In addition, in the random forest model, glutaric acid, glutamine, and hydroxybutyric acid were selected. In agreement with previous studies, enrichment analysis showed alterations in the urea cycle and ATP-binding cassette transporter pathways. Although regional rodent species bias was observed in this study, and the relatively small sample size should be taken into account, the present results are to some extent consistent with those of previous studies on humans and laboratory animals.

Immigrants in Japan face multiple health care challenges. There is limited research addressing how all-cause mortality differs between foreign residents and Japanese citizens, including the impact of the COVID-19 pandemic. We assessed whether all-cause mortality rates between Japanese citizens and foreign residents living in Japan differ, and whether these differentials changed after the start of the COVID-19 pandemic. We conducted a cross-sectional analysis using vital statistical data of all deaths among citizens and foreign residents that occurred within Japanese borders aggregated every 6 months between January 1, 2015 and June 30, 2021. Data were used to calculate sex-, region-, and 20-year age group-specific standardized mortality rates using the direct method based on the population distribution of Japanese citizens in 2021 by sex, region, and 20-year age groups. Chi-squared tests and linear regression were used to assess whether the pandemic was associated with changes in mortality rates among groups and changes in the mortality differentials between citizens and non-citizens, respectively. All-cause mortality increased monotonically with age for men and women. Men had higher mortality than women, regardless of age or nationality. All-cause mortality is lower among immigrants than Japanese citizens between the ages of 20-59, but higher under the age of 20 and over the age of 59. The pandemic was associated with significant changes in mortality in most groups, but no statistically significant changes in the mortality differentials between immigrants and Japanese citizens were detected. Young immigrants are generally healthier than their Japanese counterparts, in line with the healthy migrant hypothesis. Younger migrants are at higher risk of mortality, possibly due to increased vulnerability to psychologic stress. Older migrant mortality converged with citizen mortality, consistent with acculturation that occurs with longer duration of residence. The pandemic did not exacerbate health inequities for foreign residents with respect to mortality.

Understanding COVID-19 risk perception may help inform public health messaging aimed at encouraging preventive measures and improving countermeasures against the pandemic. We conducted an online survey of 29,708 Japanese adults in February 2021 and estimated the associations between COVID-19 risk perception and a broad array of individual factors. Two logistic regressions were constructed to estimate factors associated with the risk perception of COVID-19 (defined as responding that one might become infected within the next 6 months), and of severe illness among those who responded that they might become infected (defined as responding that one would become severely ill). After adjusting for covariates, those with a higher perceived risk of the COVID-19 vaccine had higher odds of risk perception for both infection and severe illness. Interestingly, those with higher odds of risk perception of being infected were more likely to report obtaining their information from healthcare workers whereas those with lower odds were more likely to report obtaining their information from the Internet or the government; those with lower odds of risk perception of being severely ill were more likely to report obtaining their information from the Internet. The higher the trust level in the government as a COVID-19 information source, the lower the odds of both risk perception of being infected and becoming severely ill. The higher the trust levels in social networking services as a COVID-19 information source, the higher the odds of risk perception of becoming severely ill. Public health messaging should address the factors identified in our study.

IntroductionMarriage, divorce and fertility are declining in Japan. There is concern that the COVID-19 pandemic may have accelerated the decrease in marriages and births while increasing the number of divorces. Changes in partnership behaviours and fertility have significant implications for mental health, well-being and population demographics.MethodsJapanese vital statistical data were collected for December 2011–May 2021. We used the Farrington algorithm on the daily numbers of marriages, divorces and births (per month) in order to determine whether any given month between January 2017 and May 2021 had a significant excess or deficit. Analyses were conducted at the national and regional levels.ResultsDuring the pandemic, significant deficits in the national number of marriages were noted in January 2020, April 2020, May 2020, July 2020, September 2020 and April 2021. Regional marriage patterns reflected national trends. Divorces were noted to be in deficit during April 2020, May 2020 and May 2021 at the country level. Regional analyses mirrored national divorce trends with the exception of Shikoku, which showed no deficits during the pandemic. Significant deficits in the number of total births were noted in December 2020, January 2021 and February 2021. Regionally, birth deficits were concentrated in Chubu, Kansai and Kanto. After the start of the pandemic, no significant excesses in marriages, divorces or births were noted at the national or regional level.ConclusionsMarriages and divorces declined during the pandemic in Japan, especially during state of emergency declarations. There were decreased births between December 2020 and February 2021, approximately 8–10 months after the first state of emergency, suggesting that couples altered their pregnancy intention in response to the pandemic. Metropolitan regions were more affected by the pandemic than their less metropolitan counterparts.

