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We present new estimates of the internal rate of return to early childhood education. Utilizing the nationwide expansion of preschool education in Japan between 1960 and 1980, we initially assess the impact of preschool attendance on high school graduation and college enrollment for men. Subsequently, we compute the social rate of return to preschool attendance for men by drawing upon national wage statistics to project expected wage trajectories and referencing government documents to account for the social cost of preschools. Our findings indicate a social rate of return ranging from 5.7% to 8.1%, consistent with previous estimates in the literature. [ABSTRACT FROM AUTHOR]

• About 40% of two-dose vaccinated nursery school children became ill with varicella. • Outbreaks at nursery schools might be transmitted from older students, perhaps siblings. • Vaccine effectiveness in the nursery school for more than one dose was not confirmed. • Vaccination using one dose or more can reduce severity significantly. In Japan, routine administration to one-year-old children of two-dose immunization for varicella was introduced in October 2014. Object The object of this study was to report outbreaks of varicella under routine immunization at a nursery school and in its surrounding area using data of surrounding areas from the (Nursery) School Absenteeism Surveillance System. Then, we measured the effectiveness of routine two-dose immunization for varicella to onset. We tentatively assessed its severity in a nursery school. The study period extended from April 2017 through March 2018. The study area comprised Nursery school B and other nursery schools, and elementary and junior high schools in City A. Subjects in Nursery school B were 120 children. We analyzed vaccine effectiveness (VE) as an observational study and assessed severity using Fisher's exact test. We also assessed VE for severity using linear regression. Severity was defined as the length of nursery school absence attributable to varicella infection. During the one month preceding a period of two weeks before the initial case at Nursery school B, there were 16 cases of varicella infection in nursery schools, 45 cases in elementary schools, and one case in junior high schools in City A. For children who had received one vaccine dose or more, VE was 48.1% for all ages and 49.2% among children three years old and older. No significant VE against infection was found. Vaccination using one dose or more can reduce severity significantly. Discussion and conclusion: Because many nursery school children who had received two doses of vaccine were infected, VE was estimated as low in the nursery school and not significant. Although VE for severity with more than one dose was confirmed, a second dose might not reduce severity compared to one dose. [ABSTRACT FROM AUTHOR]

Natural disasters cause numerous short- and long-term psychosocial effects on young children because of their increased vulnerability. This study aimed to examine the mental health of young children at 15 months after the Kumamoto earthquake. We conducted a self-administered questionnaire survey on the parents of 363 children aged 4–6 years across Kumamoto Prefecture. The questionnaire items included current residence, housing damage and evacuation experience during the disaster, as well as the Strengths and Difficulties Questionnaire (SDQ). The results showed that children who could stay in their home during the disaster had lower percentages of scores in the clinical range for conduct problems (odds ratio [OR] = 0.33, 95% confidence interval [CI]: 0.13–0.85) and hyperactivity/inattention (OR = 0.42, 95%CI: 0.19–0.93) on the SDQ. Furthermore, children who experienced living apart from their parents during the disaster had a higher percentage of scores in the clinical range for conduct problems (OR = 2.39, 95%CI: 1.05–5.42). At 15 months post-disaster, the mental health of the sample was worse than the normative data of Japan, indicating that the mental health of young children who experienced living at home and apart from their parents during the disaster was still affected. [ABSTRACT FROM AUTHOR]

The Nursery School Absenteeism Surveillance System (NSASSy), which includes 40% of all nursery schools in Japan, has a degree of effectiveness that is difficult to prove: nursery schools and areas without NSASSy cannot be evaluated for their incidence of infectious diseases as precisely as those with NSASSy. Instead, we examine nursery school countermeasures against infectious diseases by considering the endogeneity bias of NSASSy. After sending questionnaires to 500 Tokyo metropolitan and nearby nursery schools in November 2022, we received their responses through the end of 2022. Questionnaires asked about infection control measures of nursery schools: (1) cooperation with public health centers; (2) cooperation with staff; (3) cooperation with children's parents; (4) precautions among children; (5) countermeasure systems; (6) precaution systems; (7) recording of health conditions of children; (8) usefulness of studying while students; and (9) usefulness of training at nursery schools. Ordered probit with inverse probability weighted adjustment was used as the estimation procedure. The explanatory variable was a dummy variable for using NSASSy. Probability in weight was estimated using the first-step probit for NSASSy. Explanatory variables were a dummy variable for publicly funded nursery schools and a dummy variable for local governments that had adopted NSASSy. We analyzed 193 nursery schools. NSASSy was negative and associated significantly with (3) cooperation with children's parents and (7) recording of health conditions of children. These countermeasures were more likely to have been taken by NSASSy nursery schools. [ABSTRACT FROM AUTHOR]

