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Aim: The purpose of this study was to examine the trend in human papillomavirus (HPV) vaccination rates in Japan before and after a policy change in 2022, involving resumption of active recommendation and start of catch‐up vaccination. Methods: From 2021 to 2023, a web‐based questionnaire survey was administered to newly enrolled female college students in Yokohama, Japan. The questionnaire included items such as age, HPV vaccination status, HPV vaccine awareness, and awareness of catch‐up vaccination. We compared knowledge about the HPV vaccine and cervical cancer in 2021 and 2023, before and after resumption of the national vaccination program. Results: The HPV vaccination rates were 5.4% in 2021, 7.5% in 2022, and 35.3% in 2023, with a significant upward trend (p < 0.001). A similar upward trend was observed for HPV vaccine awareness (p < 0.001). Comparing 2022 and 2023 after the start of catch‐up vaccination, there was no significant difference in awareness of catch‐up vaccination (p = 0.669), but there was a significant increase in awareness of free vaccination tickets (p < 0.001). After resumption of the national vaccination program with adoption of the catch‐up vaccination program, there was no difference in knowledge of cervical cancer, but there was a difference in knowledge of the HPV vaccine. Conclusions: Although the HPV vaccination rate has increased after the policy change, it has not recovered to the level before the suspension of active recommendation. It is important for healthcare providers and school educators to actively communicate the safety and effectiveness of the HPV vaccine. [ABSTRACT FROM AUTHOR]

Background: This study developed a short version of a scale measuring attitudes toward people living with dementia, the Four‐Item Attitudes toward People Living with Dementia Scale (APDS4), that could be included in a large population survey. Methods: We used three datasets from Japan: a web panel survey, a community‐based mail survey, and data from a randomised controlled trial on dementia education. The original scale used was the Attitudes toward People Living with Dementia Scale developed by Kim and Kuroda. Test–retest reliability and item response theory analyses were used to reduce the number of items. The reliability, internal consistency, validity, and responsiveness of the short version were evaluated. Results: Six items with low test–retest reliability and four items with low discrimination parameters were removed from the 14‐item scale. The APDS4, consisting of four items, had test–retest reliability and internal consistency comparable to those of the original scale. Confirmatory factor analysis indicated that the APDS4 fit a unidimensional model. The validity of the APDS4 was confirmed by significant associations between the APDS4 scores and the original scale scores, knowledge of dementia, helping behaviour intentions toward people living with dementia, helping behaviour experience, attending the Dementia Supporter Training Course, and engagement in healthcare jobs. In a randomised controlled trial dataset, the APDS4 was more responsive to educational interventions than the original scale. Conclusion: The shortened APDS4 was established as a reliable, validated, and responsive scale. This scale can be used efficiently in population surveys to evaluate dementia‐friendly initiatives at the community level. [ABSTRACT FROM AUTHOR]

Background: Outcome measures during acute cardiovascular disease (CVD) phases, such as quality of death, have not been thoroughly evaluated. This is the first study that compared the family members' perceptions of quality of death in deceased CVD patients and in deceased cancer patients using a bereaved family survey. Methods: Retrospectively sent questionnaire to consecutive family members of deceased patients with CVD from ten tertiary hospitals from October 2017 to August 2018. We used the short version of the Good Death Inventory (GDI) and assessed overall care satisfaction. Referencing the GDI, the quality of death was compared between CVD patients admitted to a non-palliative care unit (non-PCU) and cancer patients in palliative care units (PCU) and non-PCUs in the Japan Hospice and Palliative Care Evaluation Study (J-HOPE Study). Additionally, in the adjusted analysis, multivariable linear regression was performed for total GDI score adjusted by the patient and participant characteristics to estimate the difference between CVD and other patients. Results: Of the 243 bereaved family responses in agreement (response rate: 58.7%) for CVD patients, deceased patients comprised 133 (54.7%) men who were 80.2 ± 12.2 years old on admission. The GDI score among CVD patients (75.0 ± 15.7) was lower (worse) than that of cancer patients in the PCUs (80.2 ± 14.3), but higher than in non-PCUs (74.4 ± 15.2). After adjustment, the total GDI score for CVD patients was 7.10 points lower [95% CI: 5.22–8.97] than for cancer patients in PCUs and showed no significant differences compared with those in non-PCUs (estimates, 1.62; 95% CI [-0.46 to 5.22]). Conclusions: The quality of death perceived by bereaved family members among deceased acute CVD patients did not differ significantly from that of deceased cancer patients in general wards, however, was significantly lower than that of deceased cancer patients admitted in PCUs. [ABSTRACT FROM AUTHOR]

Aim: Minimally invasive surgery (MIS) has been introduced as an alternative to more radical surgical procedures. The Japan Society of Gynecologic and Obstetric Endoscopy and Minimally Invasive Therapy conducted a cross‐sectional questionnaire survey to ascertain the status of MIS for endometrial cancer. Methods: The survey was conducted between May 10 and June 30, 2022. The questionnaire included information on personal attributes, academic affiliations, qualifications, hysterectomies, and intraoperative procedures performed. Results: The total number of questionnaire respondents was 436 (9.2% of the membership). The hysterectomy methods and percentage performed were as follows: simple total hysterectomy (equivalent to benign surgery), 3%; simple total hysterectomy with care to avoid shaving the cervix, 31%; extended total hysterectomy, 48%; and modified radical hysterectomy, 15%. An analysis of hysterectomies performed using MIS for endometrial cancer by qualified gynecologists of endoscopy or board‐certified gynecologic oncologists showed a tendency not to choose simple total hysterectomy compared to the gynecologists who did not hold certification (p = 0.019, p = 0.045, and p = 0.010, respectively). Additionally, 67% of respondents did not use uterine manipulators, and 59% of the respondents did not perform lymph node dissection following the guidelines for treating endometrial cancer in Japan. Conclusion: This study provided the current status of MIS for endometrial cancer in Japan. The hysterectomy method, use of uterine manipulators, and criteria for omitting lymph node dissection were generally in agreement with the guidelines. Currently, an extra‐fascial simple hysterectomy, including at least not shaving the cervix, was a major method for early invasive endometrial cancer using MIS. [ABSTRACT FROM AUTHOR]

Introduction: Information on the implementation of continuous renal replacement therapy (CRRT) in pediatric intensive care units (PICUs) is limited. We investigated the real‐world practice of this therapy in Japan. Methods: We conducted a cross‐sectional survey of 26 hospitals with PICUs in Japan. One physician per hospital responded to the questionnaire. Results: Fewer than half of the hospitals followed the CRRT practice guidelines; treatment options were often selected at a physician's discretion. PICUs varied widely in continuous renal replacement settings, circuit priming methods, frequency of circuit exchange, and policies for using CRRT in sepsis. Only two anticoagulants were used: nafamostat mesylate and unfractionated heparin. Most units did not change the nutritional dosage according to CRRT use. Many facilities were proactive concerning rehabilitation. Conclusion: Nafamostat‐centered anticoagulation management was unique to Japan. Our results may help identify areas where additional clinical studies are needed to standardize CRRT practice. [ABSTRACT FROM AUTHOR]

Background: To our knowledge, no nationwide epidemiological study of myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) has been conducted. Objective: We examined the epidemiology and clinical features of MOGAD in Japan. Methods: We distributed questionnaires on the clinical characteristics of patients with MOGAD to neurology, pediatric-neurology, and neuro-ophthalmology facilities throughout Japan. Results: In total, 887 patients were identified. The estimated number of total and newly diagnosed MOGAD patients was 1,695 [95% confidence interval (CI): 1483–1907] and 487 (95% CI: 414–560), respectively. The estimated prevalence and incidence were 1.34/100,000 (95% CI: 1.18–1.51) and 0.39/100,000 (95% CI: 0.32–0.44), respectively. The median age at onset was 28 years (range: 0–84 years). At onset, optic neuritis was present in approximately 40% of patients, irrespective of the onset age. Acute disseminated encephalomyelitis was more frequent in younger patients, whereas brainstem encephalitis, encephalitis, and myelitis were more frequent in elderly patients. Immunotherapy was highly effective. Conclusion: The prevalence and incidence rates of MOGAD in Japan are similar to those in other countries. Notable characteristics such as the preferential occurrence of acute disseminated encephalomyelitis in children exist; however, general characteristics including symptoms and treatment response are common irrespective of the onset age. [ABSTRACT FROM AUTHOR]

Background: Awareness, knowledge, beliefs, and behavioral intentions of physical activity (PA) guidelines may be important mediating factors for promoting PA. However, these pathways of the psychological process to PA behavior have not been examined. These pathways may differ depending on health literacy levels. This study investigated the pathways to PA, from guideline awareness to behavior, and further examined whether they differed by health literacy. Methods: A cross-sectional study was conducted with 7,000 Japanese participants aged 20–69 years. The participants were registered with an Internet survey company. Participants' awareness, knowledge, beliefs, and behavioral intentions regarding the PA guidelines of Japan, the volume of moderate-to-vigorous intensity PA, activity level, and health literacy were examined through a questionnaire. The PA pathways, from guideline awareness to behavior, were examined by structural equation modeling (SEM), with PA behavior as the dependent variable. Multi-group SEM was conducted to examine the moderating effect of health literacy on PA pathways. Health literacy scores were dichotomized into high and low groups in multi-group modeling by the median split. Results: SEM revealed that PA guideline awareness directly affects PA behavior and has certain indirect effects through the mediation of knowledge, beliefs, and behavioral intentions. Furthermore, the multi-group SEM showed that the proportion of indirect effects (path coefficient [PC]: 0.11, 95% confidence interval [CI]: 0.10–0.13) was higher than direct effects (PC: 0.07, 95%CI: 0.03–0.11) in the high-health literacy group. In contrast, the proportion of direct effects (PC: 0.22, 95%CI: 0.15–0.30) was higher than indirect effects (PC: 0.06, 95%CI: 0.05–0.07) in the low-health literacy group. Conclusions: PA guideline awareness is both directly and indirectly associated with PA behavior, mediated by psychological pathways of knowledge, beliefs, and behavioral intentions, and influenced by health literacy. These results suggest that health literacy should be considered when implementing PA guideline-based interventions. [ABSTRACT FROM AUTHOR]