Background: individual preventive behaviors are one of the key measures needed to prevent the spread of COVID-19. This study sought to identify the factors associated with the adoption of COVID-19 preventive measures, focusing specifically on information sources. Methods: we conducted a nationally representative cross-sectional survey of 30,053 Japanese adults in February 2021. The survey asked about socioeconomic, health-related, and psychological characteristics, attitudes toward immunization, and the use of information sources regarding COVID-19. We have constructed multivariable logistic regression to estimate the factors associated with the adoption of three preventive measures: 3Cs avoidance, hand hygiene and respiratory hygiene. Results: socioeconomic variables, psychological variables, and the use of information sources are significantly associated with the adoption of preventive measures. The more information sources one uses, the more likely one is to adopt preventive measures. Trust in healthcare professionals is positively associated with adopting preventive measures. On the other hand, negative correlations between trust in social media and preventive behaviors were observed. Conclusions: encouraging access to multiple information sources, utilizing communication channels, and modifying messaging according to target groups are essential to promote COVID-19 preventive measures.

Research characterizing changes of heart with respect to vaccine intention is scarce, and very little research considers those who were initially vaccine willing but became hesitant. Here, we sought to assess the factors related to reversals of vaccine willingness.We conducted a longitudinal, national survey on vaccination intention among Japanese adults aged 20 years or older, with the first questionnaire performed in February-March 2021 (Of 11,118 (57.9%) respondents who previously expressed interest in vaccination, 10,684 (96.1%) and 434 (3.9%) were in the vaccine willing and hesitant groups, respectively. Several covariates were found to significantly predict vaccine hesitancy, including marital status, influenza vaccine history, COVID-19 infection/testing history, engagement in COVID-19 preventive measures, perceived risks/benefits of the COVID-19 vaccine, and attitudes regarding vaccination policies and norms. The use of certain information sources was also associated with vaccine hesitancy.Sociodemographic, health-related, psychologic/attitudinal, and information-related variables predicted the development of vaccine hesitancy among those with prior willingness. Most of these predictors were also associated with vaccination status.The present work was supported in part by a grant from the Kanagawa Prefectural Government of Japan and by AIST government subsidies.

Excess deaths, including all-causes mortality, were confirmed for the first time in Japan in April 2021. However, little is known about the indirect effects of COVID-19 on the number of non-COVID-19-related deaths. We then estimated the excess deaths from non-COVID-19-related causes in Japan and its 47 prefectures from January 2020 through May 2021 by place of death. Vital statistical data on deaths were obtained from the Ministry of Health, Labour and Welfare. Using quasi-Poisson regression models, we estimated the expected weekly number of deaths due to all-causes excluding COVID-19 (non-COVID-19) and due to respiratory disease, circulatory disease, malignant neoplasms, and senility. Estimates were made separately for deaths in all locations, as well as for deaths in hospitals and clinics, in nursing homes and elderly care facilities, and at home. We defined a week with excess deaths as one in which the observed number of deaths exceeded the upper bound of the two-sided 95% prediction interval. Excess death was expressed as a range of differences between the observed and expected number of deaths and the 95% upper bound of the two-sided predictive interval. The excess percentage was calculated as the number of excess deaths divided by the expected number of deaths. At the national level, excess deaths from non-COVID-19-related all-causes were observed during April 19 to May 16, 2021. The largest excess percentage was 2.73-8.58% (excess deaths 689-2161) in the week of May 3-9. Similar trends were observed for all four cause categories. The cause-of-death categories which contributed to the excesses showed heterogeneity among prefectures. When stratified by place of death, excess mortality tended to be observed in nursing homes and elderly care facilities for all categories, in hospitals and clinics for circulatory disease, and at home for respiratory disease, malignant neoplasms, and senility. A caution is necessary that for the lastest three months (March-May 2021), adjusted data were used to account for possible reporting delays.

