[Communication between pregnant women and maternal and child health professionals and trust in professionals and awareness of source of help in the postpartum period: Evaluation using JACSIS Pregnant-Postpartum Women's Data 2020-2021].

Objective　This study aims to estimate the impact of maternal and child health professional consultation and development of support plans during pregnancy on trust in community health professionals (trust) and awareness of sources of public/private institutional support (awareness) in the postpartum period.Methods　A web-based panel survey was conducted in July-August 2021 and January-February 2022, targeting women who were pregnant during the 2021 survey and 0-5 months postpartum in 2022. We collected information about consultation opportunities and development of a support plan during pregnancy, trust and recognition, demographic characteristics, employment status, and pregnancy- and childbirth-related variables. First, logistic regression analysis was conducted by setting trust and recognition during postpartum as outcomes. Exposure variables were the consultation opportunities and development of a support plan during the pregnancy period. Second, we added the presence of a comprehensive support center for raising children, the financial index of the municipality of residence, the per capita child welfare expenditure, and the number of nurses at the comprehensive support center for maternal and child health to the analytical model as overall level of municipal support in order to check the robustness of our results.Results　Responses were obtained from pregnant women across Japan. Of the 616 respondents included in the analysis, 74.0% had opportunities for consultation, 23.7% made support plans, 69.8% trusted local maternal and child health professionals, and 63.6% recognized public/private institutional support as places for help-seeking. Logistic regression analysis showed that trust and recognition were higher among those who had opportunities to consult and had created a support plan compared to those who did not. With regard to trust, for those who had opportunities to consult, the odds ratio (OR) was 2.05 (95% confidence interval [95% CI] 1.37-3.07), and for those who developed a support plan, the OR was 2.25 (95% CI 1.41-3.60). As for recognition, the OR was 1.46 (95% CI 0.98-2.16) if given the opportunity for consultation. For development of a support plan, the OR was 3.05 (95% CI 1.94-4.80). These results did not change even after adjusting for municipal finances and the level of support for pregnant women in general.Conclusions　Consultation opportunities and developing support plans during pregnancy increased trust and recognition in the postpartum period while municipal finances or overall support for child rearing were not associated with these outcomes, thus suggesting the importance of engagement with professionals during pregnancy.

Married women's decision to delay childbearing, and loneliness, severe psychological distress, and suicidal ideation under crisis: online survey data analysis from 2020 to 2021.

BACKGROUND: The COVID-19 pandemic has affected every aspect of our lives, including the decision to become pregnant. Existing literature suggests that infertility and the decision to delay childbearing at a younger age are associated with a lower level of well-being and regrets when women start to desire a baby. Thus, the decision to delay childbearing due to the pandemic could negatively affect the well-being of women. This study focuses on how pregnancy decisions affect the well-being of women during the COVID-19 pandemic. METHODS: From the Japan COVID-19 and Society Internet Survey, a nationally representative web-based survey, 768 observations of married women aged 18 to 50 years who had the intention of getting pregnant during the pre-pandemic period (conducted in 2020 and 2021) were used. Loneliness, severe psychological distress, and suicidal ideation were used as well-being indicators. For pooled data, a generalised estimated equation (GEE) model was used to estimate how pregnancy decision related to well-being indicators. For a sub-analysis, the sample was divided by the survey year and a Poisson regression model was used. RESULTS: The GEE analysis showed an association between delaying childbearing and severe psychological distress, with the prevalence ratio (PR) being 2.06 [95% CI (1.40-3.03)]. Furthermore, loneliness and suicidal ideation that occurred after the beginning of the pandemic were significantly related to the decision to delay childbearing-1.55 [95% CI (1.03,2.34)] and 2.55 [95% CI (1.45-4.51)], respectively. Moreover, these PRs were larger for 2021 compared to 2020. CONCLUSION: During the COVID-19 pandemic, approximately one-fifth of married women who had childbearing intentions before the pandemic decided to postpone pregnancy. They exhibited a deteriorated mental health state. Furthermore, the negative associations were larger in 2021 compared to 2020. Loneliness has negative consequences for both mental and physical health, as well as elevated severe psychological distress and suicidal ideation among those who decided to postpone pregnancy. Therefore, the current results should not be overlooked by society.