This study investigated nurses' and patients' perceptions of hospital room environment and patient pajama design. Nurses working in a Japanese university hospital and patients aged 20 and older were surveyed. Over 75% of patients rated the hospital environment and hospital rooms as "very good" or "good," but less than one in three nurses rated them similarly. Patients were more likely than nurses to rate rental pajamas as "very good" or "good." Contrary to the nurses, only about one in four patients valued wearing well-designed pajamas. Nurses' and patients' perceptions differed regarding hospital pajamas, but not about improving hospital rooms. [ABSTRACT FROM AUTHOR]

Objectives: Hereditary angioedema (HAE) is a rare disease with acute attacks in the skin and mucosa throughout the body including life-threatening laryngeal edema and abdominal attacks with severe pain. Physicians, regardless of specialty, may encounter HAE patients in their daily practice; however, low disease awareness may attribute to a considerable number of undiagnosed HAE patients in Japan. This study aims to identify issues associated with the diagnosis processes of HAE and to determine levels of HAE awareness among Japanese physicians from various specialties. Methods: A web-based quantitative survey was conducted using a physicians panel. Physicians from the following departments were included in the survey: internal medicine, dermatology, pediatrics, emergency medicine, and gastroenterological surgery. Results: The proportions of physicians in dermatology, pediatrics, emergency medicine, internal medicine, and gastroenterological surgery who were able to select the C1-INH activity test as a diagnosis test for potential HAE patients were 71.8%, 59.7%, 57.1%, 40.3%, and 25.7%, respectively. Multivariate analysis showed significant association between physicians who selected "strongly suspected" AE based on the case-scenario and physicians who had knowledge of the essential HAE symptoms (laryngeal edema, swelling after tooth extraction, swelling of the tongue, and abdominal pain). Conclusions: This study showed that disease awareness of HAE varied among medical specialties, suggesting the importance of educational activities in academic societies and specialist accreditation in raising HAE awareness. Proper knowledge of complement testing and HAE symptoms may help not only to diagnose patients with AE-like symptoms as AE but also to differentially diagnose HAE from AE. [ABSTRACT FROM AUTHOR]

Background and Objectives: All 4 previous nationwide surveys of multiple sclerosis (MS) in Japan were conducted before the discovery of anti-aquaporin-4 (AQP4) antibodies; thus, neuromyelitis optica spectrum disorder (NMOSD) was included in MS, as optic-spinal MS. We aimed to clarify the epidemiologic features and trends of MS and NMOSD in Japan separately using a fifth nationwide survey., Methods: The primary survey, in which a questionnaire was sent to 3,799 selected departments (including neurology/internal medicine, pediatrics, and ophthalmology), explored the estimated number and prevalence of patients with MS or NMOSD in 2017, and the secondary survey collected detailed characteristics of the patients using a second questionnaire., Results: The response rates for the primary and secondary surveys were 60.1% and 53.9%, respectively. The estimated total number of patients with MS or NMOSD was 24,800, 2.5-fold higher than that in the fourth survey in 2003. The crude prevalence was 19.6 per 100,000 patients (14.2 for MS and 5.4 for NMOSD), compared with 7.7 per 100,000 patients in the fourth survey. Patients with MS showed milder disability (median Expanded Disability Status Scale [EDSS] score: 2.0 [interquartile range 1.0-4.5] vs 2.5 [1.0-6.0]), decreased secondary progression (8.5% vs 15.2%), and increased usage of disease-modifying drugs (63.7% vs 37.2%) compared with those with conventional MS in the fourth survey. The proportions of oligoclonal bands and Barkhof criteria fulfillment on MRI, which are features of classical MS, increased with advancing year of birth. Patients with NMOSD also showed less disability and shorter disease duration than patients with optic-spinal MS in the fourth survey (EDSS score: 3.5 [2.0-5.5] vs 3.8 [2.0-6.0]; disease duration: 8.0 [3.9-14.8] vs 10.0 [5.0-16.0]). Among patients with NMOSD, disability was exacerbated by a history of longitudinally extensive spinal cord lesions and anti-AQP4 antibody positivity, which both decreased with advancing year of birth., Discussion: The prevalences of MS (particularly with classical features) and NMOSD have been increasing in Japan, suggesting the contribution of environmental factors. However, disabilities in patients with MS and NMOSD have been mitigated. Extensive usage of various disease-modifying drugs could be a factor contributing to this disability mitigation in MS.

Background: This study aimed to determine the actual working conditions, including working hours and desired future working styles of hospital pediatricians and obstetricians/gynecologists (OB/GYNs) in Tokushima Prefecture., Method: This cross-sectional study used a self-administered questionnaire. Pediatricians and OB/GYNs (n = 96) working at 14 hospitals in Tokushima Prefecture were surveyed. The questionnaire included items related to working hours, working status, number of medical institutions, task-shifting/task-sharing status, and preferred work style. Factors associated with work hours were analyzed., Results: Approximately 40% and 10% of pediatricians and OB/GYNs worked ≥60 h/week and ≥80 h/week, respectively. Their weekly working hours were significantly positively associated with the number of nights and holidays worked and concurrent medical facilities they worked at. Multiple regression models showed that weekly working hours were significantly associated with working at night and day-off duties and the number of working medical institutions being worked at concurrently. Pediatricians and OB/GYNs who worked ≥60 h/week were not implementing a "multiple attending physician system" or "on-call system," and task-shifting/task-sharing was inadequate. A significantly higher proportion of physicians who worked long hours (≥60 h/week or ≥80 h/week) wanted to reduce the number of night and day-off duties and work hours compared with those who did not., Conclusions: The results of this study suggest that many pediatricians and OB/GYNs work long hours, and it is essential to improve their work environment, including task-shifting/task-sharing. Further enhanced recruitment and retention of hospital pediatricians and OB/GYNs is required. A detailed and large-scale study of pediatricians and OB/GYNs' working environments is essential in the future., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Nakagawa et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Prolonged sedentary behavior in pregnant women is reported to be associated with worse health-related indices and pregnancy outcomes. The aim of this study was to identify relevant factors that can be targeted in interventions to reduce sedentary behavior during pregnancy., Methods: Of 103,057 pregnancies registered in the Japan Environment and Children's Study, 83,733 pregnant women were included for analysis after excluding multiple enrollments, nonresponses, and missing outcome data. Data were collected using the International Physical Activity Questionnaire and analyzed using logistic regression models to calculate crude and adjusted odds ratios. Missing data were handled using multiple imputations, and statistical analyses were performed using SAS software., Results: Mean sedentary behavior time increased from 5.4 h/day before pregnancy to 5.9 h/day during pregnancy. The percentage of women classified in the high sedentary behavior group increased from 25.6% before pregnancy to 31.2% during pregnancy. Factors associated with high sedentary behavior during pregnancy included longer hours spent watching television and playing video games before pregnancy, higher annual household income, and working status during pregnancy. Possible protective factors against high sedentary behavior included engaging in ≥ 150 min of moderate to vigorous physical activity per week before pregnancy., Conclusions: This large-scale cohort study provides valuable insights into sedentary behavior patterns among pregnant women in Japan. To reduce the amount of time engaged in sedentary behavior during pregnancy, the planning and management of time spent watching TV and playing video games as well as establishing exercise habits before pregnancy are recommended., Competing Interests: Declarations Ethics approval and consent to participate The JECS protocol was reviewed and approved by the Ministry of the Environment’s Institutional Review Board on Epidemiological Studies (100910001) and the ethics committees of all participating institutions. All participants in this study provided written informed consent. The research protocol for the present study was approved by the Institutional Review Board of the University of Toyama (R2023172). Consent for publication Not applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Background: With the recent advent of technology, it is important to confirm the health and safety of the youth. This study aimed to prospectively evaluate the relationship between Wi-Fi, cordless phones, and mobile phone usage patterns and behavioral problems., Methods: This study involved 2465 children aged 8-17 years from the Hokkaido Study on Environment and Children's Health from October 2020 to January 2021, with a follow-up from September 2021 to March 2022. The mother-child dyad provided information on the presence of residential Wi-Fi and cordless phones, cordless phone call duration, and mobile phone usage pattern (duration of calls using mobile network and internet, online audio streaming, online video streaming, and playing online games) via a baseline questionnaire. Based on the scores on Strength and Difficulties Questionnaire at baseline and follow-up, the children were categorized into four groups: normal, persistent, improved, and concurrent., Results: No significant association was found between Wi-Fi, mobile phone calls via mobile networks, and behavioral problems. Cordless phone at home had higher odds for improvement in total difficulty scores, and cordless phone for calling more than 4 min per week had lower odds of persistent problematic prosocial behavior. Longer duration of mobile phone calling via the internet (>40 min/week) had higher odds of concurrent total difficulties. Mobile phone calling via mobile network for <5 min per week had higher odds for improved total difficulty scores. Audio streaming via mobile phones for 60-120 min had lower odds of persistent total difficulties., Conclusion: Our results showed sporadic findings between residential RF-EMF indoor sources and mobile phone usage pattern. These observed findings could be affected by residual confounding and chance findings. Ongoing follow-up studies are necessary to further explore this association through detailed exposure assessment and addressing the potential limitations of our study., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Reiko Kishi reports financial support was provided by Japanese Ministry of Internal Affairs and Communications. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Inc.)