We evaluated the impact of the new coronavirus disease (COVID-19) on healthcare access in Japan in terms of the number of outpatients and hospitalized patients as well as the length of hospital stays, during the first wave of the pandemic, up to June 2020. This observational study evaluated the monthly average number of outpatients per day at hospitals, the average number of hospitalized patients per day, and the average length of hospital stays per patient, from December 2010 to June 2020, using the hospital reports data, which are open aggregated data on the utilization of hospitals from the Ministry of Health, Labour and Welfare. These numbers were compared with those from the same period of previous years, using a quasi-Poisson regression model. We found a nationwide decrease in the number of outpatients in general hospitals and hospitalized patients, particularly in long-term care beds in Japan, as well as the excess length of hospital stays among psychiatric care patients during the first wave of the COVID-19. This limited access to healthcare demonstrated the importance of the long-term health monitoring of vulnerable populations and the need for urgent management support to healthcare facilities in preparation for possible prolonged pandemics in the future.

Environmental exposure to persistent organic pollutants during pregnancy has potential adverse health effects on the fetus. One of the environmental pollutants is polychlorinated biphenyl (PCB). Earlier, we reported the presence of PCBs in fetal tissues such as the umbilical cord. Telomere length (TL) is a biomarker of aging because it shortens with each cell division. According to the Developmental Origins of Health and Disease hypothesis, fetal exposure to environmental pollutants during pregnancy affects the occurrence of non-communicable diseases in later life. In the current study, we investigated the association between cord tissue TL and serum levels of PCBs. The subjects were 114 mother-child pairs participating in a birth cohort study, the Chiba Study of Mother and Child Health (C-MACH). Maternal serum was collected during pregnancy, and cord serum and tissue were obtained at birth. TL was assessed by qPCR using genomic DNA extracted from the cord tissue. Maternal and cord serum PCB congener levels were assessed using gas chromatography and negative ion chemical ionization qMS. In male fetuses, serum levels of PCB74 in the cord blood were significantly associated with TL following covariate adjustment, but no significant association was found in female fetuses. These data suggest that the TL of the umbilical cord is affected by fetal exposure to PCBs.

Short-chain chlorinated paraffins (SCCPs) are listed in Annex A (elimination) of the Stockholm Convention on persistent organic pollutants, and products containing SCCPs require detoxification. In the present study, the metal sodium (Na) dispersion method was applied to a wax sample containing SCCPs (58%, C10–C13 and Cl5–Cl9) to assess the dechlorination effect. Effective dechlorination of SCCPs was confirmed using 2-L and 20-L reaction systems. The initial concentrations of the wax (5, 10, 20, 30%), reaction time (10, 30, 60, 120, 180 min), and the ratios of the amount of Na dispersion and the initial amount of the wax containing SCCPs (Na/wax ratios; 3.9, 4.4, 5.2) were tested. The destruction efficiency of SCCPs was over 99.999% after 10 min of reaction at 90 °C under several conditions. The initial concentrations of the wax and the Na/wax ratios did not affect the results. The ultralow SCCP contents in exhaust gas from the reaction tank demonstrated a destruction removal efficiency of over 99.999999%. Trace levels of polychlorinated dibenzo-p-dioxins and furans, dioxin-like polychlorinated biphenyls, hexachlorobenzene, and pentachlorobenzene in the wax sample and treated materials (oil, water, and gas) met various regulatory values or exhibited the same levels as the environmental background. After dechlorination of the SCCPs, the main reaction products in the reaction liquid and final oil phase were identified as aliphatic compounds. The metal Na dispersion method was found to be an effective and decontaminated destruction technique for application to SCCPs in liquid-like samples with no formation of hazardous organic byproducts.

Background: In the absence of widespread testing, symptomatic monitoring efforts may allow for understanding the epidemiological situation of the spread of coronavirus disease 2019 (COVID-19) in Japan. We obtained data from a social networking service (SNS) messaging application that monitors self-reported COVID-19 related symptoms in real time in Fukuoka Prefecture, Japan. We aimed at not only understanding the epidemiological situation of COVID-19 in the prefecture, but also highlighting the usefulness of symptomatic monitoring approaches that rely on self-reporting using SNS during a pandemic, and informing the assessment of Japan's emergency declaration over COVID-19. Methods: We analysed symptoms data (fever over 37.5° and a strong feeling of weariness or shortness of breath), reported voluntarily via SNS chatbot by 227,898 residents of Fukuoka Prefecture during March 27 to May 3, 2020, including April 7, when a state of emergency was declared. We estimated the spatial correlation coefficient between the number of the self-reported cases of COVID-19 related symptoms and the number of PCR confirmed COVID-19 cases in the period (obtained from the prefecture website); and estimated the empirical Bayes age- and sex-standardised incidence ratio (EBSIR) of the symptoms in the period, compared before and after the declaration. The number of symptom cases was weighted by age and sex to reflect the regional population distribution according to the 2015 national census. Findings: Of the participants, 3.47% reported symptoms. There was a strong spatial correlation of 0.847 (p