Individuals who visit hospitals with neurodevelopmental disorders have recently increased. To locate the cause for this increase, various factors, such as environmental and genetic ones, are being investigated. The objective of this study is to analyze the developmental delay in children and their background. The participants were children who underwent the checkup for 18-month-old children in Togane city, Japan, from 2011 to 2021; 4,145 children—2,147 boys and 1,998 girls with a mean age of 18.8 months—were included. To examine the tendency over time and the background, we used the questionnaire about development and lifestyle reported by parents. The number of children who did not produce pointing gestures or respond to their names and low-volume sounds tended to increase over the survey period (p = 0.0125, p = 0.0435, p = 0.0275). Next, we examined the relationship between pointing gestures and lifestyle and found that there was a relationship between attending a nursery school and bedtime and pointing gestures. A slow developmental trend over the last decade has been observed among children. The background was related to attending a nursery school and bedtime, suggesting that interaction with others and sleep are important for the development of children. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to investigate the association between the incidence of early childhood caries (ECC) and factors of the daytime childcare environment among toddlers in a rural area of Japan.Material and Methods: This was a prospective cohort study. Data collected from 2011 to 2015 were obtained for initially caries-free, 18-month-old toddlers (N = 640). Dentists recorded the numbers of decayed, missing and filled teeth (caries incidence) of toddlers at baseline (age 18 months) and follow-up (age 3 years). In addition, a questionnaire survey was conducted on guardians at baseline to record data on lifestyle.Results: In total, 159 (24.8%) toddlers had newly identified ECC at follow-up. Logistic regression analyses indicated that the incidence of ECC was significantly associated with receiving daytime care at a nursery school (odds ratio [OR], 1.55; 95% confidence interval [CI], 1.05-2.30; p = .029), prolonged breastfeeding (OR, 1.71; 95%CI, 1.15-2.55; p = .008), and snacking ≥3 times a day (OR, 2.39; 95%CI, 1.53-3.74; p < .001).Conclusion: These findings suggest that receiving daytime care at a nursery school, prolonged breastfeeding, and frequent snacking are associated with an increased risk of ECC among Japanese toddlers in rural areas. [ABSTRACT FROM AUTHOR]

Objectives　The relationship between household income and dietary intake among older children and adults in Japan has been studied. However, few studies have examined the relationship in younger children, and we believe that this should be taken into consideration from early childhood to correct health disparities. In this study, we examined the relationship between family income and dietary food group intake, and investigated the adequacy of food intake based on the Japanese Food Guide Spinning Top for young children aged 3 to 6 years attending nursery school. The goal of this study was to obtain trends in food intake that can be used to improve poor dietary intake of young children caused by socioeconomic factors.Methods　A dietary survey using the food weighing or recording method and a self-administered questionnaire on dietary status were conducted on two non-consecutive days, including weekdays and weekends, from October to December 2019 or 2020. The participants were 761 young children (423 boys and 338 girls) attending nursery schools in seven cities in Japan. Equivalent income was calculated from household income and the number of family members indicated in the dietary status survey. Intake of each food group and consistency with the Japanese Food Guide Spinning Top were compared in five quintiles.Results　Compared to the low equivalent income group, the high equivalent income group showed a decreasing trend in cereal intake and an increasing trend in the intake of sugar and sweeteners, green and yellow vegetables, and dairy products. The percentage of the low-income group who did not meet the definition of adequate intake using the Japanese Food Guide Spinning Top was lower for meals that include cereals and grain products, and higher for meals that include meat and fish, vegetable, milk and dairy products, and fruits.Conclusion　The lower income group had higher intake of cereals and lower intake of vegetables and fruits compared to the higher income group. This finding is similar to the results of studies in adults and older children. However, based on the Japanese Food Guide Spinning Top, >90% of young children have a diet that fall below the adequate intake of meals, including vegetable dishes and even on weekdays, which suggests a general vegetable deficiency in young children. Multifaceted support is required to address this concern, including measures to correct disparities of income and to ensure desirable nutrient intake in early childhood.