Background: During the COVID-19 pandemic, an increased need for novel solutions such as digital contact tracing apps to mitigate virus spread became apparent. These apps have the potential to enhance public health initiatives through timely contact tracing and infection rate reduction. However, public and academic scrutiny has emerged around the adoption and use of these apps due to privacy concerns., Objective: This study aims to investigate public attitudes and preferences for contact tracing apps, specifically in Japan, using conjoint analysis to examine what specifications the public values most in such apps. By offering a nuanced understanding of the values that citizens prioritize, this study can help balance public health benefits and data privacy standards when designing contact tracing apps and serve as reference data for discussions on legal development and social consensus formation in the future., Methods: A cross-sectional, web-based questionnaire survey was conducted to determine how various factors related to the development and integration of infectious disease apps affect the public's intention to use such apps. Individuals were recruited anonymously by a survey company. All respondents were asked to indicate their preferences for a combination of basic attributes and infectious disease app features for conjoint analysis. The respondents were randomly divided into 2 groups: one responded to a scenario where the government was assumed to be the entity dealing with infectious disease apps (ie, the government cluster), and the other responded to a scenario where a commercial company was assumed to be this entity (ie, the business cluster). Samples of 500 respondents from each randomly selected group were used as target data., Results: For the government cluster, the most important attribute in scenario A was distributor rights (42.557), followed by public benefits (29.458), personal health benefits (22.725), and profit sharing (5.260). For the business cluster, the most important attribute was distributor rights (45.870), followed by public benefits (32.896), personal health benefits (13.994), and profit sharing (7.240). Hence, personal health benefits tend to be more important in encouraging active app use than personal financial benefits. However, the factor that increased motivation for app use the most was the public health benefits of cutting infections by half. Further, concern about the use of personal data collected by the app for any secondary purpose was a negative incentive, which was more significant toward app use compared to the other 3 factors., Conclusions: The findings suggest that potential app users are positively motivated not only by personal health benefits but also by contributing to public health. Thus, a combined approach can be taken to increase app use., (©Seiji Bito, Yachie Hayashi, Takanori Fujita, Ikuo Takahashi, Hiromi Arai, Shigeto Yonemura. Originally published in JMIR Public Health and Surveillance (https://publichealth.jmir.org), 14.11.2024.)

Background: Apathetic and depressive symptoms are frequently observed among older adults, and are risk factors for functional decline and dementia progression. However, how these symptoms influence functional capacity remains unclear. This study investigated the relationship between apathetic and depressive symptoms and functional capacity, considering the interaction between apathetic and depressive symptoms., Methods: A cross-sectional questionnaire survey targeting community dwelling middle-aged or older adults was conducted. We sent a questionnaire to 984 individuals and received 320 responses. Data with missing values and participants aged under 50 were excluded, resulting in 212 participants (88 men and 124 women, mean age = 73.4 ± 9.3 years). Apathetic symptoms were evaluated using the Dimensional Apathy Scale (J-DAS), which comprises executive, emotional, and cognitive and behavioral initiation aspects of apathy. Depressive symptoms were evaluated using the Geriatric Depression Scale (GDS). Functional capacity was assessed using the Japan Science and Technology Agency Index of Competence, which comprises technology usage, information practice, life management, and social engagement., Results: Mean score of each J-DAS factor and GDS was 5.3 ± 3.4 (executive), 12.0 ± 3.0 (emotional), 11.8 ± 5.1 (initiation), and 4.5 ± 3.3, respectively. The emotional and initiation aspects of J-DAS were significantly associated with information practice (β = -0.15, p < .05 for emotional; β = -0.27, p < .001 for initiation) and life management (β = -0.20, p < .01 for emotional; β = -0.22, p < .01 for initiation) in functional capacity. GDS was associated only with social engagement (β = -0.31, p < .001). Although the interaction between the initiation factor of J-DAS and GDS was significantly associated with life management (β = -0.16, p < .05), the R 2 change was insignificant. The emotional factor of J-DAS was associated with technology usage (β = -0.13, p < .05), although less strongly than age. The executive factor of J-DAS had insignificant associations with all aspects of functional capacity., Conclusions: Apathetic and depressive symptoms are independently, rather than interactively, associated with different aspects of functional capacity. As older adults with apathetic or depressive symptoms might struggle to seek help from public health services, they should be targeted with active interventions from healthcare professionals., Competing Interests: Declarations Ethics approval and consent to participate Informed consent was obtained from all subjects. Participants were informed about the objective of research, freedom to consent and retraction, and contact name along with the questionnaire. As the questionnaire was anonymous, answering it was assumed as consenting to the survey. The Ethics Committee of Hirosaki University School of Medicine approved the study (number: 2020 − 109). Consent for publication Not applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

The final disposal of the soils removed from the area affected by the Fukushima nuclear accident will be carried out by 2045. This study investigated how acceptance of final disposal differed between top-down, opinion-aggregative, and opinion-reflective approaches to the decision outcome, and what factors influenced these differences. In 2022, a survey of 3000 randomly selected participants living outside Fukushima Prefecture was conducted using the postal method, with responses obtained from 871 consenting participants. The proportions of respondents who agreed to accept the final disposal were 22.6, 37.6 and 56.9% for the top-down, opinion-aggregative, and opinion-reflective approaches, respectively. The preferences for both opinion-aggregative and opinion-reflective approaches showed significant positive associations with interest in final disposal and social benefits, and significant negative associations with intergenerational expectations and age. This study highlights the importance of procedural fairness in determining final disposal sites, and identifies factors that contribute to greater acceptance through this process., (© The Author(s) 2024. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

People generally wish to return home after being evacuated due to disaster situations. Evacuation orders have now been lifted in the Fukushima region following the nuclear accident in 2011, and the Japanese government is promoting a return policy. However, many residents who wish to return home remain unable to and continue living in evacuation sites or other areas. Sixteen residents of Katsurao village were interviewed after evacuation orders were lifted in 2016 who have not yet returned. Concerns were cited regarding radiation, prolonged evacuation, health problems, buying a house in the evacuation area and schooling. The problems identified were primarily due to the rapid ageing and decline of the regional population, reflecting similar issues throughout Japan. In particular, health problems and intention to return were thought to be closely related. Over 10 y have passed since the evacuation, and many residents have experienced familial separation and divided living situations., (© The Author(s) 2024. Published by Oxford University Press.)

The implementation of home-care robots is sometimes unsuccessful. This study aimed to explore factors explaining people's willingness to use home-care robots, particularly among care recipients and caregivers. Surveys were conducted in Japan, Ireland, and Finland. The survey questionnaire comprised four categories (familiarity with robots, important points about home-care robots, functions expected from home-care robots, and ethically acceptable uses), with 48 items assessing users' willingness to use home-care robots. The responses from 525 Japanese, 163 Irish, and 170 Finnish respondents were analyzed to identify common and distinct factors influencing their willingness to use these robots. Common factors across the countries included "willingness to participate in research and development," "interest in robot-related news," and "having a positive impression of robots". The distinct factors for each country were: "convenience" in Japan; "notifying family members and support personnel when an unexpected change occurs in an older person" in Ireland; and "design" in Finland. Therefore, developers should determine potential users' willingness to participate in the research and development of home-care robots and consider a system that involves them in the development process., Competing Interests: Declarations Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

The nursing practice environment is essential for improving the quality of nursing practice and patient service. Performing secondary analysis of data from the work environment for hospital nurses in Japan (WENS-J) study, this research investigated whether an improved, healthier work environment could enhance nurses' psychological empowerment. Self-administered questionnaire responses of 2,438 participants from 23 participating general hospitals with over 200 beds in municipalities with a population of 200,000 or more were analyzed. The questionnaire recorded participating nurses' demographic characteristics and utilized two scales: the Practice Environment Scale of the Nursing Work Index (PES-NWI) and the Psychological Empowerment Instrument (PEI), which identified adequate work environments and measured the internalization of organizational goals and objectives, respectively. Most participants (93.7%) were female nurses with a mean age of 33.7 years. Multilevel analysis (hierarchical linear models) revealed that the total PEI score was significantly related to the PES-NWI composite score and all subscales after adjusting for nurses' demographic characteristics, such as age (coefficient 0.33-0.72, all p < .001). The results suggest that a work environment such as that presented in the PES-NWI may contribute to nurses' psychological empowerment. These findings could provide insight for creating healthier work environments., (© 2024. The Author(s).)