Impact of the COVID-19 pandemic on pregnancy postponement - evidence from Japan.

Japan has faced a decline in fertility since the coronavirus disease 2019 (COVID-19) pandemic. This study aimed to investigate the rate of pregnancy postponement and its contributing factors, with a particular focus on economic- and COVID-19 infection-related indicators. This study used data from 768 observations of married women aged 18 to 50 years with pregnancy intentions. The data were obtained from two rounds of a large web-based survey conducted by the Japan COVID-19 and Society Internet Survey (JACSIS) in 2020 and 2021. A generalised estimating equation (GEE) model was employed, as well as Poisson regression models for sub-sample analysis divided by year to estimate the year differential magnitude of the contributing factors' impacts. Approximately 20% of married women with childbearing intentions postponed their childbearing. The analyses revealed that declining income and anxiety about future household finances were significantly related to delayed childbearing, while fear of COVID-19 and infection rate were not. Additionally, the adverse effects of unfavourable economic conditions were stronger in 2021. Notably, age did not influence the decision of pregnancy postponement. Older women postponed pregnancy just as much as younger women. In conclusion, this study confirmed that the COVID-19 pandemic, particularly its related adverse economic conditions, contributed to Japan's current baby bust. Considering that advanced maternal age is already common in Japan, this decreased fertility may result in the long-term negative consequence of further population decline.

Impact of loneliness on suicidal ideation during the COVID-19 pandemic: findings from a cross-sectional online survey in Japan.

OBJECTIVES: We aim to reveal how loneliness relates to suicidal ideation following the onset of the COVID-19 pandemic. DESIGN: Cross-sectional online survey. SETTING: Community cohort study in Japan. PARTICIPANTS: The second wave of a large web-based survey, Japan COVID-19 and Society Internet Survey, was conducted in February 2021, and we analysed the data of 6436 men and 5380 women who were aged 20-59 years. MAIN OUTCOME MEASURES: The prevalence ratios (PRs) of suicidal ideation due to loneliness, depression, social isolation and decline in income during the pandemic and other sociodemographic and economic information were adjusted in the analysis. STATISTICAL METHODS: Estimations were conducted by separating a male and female sample. The survey weight (inverse probability weighting) was applied for analyses, and a Poisson regression model was used with all the potential confounders adjected. RESULTS: Overall, 15.1% of male and 16.3% of female participants were found to have had suicidal ideation during the COVID-19 pandemic. Among them, 23% of male and 20% of female participants experienced suicidal ideation for the first time. The results of the Poisson regression suggested that those who were feeling lonely had higher PRs for suicidal ideation (4.83 for men (95% CI, 3.87 to 6.16) and 6.19 for women (95% CI, 4.77 to 8.45)). The relationship between loneliness and suicidal ideation remained robust even after adjusting for depression, although there were declines in PRs. Additionally, the results showed that those who were lonely, and continued to feel lonely during the pandemic, had the highest PRs of suicidal ideation. CONCLUSION: Loneliness had both direct and indirect effects on suicidal ideation mediated through depression. Those who felt lonelier during the pandemic had the highest risk of suicidal ideation. It is necessary to adopt national measures focused on providing psychological support to people who feel lonely to prevent them from taking their own lives.

The COVID-19 Pandemic and Mental Well-Being of Pregnant Women in Japan: Need for Economic and Social Policy Interventions.