In nursery schools, influenza outbreaks have occurred every year. However, influenza characteristics of its diffusion among nursery schools, within each nursery school, and among classes of different ages in nursery schools remains unclear. This paper presents an examination of these matters using the Nursery School Absenteeism Surveillance System (NSASSy). All nursery schools in ward A in Tokyo introduced to the NSASSy in 2015. The study period was November 2015 through March 2016. The data of influenza patients were extracted from NSASSy. We examined four definitions of 'starting date of community outbreak' (SDCO) of influenza: 1) the first recorded day of influenza patients (SDCO1), 2) the last day of influenza patients recorded for two consecutive days (SDCO2), 3) three consecutive days (SDCO3), and 4) four consecutive days (SDCO4). We evaluated those four definitions by duration of the initial case at each nursery school from SDCO and evaluated the proportion of nursery schools at which the initial case occurred before SDCO. The average durations of initial cases at respective nursery schools from SDCO1–4 were 40.3, 26.3, 23.1 and 13.3 days. The respective proportions of nursery schools at which the initial case occurred before SDCO1–4 were 3.1%, 6.4%, 9.4% and 40.6%. Results demonstrate that SDCO3 is an appropriate definition of SDCO. Robustness checks for other areas, seasons, and population size constitute the next challenge for research in this area. [ABSTRACT FROM AUTHOR]

We measured the association between history of influenza vaccination by age 2 years and influenza virus (IFV) infection at ages 3 and 4 years by relative risk reduction. We also examined the association between history of IFV infection by age 2 years and recurrent IFV infection at age 3 years. This study included 73,666 children from a large Japanese birth cohort. Among children vaccinated never, once or twice when aged under 2 years, 16.0%, 10.8% and 11.3%, respectively, had been infected with IFV by age 3 years, and 19.2%, 14.5% and 16.0%, respectively, by age 4 years. Compared with no history of influenza vaccination, vaccination at ages 1 and/or 2 years reduced the risk of IFV infection at age 3 by 30%–32% and at age 4 by 17%–24%. The relative risk of recurrent IFV infection at ages 3 and 4 years increased in proportion to the number of prior infections by age 2. One-season-prior influenza vaccination history reduced the IFV infection risk at age 3 years by 25%–42%. Influenza vaccination most effectively protected children at age 3 who lacked older sibling(s) and did not attend nursery school. One-season-prior IFV infection increased the relative risk of recurrent infection at age 3 years (1.72–3.33). In conclusion, influenza vaccination-induced protection may partly extend to the next season. Owing to the relative risk reduction by influenza vaccination and the increased relative risk of IFV infection from prior-season infection, annual influenza vaccination is recommended. • More infection experiences increased infection probability at ages 3 and 4 years. • Vaccination experience decreased infection probability at age 3 years by 30%–32%. • At age 3, one-season-prior vaccination decreased infection probability by 25%–42%. • Vaccination experience decreased infection probability at age 4 years by 17%–24%. • Vaccination benefits children not attending nursery school and without older siblings. [ABSTRACT FROM AUTHOR]

Background and Objectives: This study aimed to collect information on experiences in the Great East Japan Earthquake (hereafter, 3.11), current preparedness, and barriers to building up stockpiles in nursery schools in affected areas. Based on the needs heard from the staff, we decided what contents should be included in our manual developed with the Japan Dietetic Association.Methods and Study Design: A group interview was held in September 2012. We interviewed a principal, nurses, and registered dietitians working for a public and a private nursery school in Town A. We also invited an administrative dietitian who was an employee of Town A.Results: One of the barriers to building up stockpiles was that they did not have any idea of what and how many items they should store. To deal with this situation, we developed a formula that could be used to calculate the quantity of stockpiles for their facilities in a newly developed feeding manual. In terms of current preparedness, the registered dietitians were not prepared for alternative menus in emergencies or how to manage garbage when the garbage collection was disrupted by disasters. The manual recommends to obtain the services of at least two food service personnel and spare space for storing filled garbage bags until garbage collection resumes.Conclusion: Some improvements in stocks were found in both of the public and private nursery schools. To improve the situation further, more financial support and detailed guidelines should be provided by the local government and authoritative organizations. Our manual should be a great asset for all nursery schools to improve their stockpiles. [ABSTRACT FROM AUTHOR]