Objectives: In recent years, Japan has experienced a series of earthquakes and torrential rain disasters in various regions, and in Gifu City, there is concern about the possibility ofNankai Trough earthquakes in the near future. However, pharmacists' awareness of disaster preparedness and status of drug stockpiles in pharmacies are not clearly outlined., Methods: A survey on disaster prevention and stockpiling was conducted in 286 pharmacies in Gifu City. Data were collected from August to the end of October 2022. A simple aggregate was used in the study., Results: The response rate was 66.8% (191 pharmacies). Among them, 9.9% (19 pharmacies) had stockpiles of medicines for disasters, in which 33.3% of the medicines needed in the early stages of a disaster were above the average overall stockpiling rate. In addition, 2.1% (4 pharmacies) selected medicines according to national or prefectural manuals, and 96.3% (184 pharmacies) preferred to have the "national or local government" bear the cost of stockpiling., Conclusions: This study allowed us to understand the stockpiling situation of pharmacies in Gifu City in event of a disaster such as the Nankai Trough earthquake, which is likely to occur in the future. Based on these results, it is necessary to consider measures for disaster stockpiling.

Introduction: Discharge planning involves coordinating between different care settings. Failed coordination can lead to delayed care at the facilities receiving discharged patients. Nurses who implement discharge planning must consider the circumstances of the staff receiving the discharged patients., Objective: This study aims to develop a nurses' perspective-taking scale for measuring the cognitive process of imagining a staff's situation when receiving discharged patients., Methods: An online survey was conducted from September to November 2021 with nurses in Japanese acute care hospitals, using a 20-item questionnaire based on interviews and a literature review. Item reduction was conducted based on inter-item correlations, item-total correlations, and exploratory factor analysis. Confirmatory factor analysis was performed. For the exploratory and confirmatory factor analysis, the samples were randomly split in half and tested. Cronbach's alpha, intraclass correlation coefficients, and correlation coefficients were calculated using both self-developed and pre-existing measures., Results: The questionnaire was distributed to 1,289 individuals, and 416 valid responses were obtained. Item reduction and exploratory factor analysis resulted in a 10-item scale with two subscales, "imagine-other" (six items), which is imagining the other person's situation, and "imagine-self" (four items), which is imagining oneself in the other person's situation. The goodness-of-fit indices were as follows: comparative fit index, 0.95; root mean square error of approximation, 0.08; and standardized root mean squared residual, 0.06. Correlation coefficients with existing scales were 0.38, 0.57, and -0.33. Cronbach's alpha was 0.89, and the intraclass correlation coefficient was 0.54., Conclusion: The newly developed scale proved to be reliable, valid, and suitable for use. This scale can measure the degree of perspective-taking by nurses, which can improve collaboration between facilities and the effectiveness of discharge planning., Competing Interests: The authors declare that there is no conflict of interest., (Copyright: © 2024 Tanaka et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Introduction: Assertive Community Treatment (ACT), which was developed in the 1970s in the USA, is a programme that supports people with severe mental illness living in the community through a multidisciplinary team, individual care and outreach approach. It is widely known that ACT effectively decreases hospital stays and improves Global Assessment of Functioning scores. In Japan, empirical studies on ACT were conducted in the late 2000s. Through the introduction of the standardised programme and domestic network, its implementation nationwide was anticipated. However, to date, the implementation of ACT is limited. There has been no comprehensive research in Japan on what inhibits and promotes the implementation of ACT in community mental health settings. Therefore, in this study, we aimed to systematically and comprehensively investigate the factors influencing the implementation of ACT in Japan using implementation research., Methods and Analysis: A qualitative study will be conducted using semistructured interviews with key stakeholders in the ACT team. Interviews will be conducted face-to-face or online, using an interview guide. The inclusion criteria are present and past ACT teams. Recruitment will be in two steps. A preinterview questionnaire will be sent to the members of the Community Mental Health Outreach Association regarding their basic characteristics and fidelity to the ACT model, and purposive sampling will be performed based on it. The Consolidated Framework for Implementation Research will be used to collect and analyse the interview data according to the qualitative content analysis, with reference to the fidelity category, because this will help to find influencing factors by identifying constructs that appear to distinguish between high-fidelity and low-fidelity teams., Ethics and Dissemination: This study has been approved by the Tokyo Medical University Ethics Approval Committee (approval number: T2022-0175). The findings will be shared via peer-reviewed journal publications and presentations to policymakers and service users., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: The diversification of information sources and changes in social structures necessitates updates on the state of public awareness of palliative care. Therefore, we clarified the status and determinants of awareness, information sources, and beliefs, regarding palliative care in Japan., Methods: This nationwide cross-sectional survey included 10 000 participants aged ≥20 years enrolled through random sampling using a two-stage stratification in 2023. We used a mailed self-administered questionnaire (INFORM Study 2023). The questionnaire items were selected (partially modified) from the Health Information National Trends Survey (USA) to ensure comparability, included palliative care awareness, information sources, and beliefs. Weighted logistic regression was conducted to explore the determinants of awareness., Results: Of the 3452 participants that responded (response rate: 35.3%), 65.2% had palliative care awareness. The weighted logistic regression analysis revealed that respondents less likely to have any palliative care awareness were younger, were male, had limited education history, had lower household income, and were non-Internet users. Of these, sex had the clear association (adjusted odds ratio for female vs. male: 3.20 [95% CI: 2.66-3.85]). Across all age groups, healthcare professionals (58.5%) and the Internet (30.5%) were the most trusted source of information. Younger participants frequently received information online. Most participants believed that palliative care was beneficial, although 82.0% associated it with death., Conclusions: The Japanese population had a relatively high palliative care awareness, with the majority trusting information from healthcare professionals rather than the Internet. Further efforts are warranted to address barriers to receiving trustworthy palliative care information., (© The Author(s) 2024. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permission@oup.com.)

Background: Previous reports indicated still low implementation rates of multigene testing for advanced non-small cell lung cancer (NSCLC) in Japan., Methods: This is a retrospective study launched at the initiative of lung cancer patients. Patients with stage IV NSCLC from January 2019 to December 2022 were investigated for testing of 8 actionable oncogenic drivers with targeted therapies available as of 2022., Results: A total of 15,719 patients were included. Between 2019 and 2022, the percentage of patients who were not tested for any actionable oncogenic drivers remained the same, ranging from 21.5% to 33.1%. However, since late 2021, the percentage of patients tested for five or more actionable oncogenic drivers has increased. Across hospital categories and regions, the number of actionable oncogenic drivers tested was similar., Conclusions: This patient-initiated national survey in Japan reveals the recent nationwide increase in testing rates for actionable oncogenic drivers in Advanced NSCLC., (© 2024 The Author(s). Cancer Medicine published by John Wiley & Sons Ltd.)

Background: Telemedicine, or online medical care, has gained considerable attention worldwide. However, it has not been widely adopted in Japan, and the detailed status of received and provided online medical care and the reasons for its lack of popularity remain unknown., Objective: This study aims to investigate the current status of online medical care in Japan and the factors limiting its adoption from the perspective of both patients receiving and medical professionals providing online medical care., Methods: In total, 2 nationwide questionnaire surveys were conducted. The first survey, targeting both patients and healthy individuals, screened approximately 40,000 participants among 13 million people. The participants were selected to match the age distribution of the Japanese population based on government data, and their online medical care experience and medical visit status were recorded. To further investigate online medical care use and satisfaction, a web-based survey was conducted with 15% (6000/40,000) of the screened participants. The second survey, targeting medical professionals, was administered to a physician, a nurse, and a member of the administrative staff in each of 4900 randomly selected medical facilities to inquire about their online medical care practices and impressions. In addition, both surveys investigated the factors limiting online medical care expansion in Japan., Results: The response rates among patients and healthy individuals targeted for the screening and main surveys were 92.5% (36,998/40,000) and ˃80% (1312/1478, 88.77%; 1281/1522, 84.17%; 404/478, 84.5%; and 2226/2522, 88.26% in 4 survey groups), respectively. The survey of medical professionals yielded 1552 responses (n=618, 39.82% physicians; n=428, 27.58% nurses; n=506, 32.6% administrative staff). Although the facility-level response rate was low (794/4900, 16.2%), some facility categories had relatively high response rates. Only 5.29% (1956/36,998) of the patients and healthy individuals had online medical care experience. When there were more hospitals nearby and they felt it was more work to see a physician in person, they were more likely to use online medical care (more nearby hospitals: adjusted odds ratio [aOR] 1.33, 95% CI 1.18-1.50; more work: aOR 1.48, 95% CI 1.35-1.63 per survey response point in the patient group). Similarly, these factors were substantially associated with satisfaction (more nearby hospitals: aOR 1.40, 95% CI 1.14-1.73; more work: aOR 1.50, 95% CI 1.27-1.76 per survey response point in the patient group). In both surveys, the most frequently selected factor preventing the widespread use of online medical care was patients' need to switch to face-to-face medical care for mandatory tests and procedures. Inadequate awareness of and education on online medical care were also frequently selected., Conclusions: Our nationwide surveys provided insights into the current status of online medical care in Japan and simultaneously identified several problems and issues related to it, which will be useful in promoting its wider adoption., (©Yuka Sugawara, Yosuke Hirakawa, Masao Iwagami, Haruo Kuroki, Shuhei Mitani, Ataru Inagaki, Hiroki Ohashi, Mitsuru Kubota, Soichi Koike, Rie Wakimizu, Masaomi Nangaku. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 01.11.2024.)

