Paternal involvement in childcare and housework and mothers' spanking behavior: The Japanese longitudinal survey of newborns in the 21st century.

BACKGROUND: No previous study reported an association between paternal involvement in childcare and housework and maternal physical punishment. METHODS: Using data from the Japanese Longitudinal Survey of Newborns in the 21st century (N = 38,554), we analyzed responses about fathers' involvement in childcare and housework at 6 months and mothers' spanking of children at 3.5 years. Fathers' involvement in childcare and housework was scored and categorized into quartiles. Spanking frequency was asked in the "often", "sometimes", or "not at all" categories. Multivariable-adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for the mothers' often spanking children were computed for the fathers' involvement in childcare and housework. We also stratified the association by fathers' working hours (40-49, 50-59, or ≥ 60 hours/week). RESULTS: Among the 16,373 respondents, the proportion of mothers who often spanked their children was 4.8%. Compared with the lowest quartile, a higher frequency of paternal involvement in housework was associated with a lower risk of spanking children (p trend = 0.001). Adjustment for covariates attenuated the association, but significant association was observed in the 3rd quartile of paternal involvement in housework [OR (95% CI): 0.77 (0.62-0.96)]. When the fathers worked fewer than 50 hours a week, a significant negative association was observed between the fathers' frequency of childcare and the likeliness of the mothers' spanking their children (p trend = 0.02). CONCLUSIONS: The fathers' active involvement in childcare and housework could reduce the mothers' physical punishment for their children.

Preconception underweight impact on postnatal osteoporotic fracture: a retrospective cohort study using Japanese claims data.

BACKGROUND: Undernutrition and underweight are osteoporosis risk factors. Therefore, improving the health of underweight young women in Japan is an important medical issue. However, few studies have evaluated the association between being preconception underweight and postnatal osteoporotic fractures in young women. METHODS: This retrospective cohort study used a Japanese nationwide claims database (JMDC Inc.) to evaluate the effect of preconception underweight on the incidence of osteoporotic fracture within two years after delivery. Data from 16,684 mothers who delivered their first singleton babies between January 2006 and December 2020 were analysed. The combination of disease codes of fractures at sites associated with osteoporosis and medical procedures for fractures was defined as the incidence of osteoporotic fractures, whereas the body mass index (BMI) recorded 12-36 months before delivery was used as the exposure. We estimated the incidence of osteoporotic fractures by BMI category using a Kaplan-Meier curve and examined the fracture risk using Cox hazard regression analyses. RESULTS: Fifty-one women (0.31%) were affected by osteoporotic fractures within two years of delivery. More than 80% of these were rib fractures, and approximately 65% of fractures occurred after the first year postpartum. Preconception underweight (BMI < 18.5 kg/m2) was significantly associated with the incidence of postpartum osteoporotic fractures. There was no significant association between low BMI and postnatal fractures, as analysed via multiple categorical logistic regression analysis. CONCLUSION: Appropriate control of preconception weight might be critical to improving the postpartum quality of life, subsequent bone health, and neonatal care environment.

Pre-pregnancy body mass index and low birthweight: Secondary data analysis using health insurance claims data in Japan.

AIM: For women, being underweight increases their susceptibility to osteoporosis, anemia, and other conditions and affects the weight of their infants and the well-being of future generations. This study examined the association between low pre-pregnancy body mass index (BMI) and low birthweight using health insurance claims data and health checkup data, including weight measurements. METHODS: We used health insurance claims data and health checkup data (JMDC, Tokyo, Japan) of women and their newborns in Japan between 2006 and 2020. We used checkup data, which included more accurate weight measurements and blood test-based diagnoses of anemia and hyperlipidemia compared to self-reported data. Maternal pre-pregnancy BMI was compared across three groups: underweight (BMI <18.5 kg/m2), normal weight (BMI 18.5-24.9 kg/m2), and overweight (BMI ≥25.0 kg/m2). The primary outcome was low birthweight (<2500 g), and secondary outcome was preterm childbirth. Logistic regression analyses were conducted to compare outcomes in the three groups by BMI. The underweight BMI group was considered as the reference group. A subgroup analysis was performed by maternal age. RESULTS: In total, 16 363 mothers (underweight, 3418 [21%], normal weight, 11 493 [70%], and overweight, 1452 [8.9%]) were included. The risk of primary outcome (low birthweight) was significantly lower in the normal weight group than in the underweight group (4.6% vs. 5.7%; adjusted odds ratio 0.78 [95% confidence interval: 0.65-0.96]). In the subgroup analyses, no significant differences were noted in the incidences of low birthweight and preterm childbirth between maternal age groups. CONCLUSIONS: Pre-pregnancy BMI was associated with an increased risk of delivering low-birthweight infant. Awareness about the importance of women's pre-pregnancy health and appropriate BMI may reduce the incidence of low birthweight.