Abstract: Background: It has been suggested that the daytime napping patterns of children differ according to racial and cultural backgrounds. The objectives of this study were to describe the daytime nap durations of Japanese nursery school children and to elucidate their relationship to nocturnal bedtimes. Methods: The mothers of 967 children between 0 and 5 years of age recorded sleep logs for 9 consecutive nights. Considering the fact that the subject children were scheduled to take a nap on weekday afternoons, we investigated the proportion of children napping and the relationship between daytime nap duration and nocturnal bedtime on the basis of the data obtained on weekends when children were free from a specific nap schedule. Results: The percentage of children who habitually took a nap was 100% in those under 1 year old, and the percentages were 96.8%, 81.8%, 53.4%, 28.0%, and 9.0% in 1-, 2-, 3-, 4-, and 5-year-old children, respectively. There were significant relationships between nap duration and bedtime in the corresponding night in 2- to 5-year-old children. The “two hours or more” nap group showed a significantly later bedtime than the “no nap” and the “one hour or more but less than two hours” groups in the 2-year-old children (p <0.01 for both). The “two hours or more” nap group showed a significantly later bedtime than the other groups (p <0.01), and the “one hour or more but less than two hours” nap group showed a significantly later bedtime than the “no nap” group in the 3-year-old children (p <0.05). In the 4- to 5-year-old children, the “one hour or more but less than two hours” and “two hours or more” nap groups showed a significantly later bedtime than the “no nap” group (p <0.01 for both). Conclusion: Daytime naps naturally become less common after the third birthday among Japanese nursery school children. The longer the nap durations in 2- to 5-year-old children, the later they went to bed on the corresponding night. [Copyright &y& Elsevier]

Teachers in Japan often have their children sit down simultaneously, to foster a whole-class participation structure. This study analyzed changes in the sitting behavior of 3-4 year old children after they entered a public nursery school. The process of preparation for a birthday party was videotaped monthly over a three-month period, and participants' speech and behavior was extracted from the video. Analyses indicated that the time needed to start the party became shorter over the three-months. The sitting behavior of each child suggested that two distinct changes contributed to the quicker preparation. First, children who were reluctant to take their seats when they first entered the nursery school became able to sit down immediately when their chairs were set. Second, children who often changed their posture from sitting to standing and vice versa became able to refrain from standing. These results suggest that through group experiences at nursery school children change the meaning of "standing" from a neutral behavior to a socially prohibited behavior. [ABSTRACT FROM AUTHOR]

Previous studies have reported the inappropriate administration of medication at nursery schools by the staff and a lack of drug-related information from caregivers at the time of request. However, the situation concerning medication administration at nursery schools from the mothers' perspective is unknown and it is not clear what information the mothers provided to nursery staff at the request. We conducted an online survey between April and May 2019 regarding the administration of medication at the nursery school with input from 600 mothers. Overall, 510 (85%) individuals replied that the requests to administer medication were acceptable for all or some of the medications. Application forms for medications were used by 91% of the 301 mothers who had previously made such requests. Although information including the child's name, medication times, illness of the child, parent's name, and dosage form was specified by over 70% of mothers, drug-related information such as effectiveness, side effects, and drug interactions was insufficient. In total, 41 instances of inappropriate medication administration by staff were reported by 35 mothers. It is suggested that the drug information sheets provided by community pharmacies should make up for inadequate drug-related information on application forms for medications to avoid the risk of adverse events and reduce staff burden. Toward this end, it is necessary to provide easily understandable information sheets for nursery staff, as the medication is usually administered by nursery staff, not a nurse. Community pharmacists should support these measures as pharmaceutical professionals.