Aim: In response to the growing popularity of mobile devices among older adults in Japan, this study aimed to establish a reliable and valid measure of mobile device proficiency by developing a Japanese version of the Mobile Device Proficiency Questionnaire (MDPQ-J) for the Japanese population., Methods: To evaluate the reliability and validity of the MDPQ-J, we administered the questionnaire to 100 young or middle-aged participants (37.78 ± 13.90 years, 57.00% women), and 62 older participants (75.90 ± 6.01 years; 59.68% women)., Results: The MDPQ-J showed a high degree of internal consistency (Cronbach's α = 0.98). Moreover, MDPQ-J scores in older participants tended to be lower than those in young or middle-aged participants. In terms of validity, the MDPQ-J score of older participants was significantly associated with age (ρ = -0.31), the amount of time using a mobile device per day (ρ = 0.64), and the system usability scale (ρ = 0.39). Additionally, the MDPQ-J scores were significantly positively associated with the importance (ρ = 0.37), performance (ρ = 0.57), and satisfaction (ρ = 0.29) associated with daily mobile device use in older participants., Conclusions: The high reliability and validity of the MDPQ-J in the Japanese population highlight its utility in adapting mobile devices for older adults, which is crucial in an increasingly digital society. Further research should explore the mediating role of mobile device proficiency in various health-related outcomes. Geriatr Gerontol Int 2024; 24: 1223-1232., (© 2024 The Author(s). Geriatrics & Gerontology International published by John Wiley & Sons Australia, Ltd on behalf of Japan Geriatrics Society.)

Objective: Understanding the characteristics of falls among older adults is necessary to prevent them. These characteristics include questions such as when (month and time), where (places), who (age), what (injury), why (trigger), and how (direction) the falls occur. The objective of this study was to identify the characteristics of falls in individuals aged 65-74 years (young-old), 75-84 years (old-old), and ≥85 years (oldest-old)., Methods: We conducted an observational mail survey among community-dwelling older adults in Japan and collected detailed information on the incidence of falls over the past 3 years. The month, time, location, trigger, direction, and resulting trauma of each fall were analyzed and compared across the different age groups (young-old, old-old, and oldest-old)., Results: A total of 1695 falls among 1074 community-dwelling older adults were analyzed in this study. Falls were frequent during May and October as well as during the winter season from December to February, especially between 10:00 a.m. and 11:00 a.m. These fall characteristics were consistent across all the age groups. There was a higher incidence of outdoor falls among relatively young older adults, which were typically caused by tripping or slipping. However, as one progresses with age, there is a higher incidence of falls indoors, typically due to loss of balance or leg entrapment. Approximately 60% of older fallers experience some form of injury due to falls, with fractures considered the most serious, occurring in ≈10% of all falls., Conclusion: We clarified the characteristics of falls including the "when, where, who, what, why, and how" of the fall. A future challenge is to use this valuable information to develop effective fall prevention programs for older populations worldwide. Geriatr Gerontol Int 2024; 24: 1181-1188., (© 2024 Japan Geriatrics Society.)

Aim: The impact of cognitive dysfunction-associated activities of daily living (ADL) on mortality and rehospitalization for heart failure has not yet been evaluated., Methods: We retrospectively evaluated DASC-21, the incidence of all-cause mortality, and rehospitalization for heart failure after discharge in 329 older patients with heart failure., Results: The mean age was 85.1 ± 7.4 years (62.6% women). There were 110 cases of death from any cause (33.4%) during 25.5 ± 16.1 months of follow-up and 166 cases of rehospitalization from heart failure (50.5%) during 16.1 ± 15.2 months of follow-up. The DASC-21 score was not significantly associated with an increased risk of all-cause mortality or rehospitalization. For each item of the DASC-21 questionnaire, defective route-finding (item 6) (HR = 2.631, P = 0.003), common sense and capacity for judgement (item 9) (HR = 1.717, P = 0.040), instrumental ADL (IADL) for shopping (item 10) (HR = 1.771, P = 0.020), and IADL for meal preparation (item 14) (HR = 1.790, P = 0.019) were significantly associated with an increased risk of all-cause mortality. Disabilities in route finding (HR = 2.257, P = 0.005), IADL for shopping (HR = 1.632, P = 0.016), and IADL for transportation (HR = 1.537, P = 0.033) were significant risk factors for rehospitalization due to heart failure. Even in the multivariate-adjusted model, disability in defective route-finding was significantly associated with an increased risk of all-cause mortality (hazard ratio [HR] = 2.148, 95% confidence interval [CI] 1.090-4.236; P = 0.027) and of rehospitalization for heart failure (HR = 2.138, 95% CI 1.153-3.963, P = 0.016)., Conclusions: In older patients hospitalized for heart failure, route disability was associated with all-cause mortality and rehospitalization for heart failure after discharge. Geriatr Gerontol Int 2024; 24: 1130-1136., (© 2024 Japan Geriatrics Society.)

Aim: The Questionnaire for Medical Checkup of Old-Old (QMCOO) has been used nationwide in Japan as part of the health checkup for latter-stage older adults since the financial year 2020. Although the QMCOO is useful in screening for frailty, its cutoff values for predicting adverse health outcomes have rarely been assessed. Therefore, this study aimed to calculate the cutoff values for predicting all-cause mortality and disability incidence and to evaluate their predictive validity., Methods: This study included 3837 health checkup recipients aged ≥75 years residing in Higashiura Town, Aichi Prefecture, Japan. The health checkup was conducted from June 1, 2020, to January 31, 2021. Mortality and disability incidence were analyzed separately. For the latter, participants with a disability history were excluded, leaving 3040 available for analysis., Results: During the follow-up of 11 191 and 8550 person-years, 276 died and 438 developed a disability, respectively. The areas under the receiver operating characteristic curve (95% confidence intervals) for all-cause mortality and disability incidence were 0.68 (0.65-0.71) and 0.66 (0.63-0.68), respectively, with QMCOO cutoff values at 3/4 and 2/3 points. Cox proportional hazard models adjusted for age, sex, body mass index, self-reported diseases, and frequency of alcohol consumption demonstrated the predictive validity of those cutoff values., Conclusions: The optimal cutoff value of the QMCOO for predicting all-cause mortality was 3/4, while the optimal cutoff value for predicting disability incidence was 2/3 among an older Japanese population. Geriatr Gerontol Int 2024; 24: 1203-1209., (© 2024 Japan Geriatrics Society.)

Purpose: To investigate the contribution of demographic trends in countries' age and gender composition to value set validity and obsolescence., Methods: Time-trade off (TTO) valuation data from 3 EQ-5D-3L value sets of 20 years or older from the United Kingdom, Japan, and the United States were re-analyzed using Bayesian heteroskedastic Tobit models with sex and age group-specific scale parameters. Original value sets were obtained by weighting the original preference structures with the countries' original demographic composition at the time of the data collection. Updated value sets were created using the original preference structure weighted using the countries' most recent demographic composition. The differences between the original and updated value sets were monitored and compared based on 95% credible intervals., Results: The gender and age composition of the investigated countries changed in all 3 countries over time. The modelled health state preferences also depended on the respondents' gender and age. However, the overall impact of this demographic change on the investigated value sets was negligeable in all 3 countries and this finding was robust to accounting for the impact of ethnicity trends in the United States., Conclusion: Value sets may become redundant and obsolete for various reasons, but demographic change was not identified as a contributing factor., (© 2024. The Author(s).)

Aims/introduction: We aimed to explore the associations between income/employment status and diabetes care processes, health behaviors and health outcomes., Materials and Methods: This cross-sectional study used health insurance claims data between April 2021 and March 2022, and a questionnaire survey between December 2022 and January 2023 in Tsukuba City. The study analyzed the participants with diabetes (other than type 1) from those selected by stratified random sampling. We evaluated diabetes care processes, health behaviors and health outcomes by calculating weighted proportions among the groups. We also assessed the associations between income/employment status and these variables using multivariable modified Poisson regression models., Results: Of the 264 identified participants, 161 (64.2%) were men and 168 (72.8%) were aged ≥65 years old. Compared with the low-income groups, the high-income group had a higher proportion of sodium-glucose cotransporter 2 inhibitors or glucagon-like peptide-1 receptor agonists use (adjusted risk ratio [aRR] 1.70, 95% confidence interval (CI) 1.07-2.72), a higher proportion of attendance to annual health checkups for ≥2 years (aRR 1.68, 95% CI 1.07-2.64) and a lower proportion of all-cause hospitalization (aRR 0.15, 95% CI 0.04-0.48); additionally, the middle-income group had a lower proportion of high total outpatient medical expenses (aRR 0.57, 95% CI 0.35-0.92). Compared to the no work time group, the full-time work group had a lower proportion of exercise habits (aRR 0.59, 95% CI 0.35-0.99) and a higher proportion of good self-reported health (aRR 2.08, 95% CI 1.22-3.55)., Conclusions: Several variables were associated with income/employment status. Policy intervention should focus on high-risk groups identified by considering these associations., (© 2024 The Author(s). Journal of Diabetes Investigation published by Asian Association for the Study of Diabetes (AASD) and John Wiley & Sons Australia, Ltd.)

