The disaster liaison for pediatric and perinatal medicine: A new system in Japan.

BACKGROUND: Worldwide, children, newborns, and pregnant or postpartum women are vulnerable to disasters and emergency situations, and providing support to this population is of great concern. Japan is located in a disaster-prone area, so disaster response and risk reduction strategies are important priorities. METHODS: We introduce a system called the Disaster Liaison for Pediatric and Perinatal Medicine (DLPPM). This was created with a specific focus on perinatal children and pregnant women in Japan. We report the details of its activities, discuss its challenges, and draw on lessons learned for the further development of perinatal support systems, particularly for children. RESULTS: The lessons learned from the activities of the DLPPM include the following: (1) establish a support system for emergency specialists beyond those with pediatric and perinatal specialties; (2) mitigate the risk of indirect damage caused by primary disasters; and (3) establish a networking function linked to existing pediatric and perinatal medicine facilities. CONCLUSIONS: By establishing similar systems, we believe that it will be feasible to address pediatric and perinatal care needs in disaster response contexts in other countries and regions around the world.

Clustering evaluation of water quality for various classes of in-flow rivers in connected brackish lakes.

Brackish waters and estuaries at the lower reaches of rivers accumulate organic matter and nutrients from various sources in the watershed. Sufficient light and shallow water depth stimulate phytoplankton growth, resulting in a more diversified ecosystem with higher trophic levels. For effective watershed management, it is crucial to characterize the water quality of all rivers, including small and medium-sized ones. Our field survey assessed water quality parameters in 26 inflow rivers surrounding Lakes Shinji and Nakaumi, two consolidated brackish lakes in Japan. The parameters included water temperature, salinity, chlorophyll-a, and nutrients. The study used hierarchical clustering. The Silhouette Index was used to assess clustering outcomes and identify any difficulties in dispersion across clusters. The 26 rivers surrounding Lakes Shinji and Nakaumi were classified into six groups based on their water quality characteristics. This classification distinguishes itself from earlier subjective methods that relied on geographical factors. The new approach identifies a need for improved management of river water quality. The results of the cluster analysis provide valuable insights for future management initiatives. It is important to consider these findings alongside established watershed criteria.

DNA metabarcoding focused on difficult-to-culture protists: An effective approach to clarify biological interactions.

DNA metabarcoding on a single organism is a promising approach to clarify the biological interactions (e.g., predator-prey relationships and symbiosis, including parasitism) of difficult-to-culture protists. To evaluate the effectiveness of this method, Radiolaria and Phaeodaria, which are ecologically important protistan groups, were chosen as target taxa. DNA metabarcoding on a single organism focused on the V9 region of the 18S rRNA gene revealed potential symbionts, parasites and food sources of Radiolaria and Phaeodaria. Previously reported hosts and symbionts (parasites) were detected, and newly recognized combinations were also identified. The contained organisms largely differed between Radiolaria and Phaeodaria. In Radiolaria, members of the same order tended to contain similar organisms, and the taxonomic composition of possible symbionts, parasites, and food sources was fixed at the species level. Members of the same phaeodarian family, however, did not contain similar organisms, and body part (i.e., the central capsule or the phaeodium) was the most important factor that divided the taxonomic composition of detected organisms, implying that the selection of appropriate body part is important when trying to ascertain contained organisms, even for unicellular zooplankton. Our results show that DNA metabarcoding on a single organism is effective in revealing the biological interactions of difficult-to-culture protists.

Infant Mortality Rates for Farming and Unemployed Households in the Japanese Prefectures: An Ecological Time Trend Analysis, 1999-2017.

BACKGROUND: Recent research suggests that Japanese inter-prefecture inequality in the risk of death before reaching 5 years old has increased since the 2000s. Despite this, there have been no studies examining recent trends in inequality in the infant mortality rate (IMR) with associated socioeconomic characteristics. This study specifically focused on household occupation, environment, and support systems for perinatal parents. METHODS: Using national vital statistics by household occupation aggregated in 47 prefectures from 1999 through 2017, we conducted multilevel negative binomial regression analysis to evaluate occupation/IMR associations and joinpoint analysis to observe temporal trends. We also created thematic maps to depict the geographical distribution of the IMR. RESULTS: Compared to the most privileged occupations (ie, type II regular workers; including employees in companies with over 100 employees), IMR ratios were 1.26 for type I regular workers (including employees in companies with less than 100 employees), 1.41 for the self-employed, 1.96 for those engaged in farming, and 6.48 for unemployed workers. The IMR ratio among farming households was 1.75 in the prefectures with the highest population density (vs the lowest) and 1.41 in prefectures with the highest number of farming households per 100 households (vs the lowest). Joinpoint regression showed a yearly monotonic increase in the differences and ratios of IMRs among farming households compared to type II regular worker households. For unemployed workers, differences in IMRs increased sharply from 2009 while ratios increased from 2012. CONCLUSIONS: Inter-occupational IMR inequality increased from 1999 through 2017 in Japan. Further studies using individual-level data are warranted to better understand the mechanisms that contributed to this increase.