Annual numbers of diagnoses and medical expenses for obstetric diseases in Japan: A report from the National Database of Health Insurance Claims.

AIM: The present study aimed to estimate the total numbers of obstetric diseases diagnosed, total amounts of medical expenses claimed for obstetric diseases, their averages per livebirth, and yearly trends in Japan. METHODS: This is a secondary analysis of the National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB) (data from 2015 to 2019). The target population was women of reproductive age (15-49 years old) with diseases in pregnancy, childbirth, and the puerperium, defined by having O codes according to the International Classification of Diseases 10th Revision. We calculated the numbers of obstetric diseases diagnosed, amounts of medical expenses claimed for obstetric diseases marked with the "main injury/disease decision flag," and the totals divided by the annual numbers of livebirths, by year and women's age group. RESULTS: From 2015 to 2019, both the numbers of obstetric diseases diagnosed and amounts of medical expenses claimed for obstetric diseases per livebirth were on an upward trend, whereas the total numbers of obstetric diseases diagnosed were decreased. Women in advanced age groups had a higher number of diagnoses and a higher amount of medical expenses for obstetric diseases per livebirth. "Preterm labour without delivery" had the highest amounts of medical expenses claimed for and the second highest numbers of diagnoses throughout the study period. CONCLUSIONS: This study suggests that pregnant women in Japan would have an increasing number of obstetric complications and necessary medical expenses year by year. Further study is warranted to elucidate these trends and identify possible mitigation measures.

Prevalence and Associated Factors of Psychological Distress Among Single Fathers in Japan.

BACKGROUND: In Japan, ten percent of single-parent households are led by fathers. Taking care of children as a single father is very stressful and could put a strain on their health. It is very important to prevent and identify psychological distress among fathers for both their own health and to avoid negative impacts on children. This study aims to determine the prevalence of and factors associated with psychological distress among single fathers and understand how it is different from partnered fathers. METHODS: We used data from the Comprehensive Survey of Living Conditions 2016. Psychological distress, assessed using the K6 scale, was analyzed among 868 single and 43,880 partnered fathers. Logistic regression analysis was performed to assess the risk factors for psychological distress, such as employment type, sleep hours, and smoking and drinking habits. RESULTS: Single fathers had a higher proportion (8.5%) of psychological distress compared to partnered fathers (5.0%). A larger percentage of single fathers had a lower educational level and were more likely to be non-regular workers, self-employed, or unemployed than partnered fathers. Among single fathers, the crude and adjusted odds ratio for employment type and sleep hours were significantly associated with psychological distress. CONCLUSION: As single parents who are self-employed or directors are likely to have significantly reduced psychological distress than those with regular jobs, measures are needed to improve the work-family balance for non-self-employed fathers. There is a need to provide greater financial assistance and other social welfare support to single parents to ensure their and their children's good health.

Trajectories of fathers' childcare involvement and child behavioral outcomes.

BACKGROUND: Father's closeness and playful behavior influence a child's emotional and cognitive development. In this study, we aimed to assess the long-term association of paternal involvement in childcare at 1-3 years of life on subsequent behavioral outcomes at 8 years of age. METHODS: Data were obtained from the 2010 cohort of the Longitudinal Survey of Newborns in the 21st century in Japan. We used group-based trajectory modeling to predict the trajectory of total childcare scores in surveys 1, 2 and 3 to determine the overall involvement of fathers in childcare during early childhood. The level of fathers' involvement in childcare was categorized as "low", "medium" and "high". Responses from the eighth survey were used to assess child behavioral outcomes using five indicators when the child was 8 years old. Crude and adjusted logistic regression analysis was conducted to estimate the odds ratio (OR) separately for each of the behavioral outcomes of the child. RESULTS: Among the 17,027 father-child dyads included in this study, two-thirds of the fathers were of the age group 30-39 years. Compared to low involvement, children of fathers with high involvement in childcare during the early childhood years were less likely to not want to go to school even after adjusting for covariates (adjusted OR, 0.46; 95% CI: 0.32-0.66). CONCLUSIONS: Children benefit from their fathers' involvement in early childcare activities. To improve a child's well-being, fathers should be encouraged by providing them with a suitable working environment with flexible arrangements and the opportunity to involve in childcare.