Introduction/aims: Multifocal motor neuropathy (MMN) is a rare disease for which epidemiological and clinical data are limited. We conducted a nationwide survey to determine disease prevalence, incidence, clinical profile, and current treatment status in Japan., Methods: A nationwide survey was conducted in 2021 using an established epidemiological method. Questionnaires were sent to all neurology and pediatric neurology departments in Japan. An initial questionnaire was administered to determine the number of patients with and incidence of MMN. A second questionnaire was administered to collect detailed clinical information. The European Federation of Neurological Societies/Peripheral Nerve Society 2010 guidelines were used as diagnostic criteria., Results: The estimated number of patients with MMN was 507. The estimated prevalence was 0.40 per 100,000 individuals. Detailed clinical profiles were available for 120 patients. The male-to-female ratio was 2.3:1 and the median onset age was 42 years. The median disease duration at diagnosis was 25 months. Most patients presented with upper limb-dominant muscle weakness. Motor nerve conduction blocks were found in 62% of patients and positive anti-GM1 IgM antibody results in 54%. A total of 117 (98%) patients received immunoglobulin therapy, and 91% of them showed improvement. At the time of the last visit (median, 82 months from treatment initiation), 89 (74%) patients were receiving maintenance immunoglobulin therapy. A slight progression of neurological deficits was observed during follow-up., Discussion: Most patients with MMN in Japan received induction and maintenance immunoglobulin therapies, which appear to suppress long-term disease progression., (© 2024 Wiley Periodicals LLC.)

Objectives　The Ministry of Land, Infrastructure, Transport and Tourism is promoting the introduction of green slow mobility (GSM) vehicles (can drive up to 20 km/h on public roads) for mobility assistance and potential long-term care prevention. We identified four key factors to pinpoint the challenges and enhance opportunities for introducing GSM; GSM's operational achievements, a comparison of the characteristics of GSM users and non-users, purpose for using GSM, and observation of GSM's contribution to long-term care prevention among older adults.Methods　A pilot GSM study was conducted in Ikeda City, Osaka Prefecture, from October to December 2022. The service included three routes, operating six times daily on a fixed schedule, and was provided by 10 volunteer drivers. Passengers signaled for boarding, and service details were provided through leaflets. A self-administered mail survey was conducted before and after the demonstration test with 674 respondents to the post-questionnaire, and 502 respondents were asked at both time points about issues related to the service, user characteristics, and care prevention. To assess care prevention, we examined the percentage of favorable changes triggered by GSM based on "opportunities to go out," "personal and behavioral aspects," "social relations," and "psychological aspects." Additionally, we examined whether the health indices in the post-hoc survey were better among GSM users than non-users.Results　Of the 223 scheduled GSM services, 214 (96.0%) were operated by 10 volunteers driving an average of 3.1 (SD 2.4) times weekly (0-11 times), indicating an uneven distribution of driving responsibilities. Among the users, 65 (9.6%) were more engaged in community activities and emotional support than non-users. The main purposes for using GSM services were shopping and medical visits, with approximately 70% of users finding it easier to go out owing to these services. The percentage of favorable changes were noted in 3.1-26.2% and 0.2-1.5% of users and non-users, respectively. In the post-test survey, users showed higher independence on the instrumental self-maintenance subscale than non-users.Conclusion　GSM facilitates outings among older adults and may reduce the need for potential long-term care. However, a system is required to ensure that the service burden does not decrease even for a few driving volunteers. Additionally, GSM users are often socially active. Thus, strategies to increase service awareness among less active individuals should be developed.

Objective: This study aimed to examine self-reported code-status practice patterns among emergency clinicians from Japan and the U.S., Methods: A cross-sectional questionnaire was distributed to emergency clinicians from one academic medical center and four general hospitals in Japan and two academic medical centers in the U.S. The questionnaire was based on a hypothetical case involving a critically ill patient with end-stage lung cancer. The questionnaire items assessed whether respondent clinicians would be likely to pose questions to patients about their preferences for medical procedures and their values and goals., Results: A total of 176 emergency clinicians from Japan and the U.S participated. After adjusting for participants' backgrounds, emergency clinicians in Japan were less likely to pose procedure-based questions than those in the U.S. Conversely, emergency clinicians in Japan showed a statistically higher likelihood of asking 10 out of 12 value-based questions., Conclusion: Significant differences were found between emergency clinicians in Japan and the U.S. in their reported practices on posing procedure-based and patient value-based questions., Practice Implications: Serious illness communication training based in the U.S. must be adapted to the Japanese context, considering the cultural characteristics and practical responsibilities of Japanese emergency clinicians., Competing Interests: Declaration of Competing Interest All the Authors have no interest to declare., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: Vici syndrome (VICIS) is a congenital disorder characterized by agenesis of the corpus callosum, cataracts, hypopigmentation, cardiomyopathy, combined immunodeficiency, microcephaly, and failure to thrive. This study aimed to elucidate the number of patients with VICIS, its clinical characteristics and relevant genetic information in Japan., Methods: After developing diagnostic criteria for VICIS, we conducted a nationwide questionnaire-based survey of VICIS in Japan. In the initial survey, we investigated the number of VICIS patients who fulfilled definite or probable criteria. The second survey was used to obtain detailed clinical and genetic information of VICIS from institutions that responded to the initial survey., Results: Clinical information was available for 15 patients (12 definite, three probable). As of October 2023, nine patients (60%) were alive and six (40%) had died. All patients presented with developmental delay, agenesis of the corpus callosum, elevated serum aspartate/alanine aminotransferase, hypopigmentation and hypotonia. Developmental delay was profound. Most patients developed recurrent infection, high-arched palate, epilepsy, failure to thrive, and microcephaly. Cardiomyopathy and cataracts, both initially described as principal features in VICIS, were notably uncommon in our study. Based on the information collected, all 14 patients for whom information was available received home medical care: 11 (79%) received tube feeding, three (21%) required noninvasive ventilation, four (29%) required tracheostomy, and four (29%) required home subcutaneous immunoglobulin administration., Conclusion: This study revealed for the first time the nationwide status of patients with VICIS in Japan. The mortality rate of patients with VICIS is as high as 40%, and almost all VICIS patients require various forms of home medical care, necessitating comprehensive management. Additionally, we identified one adult patient, underscoring the need for comprehensive medical management extending into adulthood for patients with VICIS., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Introduction: Nocturia is a common symptom of lower urinary tract syndrome (LUTS). In previous studies, a close association between LUTS and colorectal inflammation has been reported. However, evidence regarding the association between nighttime urinary frequency and ulcerative colitis (UC) is limited. Herein, we investigated the association between nighttime urinary frequency and clinical outcomes of UC., Methods: We surveyed 287 Japanese patients with UC. A self-administered questionnaire was used to collect the information on the variables studied. Patients were divided into three groups based on nighttime urinary frequency: (1) no voids, (2) one void, and (3) two or more voids. The assessment of clinical outcomes was based on mucosal healing (MH) and clinical remission (CR). The association between nighttime urinary frequency and prevalence of MH and CR was evaluated using multivariate logistic regression analyses., Results: The prevalence of one nighttime frequency and two or more nighttime frequency in this cohort was 35.5% and 26.8%, respectively. The percentage of MH and CR was 24.7% and 59.2%, respectively. Two or more nighttime frequency (adjusted odds ratio [OR]: 0.31, 95% confidence interval [CI]: 0.13-0.73) was independently and inversely associated with MH. In nonelderly patients (<70 years) and patients in CR, an association between two or more nighttime frequency and MH remained significant (non-elderly: adjusted OR: 0.27, 95% CI: 0.09-0.72 and only CR: adjusted OR: 0.34, 95% CI: 0.12-0.90)., Conclusion: Nighttime urinary frequency was independently and inversely associated with MH in Japanese patients with UC. Nighttime urinary frequency may serve as a complementary physical sign of MH in patients with UC., (© 2024 Wiley Periodicals LLC.)

Aim: Although the presence of a walking trail within a neighborhood would be an important environmental determinant of health behaviors, such as exercise and going out-of-home, their longitudinal associations and mediators are still unconfirmed. This study examined the longitudinal associations of walking trail access with exercise behavior and going out-of-home and mediating roles of awareness and use of walking trails on their associations among older adults., Methods: A four-wave questionnaire-based longitudinal survey was conducted among Japanese older adults (Wave 1: baseline; Wave 2: after one year; Wave 3: after three years; and Wave 4: after five years). Each survey measured weekly exercise time and frequency of going out-of-home. Wave 4 survey also measured awareness and use of walking trails. This study calculated distance to nearest walking trail using geographic information systems. This study analyzed the data from all waves (n = 834) for longitudinal associations and the data from Wave 4 (n = 567) for mediated associations., Results: Latent growth modeling showed insignificant longitudinal associations of walking trail access with weekly exercise time and frequency of going out-of-home. The path analyses showed that a shorter distance to the walking trail was indirectly and significantly associated with longer weekly exercise time (standardized indirect effect=-0.03, p<.001) and a higher weekly frequency of going out-of-home (standardized indirect effect=-0.03, p<.001), mediated by awareness and use of walking trails., Conclusions: These findings indicate that the influence of walking trail access on exercise behavior and going out-of-home would be attenuated by awareness and use of walking trails among older adults., Competing Interests: Declaration of competing interest The authors have no conflicts of interest to declare., (Copyright © 2024 Elsevier B.V. All rights reserved.)

The Jikei Academic Nursing Practice Center for the Community developed a community nursing practice that matched community health problems and concerns in Chofu and Komae cities, suburban areas of the Tokyo Metropolis. This study aimed to identify health problems and high-risk populations via an understanding of the practice of health behaviors, health literacy, and quality of life. This was an online, cross-sectional study conducted in September 2023. In total, 1520 (Chofu: n = 1170; Komae: n = 350) participants were enrolled. Participants' demographic characteristics, health literacy, health behaviors, and quality of life scores were obtained. Sleep quality was poor compared with national data. Younger participants had higher poor health literacy, did not practice health behaviors, and had a lower quality of life. In addition, parenting and informal nursing care for family members were associated with unhealthy eating, smoking, drinking, and poor quality of life. This study found that health problems and concerns before planning were significant in increasing the salience of interventions for community residents. Based on the findings of this study, an action plan for community-wide nursing practice was created., (© 2024 Wiley Periodicals LLC.)