Elemental composition and ultrafine structure of the skeleton in shell-bearing protists-A case study of phaeodarians and radiolarians.

Cross-sections were prepared by ultramicrotome (UM) and focused ion beam (FIB) system in order to examine the skeletal structure of ecologically and geologically important shell-bearing protists: phaeodarians and radiolarians. The elemental composition of the skeleton was clarified by the energy dispersive X-ray spectroscopy, suggesting that the skeletons of both groups are mainly made of amorphous silica (SiO2·nH2O) with other minor elements (Na, Mg, Al, Cl, K, Ca and Fe) and that these two groups have similar elemental composition, compared with other siliceous organisms (diatoms and sponges). However, the structural difference among the two groups was confirmed: phaeodarian skeletons are porous, unlike radiolarians with solid skeletons. It was also revealed that the phaeodarian skeleton contains concentric layered structure with spaces, presumably related to the ontogenetic skeleton formation. The distinction in the skeletal ultrafine structure (porous/solid and non-dense/dense) would reflect the ecological difference among the two groups and could be an effective criterion to determine whether microfossils belong to Radiolaria or Phaeodaria. The UM and FIB combined method presented in this study could be a useful approach to examine the chemical and structural characteristics of unculturable and/or rare microorganisms.

Gazelletta kashiwaensis sp. nov. (Medusettidae, Phaeodaria, Cercozoa), Its Morphology, Phylogeny, Distribution, and Feeding Behavior.

A phaeodarian morphotype, characterized by the feet surrounded with forked pedal spines with anchor-like structures, was collected in the subtropical North Pacific. Considering the morphological and phylogenetic uniqueness, this morphotype is described as Gazelletta kashiwaensis sp. nov. The distribution of this new species is possibly affected by the Kuroshio Current. The feeding behavior of living phaeodarians was first filmed: the present new species floated in the water column stretching "protoplasmic webs" and collected diatoms by repeating the expansion and retraction of "pseudopodium-like tentacles".

Factors associated with social support in child-rearing among mothers in post-disaster communities.

BACKGROUND: Natural disasters have long-term negative impacts on the health and socioenvironmental conditions of a population, affecting the physical environment as well as the relationships within the community, including social networks. Mothers in post-disaster communities may have difficulty receiving social support not only from family members and relatives but also from members of their community, such as people in their neighborhoods. This study focused on mothers with infants and preschool-aged children in post-disaster communities. The associations of social support with sociodemographic characteristics and socioenvironmental conditions related to child-rearing among mothers in post-disaster communities were assessed. METHODS: An anonymous self-administered questionnaire survey was conducted in October 2015 in 988 households in areas affected by the Great East Japan Earthquake and Tsunami. The data collected on sociodemographic and socioenvironmental characteristics included the presence of pre-disaster acquaintances in the neighborhood and social support for child-rearing. The associations of sociodemographic and socioenvironmental characteristics with social support were examined. RESULTS: We analyzed 215 completed questionnaires from mothers living in different houses from those they lived in before the disaster to reflect continuous relationships with people from the pre-disaster communities. Social support was significantly associated with infant sex, extended family, support obtained from relatives not living together, pre-disaster acquaintances, use of child support resources, and no perceived difficulties in child-rearing. In addition, the presence of pre-disaster acquaintances was associated with categories of mental/physical place of comfort and child-rearing support, with adjusted odds ratios of 1.88 (95% CI 1.03-3.44) and 2.84 (95% CI 1.46-5.52) compared with mothers who did not have any pre-disaster acquaintances. CONCLUSIONS: Factors associated with the obtainment of social support in child-rearing among mothers in post-disaster communities were attributed not only to mothers themselves and family members but also to socioenvironmental factors such as the presence of pre-disaster acquaintances. The presence of pre-disaster acquaintances promoted rich social support in child-rearing in post-disaster communities. When reconstructing a community following changes in residence location after a disaster, the pre-disaster relationships among the community dwellers should be considered from the viewpoint of child-rearing support.

Exploring roles and capacity development of village midwives in Sudanese communities.