Parents' preferences for respite care of children with medical complexity.

BACKGROUND: The number of children with medical complexity (CMC) is increasing worldwide. For these children and their families, various forms of support are legislated; among them, short-stay respite care has a great unmet need. We examined such children's parents' preferences for respite care and their willingness to pay. METHODS: We used discrete choice experiments (DCEs) to estimate the parents' preferences and willingness to pay. Parents whose children used overnight short-stay respite services answered a questionnaire to compare two hypothetical facilities of respite care having seven attributes and three levels. The DCE data was analyzed using the conditional logit model. The willingness to pay was calculated based on DCE estimates. RESULTS: A total of 70 parents participated in this study and mean age of their children was 7.8 years (standard deviation [SD] 4.3). Among those children, 67 (96%) had the severest certification of disability, and 27 (38%) used a ventilator at home. We found that the parents' highest preferences was the best level of medical care level that can manage ventilators (coefficient 1.61, 95% confidence interval [CI]: 1.32-1.90). The better and best level of medical care, daily care, education/nursing, and emergency care were preferred over basic quality services. Willingness to pay for the best level of medical care was approximately 75,367 JPY per night. CONCLUSION: This study shows a need for respite care that can deliver high-level medical care, especially for the management of ventilators, to CMC. This finding can serve as a basis for promoting respite care services.

Randomized trial of advice from healthcare professionals to eliminate constriction by maternal clothing on the trunk to prevent preterm birth and improve health status.

AIM: Women's clothing during pregnancy may influence perinatal outcomes. A preliminary study suggested that midwives' advice to avoid wearing tight clothing during pregnancy may reduce the risk of preterm delivery. We examined the effects of such advice to pregnant women on the risk of preterm birth and health status during pregnancy. METHODS: An open-label evaluator-blinded randomized controlled trial was conducted at the National Centre for Child Health and Development in Tokyo, Japan. Normal pregnant women were randomly assigned to receive constrictive clothing elimination care or standard care at 20 weeks gestation. The control group was issued leaflets concerning anemia prevention at entry and skin care at 30 weeks' gestation, along with a brief explanation and answers to questions by midwives as standard care. The intervention group received advice from midwives concerning avoiding constrictive clothing in addition to standard care. The primary outcome was the incidence of preterm birth (<37 weeks). The secondary outcomes were 12 indicators related to preterm delivery or health status. RESULTS: Among 624 randomly assigned women, 599 (intervention group, n = 306; control group, n = 293) completed the study between February 2015 and August 2016. The incidence of preterm birth in the intervention and control groups was 4.2% (13/306) and 5.1% (15/293), respectively (p = 0.614). There were no significant differences regarding any secondary outcomes, including obstetric outcomes and physical/mental indicators, during pregnancy. CONCLUSIONS: Advice from midwives to avoid constrictive clothing during pregnancy did not influence the incidence of preterm birth or maternal health status. TRIAL REGISTRATION: UMIN000016853 (March 30, 2015).

[Survey results on the status of implementation of population approach projects for fathers across Japan by their municipalities].