Background: We aimed to assess the prevalence of lumbopelvic pain (LPP), including low back pain (LBP) and/or pelvic girdle pain (PGP), consultation rate, and desire for treatment of postnatal Japanese women., Methods: We performed a cross-sectional study of 98 postnatal Japanese women within 1 year of childbirth. We retrospectively evaluated the prevalence of LBP before and during pregnancy and the prevalence of LPP after childbirth using a self-administered questionnaire. We used the distribution of pain to differentiate LBP and/or PGP after childbirth and its intensity was assessed using a visual analogue scale. The effects of LPP on daily life were assessed using the Oswestry disability index (ODI). In addition, we assessed the consultation rate for LPP and the desire to consult a healthcare professional, using self-administered questionnaires., Results: The prevalence of LPP after childbirth was 66%. Women with a history of LBP before and during pregnancy were more likely to have LPP following childbirth (both P < 0.001). The consultation rate among the postnatal women with LPP was 9%, but 56% of the women wished to consult a healthcare professional. The ODI score was significantly higher in postnatal women who wanted to consult a healthcare professional than in those who did not (P < 0.01)., Conclusions: Two thirds of the postnatal Japanese women who participated in this study had LPP, but the consultation rate was low. However, more than half of these women had the desire to consult a healthcare professional., Competing Interests: Declaration of competing interest The authors declare that they have no competing interests., (Copyright © 2023 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: In patients with early-stage breast cancer following breast surgery, ultra-hypofractionated (UHF) breast/chest wall radiation therapy (RT) has been shown to be non-inferior to a moderate-hypofractionated (MHF) regimen, with a minimal risk of breast induration, in the FAST-Forward trial, and UHF is now becoming the standard regimen in Europe. Herein, we aimed to investigate Japanese patients' attitudes toward the UHF regimen., Methods: A questionnaire-based survey was conducted at 13 RT centers in nine prefectures across Japan. All patients underwent breast-conserving surgery, followed by either conventional fractionation (2 Gy/fr) or MHF (2.66 Gy/fr) whole-breast irradiation (WBI) with or without a tumor bed boost. The questionnaire consisted of 13 questions mainly addressing quality-of-life during RT. Key questions included an 11-point scale (0-10) for rating the patients' enthusiasm for the UHF regimen and prioritization of the following treatment-related effects: treatment efficacy, acute/late adverse effects, physical/emotional/financial burden, and breast cosmesis. The patient and treatment characteristics were assessed by a physician., Results: In total, 247 questionnaires were administered between November 2022 and June 2023. The age distribution was as follows: < 50:50 s:60 s: ≥ 70 = 59 (24%):76 (30%):63 (26%):49 (20%). Sixty-nine percent of patients rated their enthusiasm for the UHF regimen at ≥ 6 out of 10 points (45% rated 10/10). Treatment efficacy was the highest priority for most patients (89%), whereas breast cosmesis the lowest priority (53%)., Conclusions: Patients' enthusiasm for UHF-WBI was observed across the cohort. These results could motivate researchers and clinicians to introduce UHF regimens in clinical practice., (© 2024. The Author(s), under exclusive licence to The Japanese Breast Cancer Society.)

Background: In reconstructive surgery for large bone defects, the demand for bone allografts has increased over the years; however, it is unclear how the supply and demand in Japanese regional bone banks have evolved over time. This study investigated the 15-year supply and demand of bone allografts stored in a regional bone bank, along with assessing the screening process's effectiveness., Methods: The target period was 15 years from April 2005 to March 2020. The period was subdivided into three 5-year periods: first, second, and third. The study items included the number of bone allografts donated, the number of bone allografts used, donor and user facilities, surgical methods using bone allografts, and the number of bone allografts discarded. We used the Cochran-Armitage test for statistical analysis., Results: A total of 1852 bone allografts were donated to the bone bank, and a total of 1721 were used. A total of 677 bone allografts grafts were provided in the first period, 738 in the second period, and 525 in the third period, indicating a decreasing trend. The average number of allografts per surgery was 2.8 in the first, 3.1 in the second, and 1.7 in the third, showing a decreasing trend. Concerning the percentage of each surgery using bone allografts, spine fusion decreased in the third period but not significantly, whereas primary hip arthroplasty increased significantly in the third period. The total number of discarded bone allografts was 4.8% of the total number of donated bone allografts, largely because of a lack of screening tests., Conclusion: Although the number of allogeneic bone surgeries has been increasing over time, the number of allogeneic bone donations has shown a decreasing trend, and there is a need to develop a system that can provide surgeons with sufficient bone allografts., Competing Interests: Declaration of competing interest The authors declare no conflicts of interest associated with this manuscript., (Copyright © 2023. Published by Elsevier B.V.)

Objective: To clarify the infection control measures required in the event of a new infectious disease outbreak, we conducted a questionnaire survey on the infection control measures implemented against coronavirus disease 2019 (COVID-19)., Methods: An invitation to participate in this survey was sent to the heads of 2689 facilities affiliated with the members of the Japanese Society for Infection Prevention and Control in February 2023, requesting responses to the online survey using Google Forms by March 2023., Results: Six hundred and forty-five facilities, including 20 clinics and 625 hospitals, participated in the survey. This survey revealed that various infection control measures were implemented, including universal masking in the non-COVID-19 ward (96.5 %), screening tests for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on scheduled admission (89.0 %), SARS-CoV-2 tests (98.7 %), and isolation in private rooms (76.5 %) for inpatients with fever. However, nosocomial infections and clusters of COVID-19 occurred in 94.4 % and 90.9 % of cases during the investigation period, respectively. One of the reasons for these results is that healthcare personnel (HCP) and patients were common index cases of nosocomial infections, and the most common cause of clusters was the work of symptomatic HCPs. These results suggest that HCPs should understand that they can be index cases or spreaders. On the other hand, the most common support from external facilities was healthcare centers, followed by physicians or nurses from other hospitals., Conclusion: In response to the emergence of infections, it is important to consider implementing infection control measures for HCPs and patients., Competing Interests: Declaration of Competing interest None., (Copyright © 2024 Japanese Society of Chemotherapy, Japanese Association for Infectious Diseases, and Japanese Society for Infection Prevention and Control. Published by Elsevier Ltd. All rights reserved.)

Purpose: To investigate the incidence and prognostic factors of ocular sequelae in Stevens-Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN) cases arising between 2016 and 2018 in Japan, and compare the findings with those presented in the previous 2005-2007 survey., Design: Retrospective, national trend survey., Methods: Dermatologic case report forms (CRFs) (d-CRFs) were sent to 257 institutions that treated at least 1 SJS/TEN case, and 508 CRFs were collected from 160 institutions. Ophthalmologic CRFs (o-CRFs) regarding patient demographic data, onset date, ocular findings (first appearance, day of worst severity, and final follow-up), topical treatment (betamethasone), outcome (survival or death), and ocular sequelae (visual disturbance, eye dryness) were sent to the ophthalmologists in those 160 institutions. The results of this survey were then compared with that of the previous 2005-2007 survey., Results: A total of 240 cases (SJS/TEN: 132/108) were included. The incidence of ocular sequelae incidence was 14.0%, a significant decrease from the 39.2% in the previous survey (SJS/TEN: 87/48). In 197 (82.1%) of the cases, systemic treatment was initiated within 3 days after admission, an increase compared to the previous survey (ie, treatment initiated in 82 [60.7%] of 135 cases). Of the 85 cases with an Acute Ocular Severity Score of 2 and 3, 62 (72.9%) received corticosteroid pulse therapy and 73 (85.9%) received 0.1% betamethasone therapy; an increase compared to the 60.0% and 70.8%, respectively, in the previous survey. Ocular-sequelae-associated risk factors included Acute Ocular Severity Score (P < .001) and specific year in the survey (P < .001)., Conclusions: The ophthalmologic prognosis of SJS/TEN has dramatically improved via early diagnosis, rapid assessment of acute ocular severity, and early treatment., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: The Scoliosis Research Society SRS-22 questionnaire is a standard tool to assess the Health-Related Quality of Life (HRQoL) in scoliosis patients but, because of cultural differences limited use among Arabic patients. The aim is to perform a cross-cultural adaptation and validation of Arabic version of Scoliosis Japanese Questionnaire-27 and test it on Saudi patients with adolescent idiopathic scoliosis (AIS)., Methods: This a cross sectional study run between July 2021 and December 2022 recruited 194 patients. The cross-cultural adaptation process was performed using the American Association of Orthopedic Surgeons (AAOS) Outcomes Committee method. All patients had completed the Arabic version of Scoliosis Japanese Questionnaire-27 and SF-12 preoperatively and 3-month postoperatively. The validity and internal consistency were tested using the Intraclass correlation coefficient (ICC), Cronbach alpha, Pearson correlation coefficient, and confidence interval (CI)., Results: We analyzed the result of 194 female adolescent patients. The average age is 14 ± 2.4 years (range from 10 to 21 years). The majority of patients have a Lenke type 1 curve (54 %). The overall Cronbach alpha (CA) of all domains of Scoliosis Japanese Questionnaire-27 is 0.92. However, the Cronbach alpha for the mental health (Q17,18,20,21,23,24) and, self-image (Q12-14,22,25,26) are 0.93 and 0.84 respectively., Conclusion: The Arabic version of Scoliosis Japanese Questionnaire-27 is a reliable and valid instrument and can be applied to evaluate the quality of life in patients with AIS., Competing Interests: Declaration of competing interest No potential conflict of interest relevant to this article was reported. No fund was received to conduct this study. Patients accepted and signed the consent form approved by institutional review board., (Copyright © 2023 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.)