Background On April 7, 2020, the Japanese government declared a state of emergency regarding the novel coronavirus (COVID-19). Given the nation-wide spread of the coronavirus in major Japanese cities and the rapid increase in the number of cases with untraceable infection routes, large-scale monitoring for capturing the current epidemiological situation of COVID-19 in Japan is urgently required. Methods A chatbot-based healthcare system named COOPERA (COvid-19: Operation for Personalized Empowerment to Render smart prevention And AN care seeking) was developed to surveil the Japanese epidemiological situation in real-time. COOPERA asked questions regarding personal information, location, preventive actions, COVID-19 related symptoms and their residence. Empirical Bayes estimates of the age-sex-standardized incidence rate and disease mapping approach using scan statistics were utilized to identify the geographical distribution of the symptoms in Tokyo and their spatial correlation r with the identified COVID-19 cases. Findings We analyzed 353,010 participants from Tokyo recruited from 27th March to 6th April 2020. The mean (SD) age of participants was 42.7 (12.3), and 63.4%, 36.4% or 0.2% were female, male, or others, respectively. 95.6% of participants had no subjective symptoms. We identified several geographical clusters with high spatial correlation (r = 0.9), especially in downtown areas in central Tokyo such as Shibuya and Shinjuku. Interpretation With the global spread of COVID-19, medical resources are being depleted. A new system to monitor the epidemiological situation, COOPERA, can provide insights to assist political decision to tackle the epidemic. In addition, given that Japan has not had a strong lockdown policy to weaken the spread of the infection, our result would be useful for preparing for the second wave in other countries during the next flu season without a strong lockdown. Funding The present work was supported in part by a grant from the Ministry of Health, Labour and Welfare of Japan (H29-Gantaisaku-ippan-009).

Herein, the concentrations of formic acid, acetic acid, and ammonia in samples of indoor air for 47 new houses were measured two weeks after completion. The houses were fabricated with light-gauge steel structures. The measurements were performed in living rooms and bedrooms without furniture and outdoors. Air samples were analyzed using ion chromatography. The mean values were 28 (living room), 30 (bedroom), and 20 &mu, g m&minus, 3 (outdoor air) for formic acid, 166 (living room), 151 (bedroom), and 51 &mu, 3 (outdoor air) for acetic acid, and 73 (living room), 76 (bedroom), and 21 &mu, 3 (outdoor air) for ammonia. The total values of the three substances accounted for 39.4&ndash, 40.7% of the sum of chemical compound values. The analyzed compounds were indicated by two principal components (PC), PC1 (30.1%) and PC2 (9%), with 39.1% total variance. Formic acid, acetic acid, and ammonia were positively aligned with PC1 and negatively aligned with PC2. Factors such as room temperature, aldehydes, and phthalates were positively aligned with PC1 and negatively aligned with PC2. Furthermore, concentrations of formic acid, acetic acid, and ammonia were significantly and positively correlated with room temperature (p &lt, 0.05).

Summary: Background: Optimizing media campaigns for those who were unsure or unwilling to take coronavirus disease (COVID-19) vaccines is required urgently to effectively present public health messages aimed at increasing vaccination coverage. We propose a novel framework for selecting tailor-made media channels and their combinations for this task. Methods: An online survey was conducted in Japan during February to March, 2021, with 30,053 participants. In addition to their sociodemographic characteristics, it asked the attitude toward vaccination and information sources (i.e., media channels) for COVID-19 issues. Multinomial logic regression was fitted to estimate the combinations of the media channels and their odds ratio (OR) associated with vaccination attitudes. Findings: The proportion of respondents who were unsure or unwilling to take the vaccination was skewed toward younger generation: 58.1% were aged under 35, while 28.1% were 65 years or older. Media channels such as “Non-medical and Non-TV” and “Non-medical and Non-government” were associated with the unsure group: OR (95% Confidence intervals, (CI)) = 1.75 (1.62, 1.89) and 1.53 (1.44, 1.62), respectively. In addition, media channels such as “Newspapers or the Novel Coronavirus Expert Meeting”, “Medical or Local government”, and “Non-TV” were associated with the unwilling group: OR (95% CI) were 2.00 (1.47, 2.75), 3.13 (2.58, 3.81), and 2.25 (1.84, 2.77), respectively. Interpretation: To effectively approach COVID-19 vaccine unsure and unwilling groups, generation-specific online and offline media campaigns should be optimized to the type of vaccine attitude. Funding: Funded by the Ministry of Health, Labour and Welfare of Japan (H29-Gantaisaku-ippan-009) and the Japan Agency for Medical Research and Development (AMED) (JP20fk0108535).