INTRODUCTION: Home birth remains a strong preference and village midwives are the only option for maternal and neonatal care for many rural women in Sudan. This study assessed whether interventions such as strengthening linkages among health facility/staff, skilled birth attendants and village midwives (VMWs); strengthening the supervision system; and strengthening the governance capacity of local health departments improved their service delivery, and it examined factors linked with improved performance of VMWs in their communities. METHODS: This descriptive study comprised a cross-sectional baseline survey, two intervention years and an endline survey. Data collection involved in-depth, semi-structured questionnaire interviews. Fifty-seven VMWs and 151 community women were targeted for the study in Sinnar, a south-eastern state of Sudan. Participants were interviewed about demographic information, perceptions of operational barriers, training provided, function in the community, supervision and referral for emergency cases. RESULTS: Results showed the monthly average number of VMW-assisted home births increased from 1.4 at the baseline survey in October 2011 to 3.3 at the endline survey in October 2013. The annual average number of emergency cases referred by VMWs increased from 1.6 to 3.5, and the percentage of VMWs using official monthly reports increased from 33% to 80%. VMWs reported improved bonds with their supervisors and relationships in the community. CONCLUSION: Improved service provision may be associated with development of supervision systems for VMWs, active provision of community activities, strengthened linkages between health facilities and VMWs and enhanced community trust of VMWs. Given issues such as shortages and poor retention of human resources for maternal and newborn health service delivery in particular settings, international communities should focus on strengthening capacity of community midwives for home births as a realistic measure.

Changing Knowledge and Practices of Mothers on Newborn Care through Mother Class: An Intervention Study in Indonesia.

Poor knowledge and practices of newborn care may contribute to high neonatal mortality. This study aims to analyze the effect of prenatal education, namely 'mother class', on knowledge and practices of newborn care among mothers in Tangerang Selatan District, Indonesia. An intervention study with a quasi-experimental design was conducted. Using a questionnaire, 427 mothers were interviewed: an intervention group (n = 214) that attended mother class and a control group (n = 213) that had not. A home visit followed the intervention to assess newborn care practices. Mother class used Maternal and Child Health Handbook as the main reference material. Attending mother class significantly increased knowledge of breastfeeding initiation and hepatitis B immunization (p < 0.05). Mothers in the intervention group had the likelihood of practicing good newborn care compared with the control group (odds ratio: 1.812; 95% confidence interval: 1.235-2.660). Mother class improves knowledge and newborn care practices and strengthens interactions between mothers and health care providers.

A New Phaeodarian Species Discovered from the Japan Sea Proper Water, Auloscena pleuroclada sp. nov. (Aulosphaeridae, Phaeosphaerida, Phaeodaria).

A new phaeodarian species, characterized by the presence of long developed side branches recurved proximally and distally on the surface of its radial tube, was described as Auloscena pleuroclada. This new species was only collected from the layers below the 250 m depth in the Sea of Japan. They have never been found in the shallower layers (above 250 m) of this sea or in other investigated areas. The distribution of the present new species is presumably restricted within the deep water of this area, and this species could be a specific phaeodarian adapted to the deep-sea environment.

A biogenic geodesic dome of the silica skeleton in Phaeodaria.

Unique architectures of microbial skeletons are viewed as a model for the architectural design of artificial structural materials. In particular, the specific geometric arrangement of a spherical skeleton 0.5-1.5 mm in diameter of shell-bearing protists, Phaeodaria (Aulosphaera sp.), is remarkably interesting because of its similarity to a geodesic polyhedron, which is a hollow framework with 6-branched nodes that requires minimal building material for maximal strength. A phaeodarian skeleton composed of silica rods 5-10 µm in diameter was characterized as a distorted dome that is based on an icosahedron sectioned with a 7-frequency subdivision. The major difference of the biogenic architecture from the ideal geodesic dome is the coexistence of 7- and 5-branched nodes with the distortion of the frames and the presence of radial spines. From a microscopic perspective, the frames and radial spines were revealed to be hollow tubes having inner fibers and lamellar walls consisting of silica nanoparticles 4-8 nm in diameter with interlayer organic matter. The high degradability of the silica skeleton in seawater after cell mortality is ascribed to the specific nanometric composite structure. The biological architectonics sheds light on the production of environmentally friendly, lightweight structural materials and microdevices.

Service provision conditions for foreign residents in municipalities in Japan.