Objectives　This study aimed to examine the status of implementation and details of population-based approach projects that primarily target fathers nationwide. It also seeked to discuss the possibility of providing childcare support to fathers in the community.Methods　This study analyzed the overall results of two surveys undertaken. The primary survey was conducted between December, 2020 and February, 2021 by administering a mail questionnaire within 1,741 municipalities across Japan. A secondary interview survey was then conducted from August to September, 2021, among the municipalities that responded that they are "implementing projects mainly for fathers," and those that obtained consent to participate in this survey.Results　The 837 municipalities (response rate = 48.1%) that responded to the primary survey were included in the analysis. Many municipalities provided paternal and family support in addition to childcare support for mothers, at the time of issuing maternal and child health handbooks and in parent classes. This support was inclusive of distributing leaflets and pamphlets for fathers (P=0.036), encouraging fathers to participate in parent classes (P<0.001), setting dates and times that are easy for fathers to participate in (P<0.001), and including content for fathers (P<0.001). There were significantly more responses from local governments of the municipalities with a total population of 70,000 or more. The number of municipalities that "implemented childcare support that primarily targeted fathers instead of mothers" was 54 or 6.5% of the total. However, about 70% of the municipalities that had not implemented such programs recognized the need for their implementation. In the 21 municipalities where the interviews were conducted, there were 10 projects implemented during pregnancy, 12 during the childcare period after delivery, and 1 implemented across both. The contents of the implemented programs varied widely, with each municipality devising its own programs based on regional characteristics, which had generally favorable evaluations from the participants. In contrast, many municipalities mentioned that the small number of participants was an issue.Conclusion　Although fathers are encouraged to participate in childcare and housework within households, it is rare for them to be given opportunities to gain the required knowledge and skills. Most projects provide support for fathers as supporters of mothers. Going forward, in addition to surveys targeting fathers, there is a need to present project models that can be implemented by the local governments.

Public attitudes in the clinical application of genome editing on human embryos in Japan: a cross-sectional survey across multiple stakeholders.

Recent advances in genome editing technology are accompanied by increasing public expectations on its potential clinical application, but there are still scientific, ethical, and social considerations that require resolution. In Japan, discussions pertaining to the clinical use of genome editing in human embryos are underway. However, understanding of the public's sentiment and attitude towards this technology is limited which is important to help guide the debate for prioritizing policies and regulatory necessities. Thus, we conducted a cross-sectional study and administered an online questionnaire across three stakeholder groups: the general public, patients and their families, and health care providers. We received responses from a total of 3,511 individuals, and the attitudes were summarized and compared among the stakeholders. Based on the distribution of responses, health care providers tended to be cautious and reluctant about the clinical use of genome editing, while patients and families appeared supportive and positive. The majority of the participants were against the use of genome editing for enhancement purposes. Participants expressed the view that clinical use may be acceptable when genome editing is the fundamental treatment, the risks are negligible, and the safety of the technology is demonstrated in human embryos. Our findings suggest differences in attitudes toward the clinical use of genome editing across stakeholder groups. Taking into account the diversity of the public's awareness and incorporating the opinion of the population is important. Further information dissemination and educational efforts are needed to support the formation of the public's opinion.

Antenatal screening timeline and cutoff scores of the Edinburgh Postnatal Depression Scale for predicting postpartum depressive symptoms in healthy women: a prospective cohort study.

BACKGROUND: It is worthwhile to identify women at risk of developing postpartum depression during pregnancy. This study aimed to determine the optimal time and cutoff score for antenatal screening for prediction of postpartum depressive symptoms (PDS) using the Edinburgh Postnatal Depression Scale (EPDS) and to identify risk factors for PDS. METHODS: The target population was healthy pregnant women receiving antenatal care at a university hospital in Tokyo, Japan. During the first, second, and third trimesters, 3-4 days postpartum, and one month postpartum, they were asked to take the Japanese version of the EPDS questionnaire. The primary outcome of the study was PDS, defined as an EPDS score ≥ 9 at one month postpartum. The area under the receiver operating characteristics curve (AUC), sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of EPDS scores at each antenatal screening time were calculated. RESULTS: From 139 pregnant women, 129 were successfully followed up throughout the study. The number of women with an EPDS score ≥ 9 during the first, second, and third trimesters, 3-4 days postpartum, and one month postpartum were 6/126 (4.8%), 9/124 (7.3%), 5/117 (4.3%), 17/123 (13.8%), and 15/123 (12.2%), respectively. Screening during the second trimester had the highest AUC to predict PDS (0.89) among antenatal screenings. The optimal EPDS cutoff score during the second trimester was 4/5 (sensitivity: 85.7%; specificity: 77.1%; PPV: 33.3%; NPV: 97.6%). An EPDS score ≥ 5 during the second trimester (adjusted odds ratio [aOR]: 15.9; 95% confidence interval [95%CI]: 3.2-78.1) and a family history of mental illness (aOR: 4.5; 95%CI: 1.2-17.5) were significantly associated with PDS. CONCLUSIONS: Our study suggests that the EPDS score at the second trimester with the cutoff value of 4/5 may be adequate for initial screening for prediction of PDS. Women with an EPDS score ≥ 5 at the second trimester require more elaborate follow-up.