Objectives　Resilience is the ability to navigate adversity and recover from challenging situations. Developing resilience at a young age promotes mental health and provides benefits throughout one's lifespan. Validated measures for assessing resilience at a young age are required in both clinical practice and epidemiological studies. The Child and Youth Resilience Measure-Revised (CYRM-R) is a tool used worldwide to assess resilience in children and young people. The objective of this study was to develop a Japanese version of the CYRM-R and investigate its psychometric properties.Methods　Children in grades 5-9 were recruited via a two-stage cluster random sampling taken from the Japan Adolescent and Youth (JAY) Longitudinal Cohort Study. The participants completed the Japanese version of the CYRM-R . The CYRM-R consists of two subscales, personal resilience and caregiver resilience, with a total of 17 items. The linguistic validity of the Japanese version of the CYRM-R was ensured through translation and back-translation.Cronbach's alpha coefficients were examined for the total score and the two subscales to assess the internal consistency of the Japanese version of the CYRM-R scale. In addition, correlation coefficients of the subscales were calculated. For factorial validity, a confirmatory factor analysis was conducted on the same two-factor structure as in the original version to assess the model's goodness of fit. Results　A total of 2,266 children (50.0% male) were included in the study. The overall Cronbach's alpha of the Japanese version of the CYRM-R obtained from this sample was 0.956; For the personal resilience subscale, Cronbach's alpha was 0.932; for the caregiver resilience subscale, it was 0.919. Significant positive correlations were also found between subscales (r = 0.827, p < 0.001). A confirmatory factor analysis was conducted using a two-factor structure for validity. The model fit was good (RMSEA = 0.085, SRMR = 0.041, CFI = 0.934).Conclusion　The Japanese version of the CYRM-R maintained the same two-factor structure as the original version. The study findings showed that the Japanese version of the CYRM-R had adequate internal consistency and factorial validity for assessing resilience in children and youth. Therefore, this scale is a valuable tool for identifying individuals or groups at risk in terms of children's resilience and for evaluating the effectiveness of support and interventions.

In 2022, the value of United States (US) beef and beef product exports was $11.7 billion, and the US was the world's largest beef producer and second-largest beef exporter by volume. Therefore, we conducted surveys to evaluate beef purchasing behavior among consumers in important and emerging US beef export markets, including Japan, the United Kingdom (UK), Germany, and Mexico. Results reveal differences in consumers' beef purchasing behavior across countries. Most Mexican consumers purchase beef two-to-three times a week, while consumers in other countries typically purchase it once a week. Using ordered probit models, we examined the factors associated with beef purchase frequency in each country. Japanese consumers who consider price to be an important factor when purchasing beef are less likely to purchase it frequently. German consumers, for whom brands are important when buying beef, are more likely to buy it frequently. British consumers, who consider hormone-free production to be important when purchasing beef, are less likely to buy it frequently. Mexican consumers, who consider grass-fed production to be an important factor when purchasing beef, are less likely to buy it frequently. Across all countries, individuals who purchase beef at supermarkets and from butchers are more likely to purchase it more often. Results also indicate that various consumer demographics are associated with beef purchase frequency across countries. The findings provide valuable insights for stakeholders regarding international consumer beef purchasing behavior., Competing Interests: Declaration of competing interest None for all authors., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Aim: Stigma against people who have alcohol and drug problems severely affects their health and well-being. An instrument based on stigma theory assessing individual-level stigma is essential for a comprehensive understanding of their stigma. We evaluated the validity and reliability of the Japanese version of the Substance Use Stigma Mechanism Scale (SU-SMS-J) among a population who had alcohol or drug use problems., Methods: Adults with experience in substance use disorders from psychiatry outpatient departments and rehabilitation facilities participated in the self-administered questionnaire survey. Confirmatory factor analysis was conducted to test the structural validity of the 5-factor model proposed in other language versions, and factor loadings and correlation between the subscales were confirmed. The correlations between the SU-SMS-J and psychometric properties related to substance use (e.g., severity of substance use, motivation to change) were investigated to assess concurrent validity. Internal consistency was assessed using Cronbach's alpha coefficients., Results: Data from 126 participants were analyzed. The 5-factor model was acceptable with good or reasonable model fit indices. The correlations between subscales were weak to moderate, and this result suggested the SU-SMS-J assessed different but related components of stigma: enacted, anticipated, and internalized stigma from different stigma sources (family and healthcare workers). The SU-SMS-J and subscales showed moderate concurrent validity. Internal consistency was mostly sufficient, with Cronbach's alpha coefficients of 0.86 for all items and 0.66-0.93 for subscales., Conclusions: The SU-SMS-J is valid and reliable for use among populations with substance use problems in various settings in Japan., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Takano et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: In questionnaire surveys, questions about self-reported number of teeth (SRNT) are often used as a measure oral health. This study investigated the validity of SRNT in older Japanese people., Methods: In total, 4984 75- and 80-year-old patients who underwent dental examinations were enrolled. A self-administered questionnaire that asked about the number of teeth was used in the analysis. The percentage agreement and kappa value were calculated for the agreement between SRNT and observed numbers of teeth. To identify factors that affect the reliability of SRNT, a logistic regression analysis was performed using correctness of SRNT as the dependent variable., Results: Among the 3950 participants who responded as to whether they had ≥ 20 teeth, the degree of agreement was 92.9% (kappa value 0.856, p < 0.001) in an objective evaluation. Of the 2621 participants who reported their numbers of teeth, the SRNT and observed number of teeth matched in 57.5% (kappa value 0.559; p < 0.001). Observed number of teeth and annual dental checkup had a significant effect on the accuracy of SRNT. Multivariate logistic regression analysis, with the agreement between SRNT and the observed number of teeth (i.e. whether the number of teeth exceeded 20) as the dependent variable, showed that the observed number of teeth, use of interdental cleaning tools, and annual dental checkup were significantly associated with the agreement between SRNT and the actual number of teeth. In multivariate analysis with tooth number agreement (± 1 tooth) as the dependent variable, the observed number of teeth and use of interdental cleaning tools were significantly associated with the agreement between SRNT and the observed number of teeth., Conclusion: Although SRNT did not perfectly match the observed numbers of teeth, the results of this study imply that the SRNT of older people is reliable and useful in epidemiological studies., (© 2024. The Author(s).)

Background: Japanese dietary patterns have traditionally focused on vegetables, legumes, and fish; however, in the last few quarters of the century, the consumption of meat, processed food, and ultra-processed food has become popular. It is anticipated that these changes in the Japanese dietary environment will increase the risk of developing psychosomatic disorders., Methods: In this study, we examined the relationship between dietary habits, psychosomatic disorders, and a sense of achievement. For men and women aged 20-80 years ( n = 851) living in and around Ebetsu City, Hokkaido, Japan, a questionnaire on dietary habits over the past year, including mental and physical stress and a sense of achievement, was administered. The associations between dietary habits and psychosomatic disorders or a sense of achievement were analyzed using logistic regression ( n = 654)., Results: The associations between dietary habits and psychosomatic disorders differ depending on sex and age. We found that subjects who consumed more processed meat and ultra-processed food reported more psychosomatic disorders. On the other hand, those who perceived a sense of achievement consumed higher amounts of vegetables, albeit with a lower fish intake., Conclusions: In this study, we demonstrated that dietary habits and food ingredients are associated with mental and physical stress and a sense of achievement. Fish, which is considered to be good for the body, was mostly consumed by subjects who experienced mental and physical stress. These data indicate that highly stressful conditions may encourage fish consumption, as the body needs to mitigate psychosomatic disorders.

Objectives: The Russian-Ukrainian War of 2022 (RUW-2022) was accompanied by the subsequent risk of accidents at a nuclear power plant in Ukraine. This study investigated posttraumatic stress (PTS) symptoms related to media reports of an attack on a Ukrainian nuclear power plant during the RUW-2022 among victims of the Fukushima nuclear disaster and revealed their association with radiation risk perception (RRP) of the accident., Methods: This cross-sectional study targeted 1193 residents of Naraha Town in Fukushima Prefecture. PTS symptoms were measured using the Japanese version of the Impact of Events Scale-Revised (IES-R). Univariate and multivariate analyses explored the association between IES-R scores and background factors, particularly RRP., Results: Participants with higher RRP showed significantly higher IES-R scores; furthermore, the proportion of disruption because of radiation anxiety was significantly larger among higher RRP residents. Radiation anxiety mediated the association between RRP and PTS symptoms (total IES-R score and sub-item of intrusion)., Conclusions: People with higher RRP in Fukushima may continue to be at risk of persistent, unwanted PTS symptoms due to future nuclear crises. Therefore, mental health practitioners need to continue providing support in affected areas for a longer period than anticipated. Moreover, a population-based approach to cope with these stressors from media reports is essential.