Background: A better understanding of the epidemiology of pediatric out-of-hospital cardiac arrest (OHCA) occurring in nursery schools and kindergartens is indispensable to establish an evidence-based strategy for prevention and improved outcomes. This study aimed to describe the incidence, characteristics, and outcomes of pediatric OHCAs that occurred in certified nursery schools and kindergartens., Methods: Stop and Prevent cardIac aRrest, Injury, and Trauma in Schools (SPIRITS) is a study to construct and analyze a nationwide registry of pediatric OHCAs occurring in school settings in Japan. Using data from the SPIRITS registry, we assessed the incidence, characteristics, and outcomes of pediatric OHCAs that occurred in certified nursery schools/kindergartens between April 2008 and December 2016., Results: During the study period, 37 OHCA patients (31 in certified nursery schools and 6 in kindergartens) were confirmed. The overall incidence rate was 0.13 per 100,000 children per year. Among 37 patients, 57% (21/37) had an OHCA while napping and 35% (13/37) experienced OHCA that was witnessed by bystanders. Although public-access automated external defibrillator pads were applied by bystanders in 24% (9/37) of cases, only 1 patient actually received defibrillation. Overall, the proportion of 1-month survival with favorable neurological outcomes after OHCA was 19% (7/37). Among those with OHCA of non-medical origins, 60% (3/5) of patients experienced arrest caused by suffocation, 60% (3/5) by drowning, and 100% (1/1) by head injury. In contrast, no patient had 1-month favorable neurological outcomes among those with OHCA of medical origins such as presumed cardiac origin (0/17), sudden infant death syndrome (0/6), acute viral myocarditis (0/1), respiratory disease (0/1), and ventricular fibrillation (0/1)., Conclusions: In this population, the majority of pediatric OHCAs occurring in certified nursery schools/kindergartens had non-ventricular fibrillation rhythm, and their outcomes after OHCA of medical origin were poor., (Copyright © 2020. Published by Elsevier Ltd.)

Access to green space (GS) is vital for children's health and development, including during daycare. In Japan, deregulation to alleviate daycare shortages has created a new category of so-called unlicensed daycare centers (UDCs) that often lack dedicated GS. UDCs rely on surrounding GS, including parks, temples and university grounds, but reports of conflicts highlight the precarity of children's well-being in a rapidly aging country. Knowledge about GS access in Japanese UDCs remains scarce. Our mail-back survey (n = 173) of UDCs and online survey (n = 3645) of parents investigated threats to GS access during daycare across 14 Japanese cities. Results suggest that UDCs use a variety of GS and aim to provide daily access. Caregivers are vital in mediating children's access, but locally available GS diversity, quality and quantity as well as institutional support were perceived as lacking. Parents did not rank GS high among their priorities when selecting daycare providers, and showed limited awareness of conflicts during GS visits. Implications of this study include the need for caregivers and parents to communicate and collaborate to improve GS access, and the importance of strong public investment into holistically improving GS diversity, quality and quantity from the perspective of public health and urban planning.

Background: There are no reports on the prevalence and social acceptance of food allergies (FAs) and FAinduced symptoms in nursery schools in Japan., Purpose: The purpose of this study is to clarify the current status of FA among children in nurseries., Methods: Investigations were conducted in childcare facilities nationwide through survey request forms found on the Web page or sent via post., Result: We received responses from 15722 out of the 32210 institutions (48.8%) to whom survey request forms were sent.The overall prevalence of FA was 4.0%, with 6.4% at age less than 1 year, 7.1% at age 1, 5.1% at age 2, 3.6% at age 3, 2.8% at age 4, 2.3% at age 5, and 0.8% at age 6. Ninety-three point four percent of the institutions responded that they catered to children with FA, whereas 3.3% of the institutions responded that they did not. The details of the meal service were as follows: 52.4% were meals without causative foods, 39.5% were alternative meals without causative foods, and 3.3% were packed lunches from home. Seven point six percent of infants had at least one FA symptom in the institutions., Conclusion: Several nursery schools were accepting children with FA, and school lunches were also modified by removing causative food and providing alternative meals. On the other hand, several infants experience FA-induced symptoms, and it is necessary for each department to establish a system to reduce accidental ingestion and to ensure proper emergency response.