Socioeconomic and lifestyle factors associated with mental health problems among Mongolian elementary school children.

PURPOSE: Lifestyle factors of children and adolescents' mental health problems are an emerging health issue in low- and middle-income countries (LMICs). However, there is a lack of studies on lifestyle factors in LMICs. This study examined the socioeconomic and lifestyle factors associated with mental health problems among school-age children in Mongolia. METHODS: A population-based cross-sectional survey was conducted among 4th-year students at public elementary schools in one district in Ulaanbaatar. The Strengths and Difficulties Questionnaire (SDQ) and a self-administrated socioeconomic and lifestyle questionnaire were completed by participants' guardians. A multivariate logistic regression analysis was performed. RESULTS: Of the 2301 children surveyed, 1694 without missing responses were included in the analysis. The multivariate logistic regression analysis showed that male gender [adjusted odds ratio (AOR) 1.64 (1.29-2.10)], low maternal education [AOR 1.89 (1.16-3.05)], short sleep [AOR 1.41 (1.10-1.80)], no physical activity [AOR 1.31 (1.03-1.67)], and long screen time (AOR 1.53 (1.20-1.94)) were associated with high risk of mental health problems. Low maternal education, low household income, no physical activity habit, and long screen time were associated with internalising problems. Meanwhile, male gender, low maternal education, and long screen time were associated with externalising problems. CONCLUSION: The results are consistent with previous studies in high-income countries, indicating that there are globally common socioeconomic and lifestyle risk factors. The findings of this study may help develop a targeted preventive intervention for high-risk groups, such as socioeconomically disadvantaged groups, as well as a universal preventive intervention to foster a healthy lifestyle in Mongolia.

Barriers, facilitators, and implementation strategies for the initiation of Child Death Review system in Japan: a modified Delphi method study.

BACKGROUND: To further curb preventable child deaths, some countries have implemented Child Death Review (CDR). CDR is a comprehensive multidisciplinary process that investigates, reviews, and registers all child deaths to consider prevention strategies. This study deciphered the barriers, facilitators, and implementation strategies in Japan. METHODS: This study used a three-round modified Delphi method. The expert panel consisted of local government officers and health professionals responsible for the CDR pilot project in Japan. As a modification, the initial list of barriers, facilitators, and implementation strategies to address each barrier and facilitator was prepared based on project reports and interviews with local government officers. Throughout the three rounds, the panel evaluated predefined barriers and facilitators, suggested and evaluated additional items, and appraised the potential effectiveness of the implementation strategies on barriers and facilitators which they were meant to address. The importance of barriers and facilitators, and the potential effectiveness of implementation strategies were evaluated using 5-point Likert scale. The priority of the combinations of barriers, facilitators, and implementation strategies were determined considering their importance and effectiveness. RESULTS: A total of 31 experts participated in the panel. Response rates were 96.8%, 80.6%, and 90.3% for the first, second, and third rounds, respectively. A total of 13 barriers, eight facilitators, and 72 implementation strategies corresponding to the barriers and facilitators reached consensus. At the national government level, a barrier-strategy combination of "lack of legislation (barrier)" and "legislation for CDR (strategy)," and a facilitator-strategy combination of "good multi-agency collaboration (facilitator)" and "official notices from the national government (strategy)" were at the highest priority. At the local government level, combinations of "lack of legislation (barrier)" and "constant budget allocations (strategy)," "lack of legislation (barrier)" and "citizens' acceptance (strategy)," and "good multi-agency collaboration (facilitator)" and "appointment of a full-time staff (strategy)" were at the highest priority. CONCLUSION: This study demonstrated that legislation is the key to better implementation of CDR in Japan. Legislation can address various barriers such as personal information collection, multi-agency collaboration, high workload, and budget instability. Without legislation, careful strategies must be taken to solve difficulties caused by its absence. TRIAL REGISTRATIONS: None.

The RE-AIM framework-based evaluation of the implementation of the Maternal and Child Health Handbook program in Angola: a mixed methods study.