Objectives: This study examined the actual conditions of service provision to foreign residents (FRs) addressing prevention of lifestyle-related diseases (LRDs) and disaster preparedness/disaster responses (DPRs) in Japanese municipalities. Materials and Methods: A cross-sectional study was performed using a self-administered questionnaire with representatives of public health nurses in each municipality in Japan from December 2021 to January 2022. Results: Services considering FRs are more likely to be implemented in cities than in towns, and in municipalities where FRs account for ≥2.2% of the population (proportion of FRs in the Japanese population at the time of the study) than in those with fewer FRs. Cities have larger populations and greater financial resources than towns. Factors associated with the implementation of services and measures necessary for providing services to FRs were the classification of the municipality as a city, a high percentage of FRs, and large variation in corresponding nationalities/countries of origin. Conclusions: Cross-disciplinary efforts and collaborations need to be strengthened to share available resources within local governments and experiences in providing services for FRs in other divisions/sections, rather than considering only how to provide services for FRs in the public health division/section.

Infection surveillance after a natural disaster: lessons learnt from the Great East Japan Earthquake of 2011.

PROBLEM: On 11 March 2011, the Great East Japan Earthquake produced a catastrophic tsunami that devastated the city of Rikuzen-Takata and left it without an effective health infrastructure and at increased risk of outbreaks of disease. APPROACH: On 2 May 2011, a disease-surveillance team was formed of volunteers who were clinicians or members of Rikuzen-Takata's municipal government. The team's main goal was to detect the early signs of disease outbreaks. LOCAL SETTING: Seven weeks after the tsunami, 16 support teams were providing primary health care in Rikuzen-Takata but the chain of command between them was poor and 70% of the city's surviving citizens remained in evacuation centres. The communication tools that were available were generally inadequate. RELEVANT CHANGES: The surveillance team collected data from the city's clinics by using a simple reporting form that could be completed without adding greatly to the workloads of clinicians. The summary findings were reported daily to clinics. The team also collaborated with public health nurses in rebuilding communication networks. Public health nurses alerted evacuation centres to epidemics of communicable disease. LESSONS LEARNT: Modern health-care systems are highly vulnerable to the loss of advanced technological tools. The initiation--or re-establishment--of disease surveillance following a natural disaster can therefore prove challenging even in a developed country. Surveillance should be promptly initiated after a disaster by (i) developing a surveillance system that is tailored to the local setting, (ii) establishing a support team network, and (iii) integrating the resources that remain--or soon become--locally available.

Role of Maternal and Child Health Handbook on Improving Maternal, Newborn, and Child Health Outcomes: A Systematic Review and Meta-Analysis.

The objective of this review is to assess and synthesize the role of the maternal and child health (MCH) handbook on improving healthcare service utilization, behavior change, and health outcomes for women and children. A systematic search of all relevant existing reports was conducted on 14 January 2021, using the following online bibliographic databases: PubMed, EMBASE, MEDLINE, The Cochrane Library, Academic Search Premier, Emcare, APA PsycINFO, and Web of Science. Two reviewers independently performed study selection, data extraction, and quality assessment. We included 7 trials from 1430 articles, and a total of 2643 women. As overall risk of bias assessment, most domains of the Cochrane risk-of-bias assessment tool showed a high or unclear risk of bias. The risk of ≥6 antenatal care (ANC) visits was 19% higher (RR 1.19, 95% CI 1.09 to 1.30, I2 = 47%, 2 studies, 955 women, moderate certainty of evidence) and skilled birth attendants during delivery was 13% higher (RR 1.13, 95% CI 1.04 to 1.24, I2 = 0%, 2 studies, 1094 women, low certainty of the evidence) in the intervention group than in the control group. The MCH handbook can increase maternal health service utilization and early breastfeeding practice. It also leads to a sense of autonomy during ANC, better communication with healthcare providers, and support from family members.

DNA metabarcoding focusing on the plankton community: an effective approach to reconstruct the paleo-environment.

DNA metabarcoding (DNA-MB) targeting the whole plankton community is a promising approach in studies of sediment samples from water bodies, but its effectiveness in ancient material is not well demonstrated. We applied DNA-MB of plankton in a sediment core to reconstruct the paleo-environment of Lake Shinji, Japan, through a marine lagoon/freshwater lake transition during the past 2300 years. We interpreted core-sample plankton taxonomy and habitat by reference to the modern plankton community in water samples. OTUs (operational taxonomic units) belonging to Dictyochophyceae were 81.05% of the total reads in sediments. However, Ciliophora, Copepoda and Labyrinthulea formed the majority of plankton taxa in the water samples, suggesting that they are under-represented in sediment. A drastic change in plankton composition correlated with a large decrease in sediment sulfur concentration, implying the change of aquatic environment from marine lagoon to freshwater lake. This event took place ca. 1200 CE in Lake Shinji. A 250 year-long transitional period followed, during which the total DNA sequence reads were very low. This suggests that salinity fluctuations created a hostile environment for both marine and freshwater plankton species. Our results show that DNA-MB of the whole plankton community is effective in reconstructing paleo-environments.