Maternal exposure to polychlorinated biphenyls (PCBs) results in abnormal fetal development, possibly because of epigenetic alterations. However, the association between PCB levels in cord serum with fetal DNA methylation status in cord tissue is unclear. This study aims to identify alterations in DNA methylation in cord tissue potentially associated with PCB levels in cord serum from a birth cohort in Chiba, Japan (male neonates = 32, female neonates = 43). Methylation array analysis identified five sites for female neonates (cg09878117, cg06154002, cg06289566, cg12838902, cg01083397) and one site for male neonates (cg13368805) that demonstrated a change in the methylation degree. This result was validated by pyrosequencing analysis, showing that cg06154002 (tudor domain containing 9: TDRD9) in cord tissue from female neonates is significantly correlated with total PCB levels in cord serum. These results indicate that exposure to PCBs may alter TDRD9 methylation levels, although this hypothesis requires further validation using data obtained from female neonates. However, since the present cohort is small, further studies with larger cohorts are required to obtain more data on the effects of PCB exposure and to identify corresponding biomarkers.

To avoid recycling plastic waste containing polybrominated diphenyl ethers (PBDEs) or hexabromocyclododecane (HBCD), which are listed in the Stockholm Convention on Persistent Organic Pollutants (POPs), a simple method to determine their contents at the time of waste disposal is needed. Herein, we developed a rapid analytical method using a gas chromatograph coupled with quadrupole mass spectrometry or electron capture detection to simultaneously detect PBDEs and HBCD in plastic waste. PBDEs and HBCD were ultrasonically extracted from plastic samples using toluene. The dissolved polymer matrix was then removed using n-hexane and 44% H2SO4-impregnated silica gel before analysis of the extract. A run time of less than 10 min was achieved using a custom, short GC column (5 m). The detection limits of the method were below the upper threshold of the low POP content limits defined by the Basel Convention (

Summary Background Identifying and understanding reasons for being unsure or unwilling regarding intention to be vaccinated against coronavirus disease (COVID-19) may help to inform future public health messages aimed at increasing vaccination coverage. We analyzed a broad array of individual's psychological dispositions with regard to decision-making about COVID-19 vaccination in Japan. Methods A nationally representative cross-sectional web survey was conducted with 30053 Japanese adults aged 20 years or older at the end of February 2021. In addition to the question on the individual's intention to be vaccinated against COVID-19, respondents were asked about their sociodemographic, health-related, and psychological characteristics as well as information sources about COVID-19 and their levels of trust. Also, those who responded ‘not sure’ or ‘no’ regarding intention to take COVID-19 vaccine were asked why. Multinomial logistic regression with sparse group Lasso (Least Absolute Shrinkage and Selection Operator) penalty was used to compute adjusted odds ratios for factors associated with the intention (not sure/no versus yes). Findings The percentages of respondents who answered ‘not sure’ or ‘no’ regarding intention to be vaccinated against COVID-19 vaccine were 32.9% and 11.0%, respectively. After adjusting for covariates, the perceived risks of COVID-19, perceived risk of a COVID-19 vaccine, perceived benefits of a COVID-19 vaccine, trust in scientists and public authorities, and the belief that healthcare workers should be vaccinated were significantly associated with vaccination intention. Several sources of information about COVID-19 were also significantly associated with vaccination intention, including physicians, nurses, and television, medical information sites with lower odds of being unsure or unwilling, and internet news sites, YouTube, family members, and scientists and researchers with higher odds. The higher the level of trust in television as a source of COVID-19 information, the higher the odds of responding ‘not sure’ (odds ratio 1.11, 95% confidence interval 1.01–1.21). We also demonstrated that many respondents presented concerns about the side effects and safety of a COVID-19 vaccine as a major reason for being unsure or unwilling. To decide whether or not to get the vaccine, many respondents requested more information about the compatibilities between the vaccine and their personal health conditions, whether other people had been vaccinated, the effectiveness of vaccines against variants, and doctors’ recommendations. Interpretation Our findings suggest that public health messaging based on the sociodemographic and psychological characteristics of those who are unsure or unwilling regarding intention to be vaccinated against COVID-19 vaccine may help to increase vaccine uptake amongst this population. Funding The present work was supported in part by a grant from the Ministry of Health, Labour and Welfare of Japan (H29-Gantaisaku-ippan-009).