OBJECTIVE: This study explores the mental well-being of pregnant women in Japan during the coronavirus disease (COVID-19) pandemic. METHODS: We collected 1777 responses from pregnant women through an online survey. Using the Japanese version of the Edinburgh Postnatal Depression Scale (EPDS), we calculated the percentage of pregnant women above the cutoff (≥ 13), and the factor scores of anhedonia, anxiety, and depression. Regression analyses were performed to identify factors and socioeconomic characteristics correlated with depressive symptoms. RESULTS: The point prevalence of pregnant women with an EPDS score of ≥ 13 was 17%. The mean scores were 0.73, 3.68, and 1.82 for anhedonia, anxiety, and depression, respectively. The probability of becoming above the cutoff score positively correlated with the cancellation of planned informal support, higher perceived risk for infection of COVID-19, difficulties in household finances, and lack of social support. Moreover, being younger, less wealthy, unemployed, and without a partner showed a significantly higher possibility of having a score above the cutoff. CONCLUSIONS: The present study found a high percentage of pregnant women with depressive symptoms. Notably, COVID-19-related variables, including perceived risk for the infection, fear of decreasing economic wealth, and social support, were significantly associated with depressive symptoms.

Depressive Symptoms in Mothers With Infants: The Quantitative Evidence of the Association of COVID-19 Crisis-Related Factors in Japan.

OBJECTIVE: This study explores the depressive symptoms in postpartum women during the coronavirus disease 2019 (COVID-19) crisis in Japan. METHODS: An online survey conducted from May 31 to June 6, 2020 resulted in 3073 responses obtained from mothers with infants < 12 mo. RESULTS: The point prevalence of the Edinburgh Postnatal Depression Scale (EPDS) score of ≥ 9 was 28.66% for primipara and 25.83% for multipara. Logistic regression analysis indicated a negative association between the COVID-19 crisis and EPDS ≥ 9; specifically, decreased social support and financial concern were identified as risk factors. The COVID-19-related experiences significantly increased the score of each factor of EPDS, ie, anxiety, anhedonia, and depression. CONCLUSIONS: During the COVID-19 crisis, the number of mothers who faced depreciation in social support and income had increased. Moreover, spending their perinatal period during the crisis increased the propensity of facing unexpected changes, such as changes of hospitals for delivery, or cancellation of parenting classes. These multiple factors were associated with an elevated risk of depression in postpartum women. In a prolonged crisis, postpartum mental health should be treated carefully with the prevention of infection.

The effect of social restrictions, loss of social support, and loss of maternal autonomy on postpartum depression in 1 to 12-months postpartum women during the COVID-19 pandemic.

BACKGROUND: This study focused on postpartum women, who are one of the most vulnerable populations during the COVID-19 pandemic, aiming to reveal mental health consequences of social restrictions, loss of social support, and loss of autonomy. METHODS: We conducted a cross-sectional study for postpartum women in October 2020 in Japan (N = 600). The Edinburgh Postpartum Depression Scale (EPDS) was used to measure postpartum depression. The prevalence ratios were estimated by log-binomial regression models, adjusting for age, education, household income, residential area, parity, the timing of delivery, and a prior history of depression. RESULTS: The prevalence of postpartum depression was 28.7% (EPDS ≥9, which is frequently used in Japan), 18.6% (≥11), and 13.1% (≥13). Social restrictions, including cancellation of home visits by healthcare professionals and cancellation of infant checkups or vaccinations, loss of support during pregnancy or after delivery, including loss of opportunities to consult with healthcare professionals or friends and cancellation of parents or other family members' visits to support, and loss of autonomy about delivery or breastfeeding, were associated with postnatal depression. CONCLUSIONS: At least 13% of women who delivered and raised babies during the COVID-19 pandemic had postpartum depressive symptoms. COVID-19 related social restrictions and loss of social support from healthcare professionals, families, and friends were significantly associated with postpartum depression. In addition, loss of maternal autonomy in delivery and breastfeeding was associated with postpartum depression. The results indicate that both formal and informal support should not be limited to preventing postpartum depression during a pandemic.

Betel quid chewing and its associated factors in Myanmar: A quantitative study.