Re-invigorating Japan's commitment to global health: challenges and opportunities.

Over the past 50 years, Japan has successfully developed and maintained an increasingly equitable system of universal health coverage in addition to achieving the world's highest life expectancy and one of the lowest infant mortality rates. Against this backdrop, Japan is potentially in a position to become a leading advocate for and supporter of global health. Nevertheless, Japan's engagement with global health has not been outstanding relative to its substantial potential, in part because of government fragmentation, a weak civil society, and lack of transparency and assessment. Japan's development assistance for health, from both governmental and non-governmental sectors, has remained low and Japanese global health leadership has been weak. New challenges arising from changes in governance and global and domestic health needs, including the recent Great East Japan Earthquake, now provide Japan with an opportunity to review past approaches to health policy and develop a new strategy for addressing global and national health. The fragmented functioning of the government with regards to global health policy needs to be reconfigured and should be accompanied by further financial commitment to global health priorities, innovative non-governmental sector initiatives, increased research capacity, and investments in good leadership development as witnessed at the G8 Hokkaido Toyako Summit. Should this strategy development and commitment be achieved, Japan has the potential to make substantial contributions to the health of the world as many countries move toward universal coverage and as Japan itself faces the challenge of maintaining its own health system.

Ecology, Morphology, Phylogeny and Taxonomic Revision of Giant Radiolarians, Orodaria ord. nov. (Radiolaria; Rhizaria; SAR).

The phylogenetic affiliation of Oroscenidae, a family of Radiolaria possessing large siliceous skeletons, was thoroughly revised in this study. Plankton sampling was conducted over seven years in seven sea areas of the Northern Hemisphere. Molecular analyses on the obtained specimens revealed that living oroscenids are phylogenetically different from hitherto-known radiolarian orders. The detailed examinations by Microfocus X-ray Computed Tomography and Scanning Electron Microscopy clarified that oroscenids and the related family (Thalassothamnidae) have unique skeletal characteristics different from other radiolarian orders. Judging from their phylogenetic distinctiveness and the difference in the morphology and ecology, Oroscenidae and Thalassothamnidae should be classified in a single order distinct from other radiolarian orders, and consequently, a new order, Orodaria, is established.

Can digital health technologies exacerbate the health gap? A clustering analysis of mothers' opinions toward digitizing the maternal and child health handbook.

BACKGROUND: The use of mobile health has increased worldwide, but along with its increased utilization comes the risk of the digital divide, inequity in access to information and communications technologies, exerting greater influence on health inequity caused by socioeconomic determinants of health. There is a growing need to investigate whether the digitization of existing health interventions has a risk of worsening the health gap. METHODS: We investigated the attitudes of mothers and pregnant women toward digitization of the Maternal and Child Health Handbook (MCHH), a popular personal health record (PHR) used by almost every pregnant woman or mother in Japan, using a cross-sectional survey. We determined sociodemographic factors associated with favorable opinions toward digitization using a multivariate regression model. We then grouped the participants using partitioning around medoids clustering, a machine-learning approach, to interpret their varying attitudes toward digitization in light of their sociodemographic characteristics as well as their affinity toward the paper MCHH. FINDINGS: Higher income and educational level, older age, and less reliance on the MCHH were significantly associated with favorable opinion toward digitization. Clustering analysis identified four latent clusters. The cluster with the highest socioeconomic status (SES) was the most favorable toward digitization, while two clusters with the lowest SES, one of which relied heavily on the paper MCHH, were less favorable of digitization compared to the high SES cluster. The final cluster was comprised of mothers with the experience of raising multiple children and did not rely heavily on the MCHH. INTERPRETATION: Our study identified a socioeconomic divide in opinions toward digitization of an existing health intervention. A hasty digitization may result in an unbalanced uptake of the digitized health intervention among different social classes.

Phylogenetic Revision of the Order Entactinaria-Paleozoic Relict Radiolaria (Rhizaria, SAR).

Entactinaria, an order of Radiolaria, are defined by a specific skeletal structure called "initial spicular system (ISS)". The oldest entactinarians appeared in the Ordovician period, and the extant species are thought to have survived until today. However, the morphological observation revealed that the ISSs of entactinarian families are highly variable, and the validity of this characteristic is questionable. This is supported by the results of 18S and 28S rRNA molecular phylogenetic analysis that suggested the polyphyly of the four families analyzed in this study. Orosphaeridae, Rhizosphaeridae, Hexalonchidae and Hexastylidae should be excluded from the order Entactinaria. Considering the present results and the diversity in the ISS, it is also possible that "living entactinarians" are polyphyletic.