An analytical method for higher brominated congeners of polybrominated diphenyl ethers (PBDEs) was optimised using a gas chromatograph equipped with an electron impact ionisation-quadrupole mass spectrometer (GC-EI-qMS) and five native PBDEs and three 13C12-labelled congeners in biological and environmental samples (mussels, sediment, dust). In the optimised instrumental conditions, abundance and repeatability improved with increase in temperature of the ion source. The instrumental detection limits (IDLs) for BDE-196, BDE-197, BDE-206, BDE-207 and BDE-209 were 0.1, 0.1, 0.2, 0.3 and 0.6 pg, respectively. When compared to the previous reports, the IDLs were the same as for electron capture negative ionisation (ECNI) or EI-double focusing magnetic sector (EI-Sector) mass spectrometer, indicating that sensitive determination could be achieved using a conventional GC-EI-qMS. Validation of the method was carried out by the analysis of reference materials and mussel samples. We confirmed that the concentration...

Information on accumulation of polychlorinated biphenyl metabolites (OH-PCBs) and hydroxylated polybrominated diphenyl ethers (OH-PBDEs) in the blood of marine fish is limited. The present study, we determined the residue levels and patterns of PCBs, OH-PCBs, PBDEs, OH-PBDEs and methoxylated PBDEs (MeO-PBDEs) in the blood collected from scalloped hammerhead shark ( Sphyrna lewini ) and Japanese amberjack ( Seriola quinqueradiata ), species of predatory fish at Japanese coastal waters. The predominant homologues found in Japanese amberjacks were mono- and di-chlorinated OH-PCBs, and scalloped hammerhead sharks were octa-chlorinated OH-PCBs. The predominant OH-PCB isomers were lower-chlorinated OH-PCBs such as 6OH-CB2 and 2′OH-CB9 in Japanese amberjacks. This result suggests that exposure of Japanese amberjacks to lower-chlorinated OH-PCBs might be from the ambient aquatic environment. In scalloped hammerhead sharks, 4,4′diOH-CB202, 4OH-CB201 and 4OH-CB146 were the predominant isomers accounting for approximately 60% of the total OH-PCBs. The predominant MeO-PBDE isomers were 6MeO-BDE47 followed by 2′MeO-BDE68 in both species. As for OH-PBDE isomers, 6OH-BDE47 was predominant followed by 2′OH-BDE68 in Japanese amberjacks and scalloped hammerhead sharks. Residue levels of ΣMeO-PBDEs and ΣOH-PBDEs showed a significant positive correlation ( p = 0.029). This result suggests that MeO-PBDEs and OH-PBDEs share a common source or a metabolic pathway in fishes. Characteristic differences found in the profiles of OH-PCBs and OH-PBDEs in Japanese amberjack and scalloped hammerhead shark show the need for further studies on the differences in exposure profiles, metabolic capacities and toxic effects in fish.

Objectives On March 28, the Japanese government decided on the "Basic Policies for Novel Coronavirus Disease (COVID-19) Control", and called on the public to thoroughly implement social distance measures (i.e. behavioral restrictions to limit the frequency and intensity of human contact), especially telework. Methods We used population-level questionnaire data from a social networking service (SNS) with 275,560 respondents from March 5 to April 6 to evaluate the relationship between telework implementation and the presence of a fever (body temperature above 37.5°C) within one month as a surrogate indicator of COVID-19 infection, by occupation type and age group. Results Among company employees, a statistical significance was identified in the 15–29 and 30–59 age groups, showing higher fever rates in the non-teleworker group (for 15–29 age group, non-teleworkers: 7.64%; teleworkers: 6.45%; p=0.02; for 30–59 age group, non-teleworkers: 3.46%; teleworkers: 3.14%; p=0.02). Conclusions Telework remains a controversial topic in Japan as the government called for emergency measures. While caution is warranted in interpreting our findings because our data is limited to the voluntary SNS users, they will be essential to push forward with more measures to promote social distancing measures in the midst of Japan's current tense political climate., Highlights • Slow progress in the introduction of telework as a COVID-19 measure in Japan. • Analysis using COVID-19 monitoring responses from over 270,000 SNS users in Japan. • Statistical relationship between teleworking and fever among company employees. • The urgent need for social support in the implementation of telework in Japan.