BACKGROUND: Betel quid is more widely consumed than tobacco in Myanmar. It brings adverse health effects regardless of whether it contains tobacco; however, Myanmar has no clear prevention strategy. This study aims to show a broader picture of the prevalence of betel quid chewing and the observable characteristics of its consumers in Myanmar by comparing it to tobacco usage. METHODS: This study used the 2015-2016 Myanmar Demographic and Health Survey data. First, we identified characteristics of betel quid consumers by a logit model. Next, we focused on exploring who would be likely to become heavy users, conditioned on being a betel quid consumer by controlling for possible sample selection bias. RESULTS: We found differences in characteristics for betel chewers and tobacco smokers, and for betel quid users and heavy users. CONCLUSION: These results suggest that betel quid consumption should be regulated by a specific prevention strategy rather than by Myanmar's existing tobacco prevention strategy.

Trust and well-being of postpartum women during the COVID-19 crisis: Depression and fear of COVID-19.

During crisis, trust has been found to have a buffering effect in the prevention of the deterioration of mental well-being, as trust is considered to reflect the individual's capability to gain social resources including both formal and informal support. Additionally, during the COVID-19 pandemic, political trust has been found to reduce anxiety. Taking these findings into account, this study explores the association of generalised and political trust with mental well-being on current postpartum women who were particularly at risk due to a decline in social support leaving them an increased burden of caring newborns during the pandemic. We conducted a crosssectional survey in October 2020 in Japan (n=558). Depressive symptoms (above the cutoff of the Edinburgh Postnatal Depression Scale (EPDS)) and Fear of Coronavirus-19 Scale (FCV-19S) scores were used as mental well-being indicators. Generalised and political trust were captured by binary variables. Results of regression analyses, in which covariates were fully adjusted, showed that higher generalised trust had a statistically significant association with lower possibility of depressive symptoms and a lower FCV-19S score, while political trust was not significantly associated with either indicator. For further understanding, we divided respondents into two groups; women living in cities where higher COVID-19 cases were reported and women living in areas with lower COVID-19 cases, to test whether the role of trust differs depending on the infection spread status. It was found that a higher generalised trust was significantly associated with a lower probability of having depressive symptoms in the areas with lower COVID-19 cases. However, statistical significance was not observed in the areas with high COVID-19 cases. This highlighted that even postpartum women who were normally capable of receiving formal and informal social support need to be taken care of in the current situation.

Geriatric Depressive Symptoms in Myanmar: Incidence and Associated Factors.

Myanmar is one of many countries currently facing a growing older adult population; yet, the mental health status of the country's older adults is understudied. This is the first article to investigate the prevalence of geriatric depressive symptoms and its associated factors in Myanmar. We use data from the most recent large-scale older adult survey conducted in 2016, which employed the four-item short version of the Geriatric Depression Scale (GDS-4). Descriptive statistics reveal that, depending on the threshold applied, about 16% to 56% of the surveyed older adults have indications of depressive symptoms. We find that both economic and health status have a statistically significant association with depressive symptoms, but no basic individual characteristics are associated with it. Our findings suggest the importance of a social security system for older adults. Expanding the scope of the pension scheme and improving the provision of health care may be among the important policy options.

Bilateral scalp necrosis with giant cell arteritis.

We present a patient with bilateral scalp necrosis caused by giant cell arteritis (temporal arteritis). A 67-year-old woman, who had been treated with 5 mg of oral prednisolone every other day for polymyalgia rheumatica, developed painful egg-sized regions of necrosis on both of her temples. Doppler pulsemetory revealed bilateral obstruction of the temporal arteries. Biopsy revealed ischemic necrosis of the skin and necrotic angiitis of the temporal arteries with giant cell infiltration. Bilateral stenosis of the internal carotid arteries and moderate retinal bleeding were revealed by angiography. Daily administration of prednisolone (20 mg/day) with intravenous and topical limaprost alphadex markedly improved her condition. The ulcers reepithelized without surgical treatment. There are few reports of bilateral scalp necrosis. Rapid and complete obstruction of the temporal artery may result in this condition. Simultaneous development of two ulcerative lesions in the ventro-parietal cranial regions is thought to correspond to systemic arterial involvement, including involvement of the internal carotid arteries.