BACKGROUND: The World Health Organization recommends the Maternal and Child Health Handbook (MCH-HB) to promote health service utilization from pregnancy to early childhood. Although many countries have adopted it as a national health policy, there is a paucity of research in MCH-HB's implementation. Thus, this study aimed to evaluate the MCH-HB's implementation status based on the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, Maintenance), and identify facilitators of, and barriers to its implementation in Angola to understand effective implementation strategies. METHODS: A cross-sectional survey was conducted targeting all health facilities which implemented MCH-HB, subsamples of health workers, and officers responsible for the MCH-HB at the municipality health office. Using the 14 indicators based on the RE-AIM framework, health facilities' overall implementation statuses were assessed. This categorized health facilities into optimal-implementation and suboptimal-implementation groups. To identify barriers to and facilitators of MCH-HB implementation, semi-structured interviews were conducted among health workers and municipality health officers responsible for MCH-HB. The data were analyzed via content analysis. RESULTS: A total of 88 health facilities and 216 health workers were surveyed to evaluate the implementation status, and 155 interviews were conducted among health workers to assess the barriers to and facilitators of the implementation. The overall implementation target was achieved in 50 health facilities (56.8%). The target was achieved by more health facilities in urban than rural areas (urban 68.4%, rural 53.6%) and by more health facilities of higher facility types (hospital 83.3%, health center 59.3%, health post 52.7%). Through the interview data's analysis, facilitators of and barriers to MCH-HB were comprehensively demonstrated. MCH-HB's content advantage was the most widely recognized facilitator and inadequate training for health workers was the most widely recognized barrier. CONCLUSIONS: Strengthening education for health workers, supervision by municipality health officers, and community sensitization were potential implementation strategies. These strategies must be intensified in rural and lower-level health facilities.

Factors related to parenting stress among fathers of preschool children in Japan.

BACKGROUND: Even though fathers participate in childcare at a higher rate than before, there remains a lack of research on the factors that contribute to parenting stress among fathers. This study explored the socioeconomic and demographic factors associated with parenting stress among fathers of preschool children. METHODS: Our study included 17 645 fathers who participated in the 2016 Comprehensive Survey of Living Conditions in Japan. Parenting stress was assessed using a single question. Socioeconomic and demographic factors were predictors. Logistic regression analysis was conducted to estimate the odds ratio (OR) and 95% confidence interval (CI) for parenting stress. RESULTS: Overall, 6.6% fathers experienced parenting stress. Fathers with a youngest child aged 0-2 years were more likely to experience parenting stress than those with a youngest child aged 3-6 (OR: 1.45, 95% CI: 1.25-1.68). Compared with fathers who lived in two-parent households without grandparents, those who lived in single-father households (both with and without grandparents) were more likely to experience parenting stress (OR: 12.13, 95% CI: 5.60-26.29 and OR: 4.19, 95% CI: 2.04-8.60, respectively). Furthermore, there was a significant negative association between education and parenting stress. CONCLUSIONS: Having a child aged 0-2 years, single fatherhood, and higher education were associated with parenting stress among fathers of preschool children. Healthcare professionals need to be aware of these factors when supporting fathers in raising their children.

[Review on the influence of paternal involvement in childcare on mothers, children, and fathers].

Objectives　Recently, paternal involvement in childcare has been gaining public attention in Japan. However, studies on the influences of active paternal involvement remain scarce. This study aimed to review the findings on the influence of paternal involvement in childcare on mothers, children, and fathers themselves from studies conducted in Japan and published mainly after 2010. Additionally, we examined methodological issues that need to be addressed when researchers conduct studies on paternal involvement in the future.Methods　We reviewed 26 journal articles (22 in Japanese and 4 in English) from four databases: "Igaku Chuo Zasshi Web (Japana Centra Revuo Medicina History and Activities)," JSTPlus, JMEDPlus, and PubMed with conditions such as studies conducted in Japan, families with young children, and questionnaire-based quantitative studies. We described respondents (mothers, fathers, or both) and assessed paternal involvement in childcare, outcomes, and findings.Results　We reviewed studies on paternal involvement in childcare published in Japanese after 2010 and English after 2000 and observed two trends across the studies. The first was that if mothers acknowledge active paternal involvement in childcare, mothers' parenting stress seemed to be lower, and they seemed to be happier. Moreover, for children's health and development, active paternal involvement seemed to be associated with positive results, such as prevention of unintentional injuries and obesity. However, in the second trend, we observed that active paternal involvement, assessed by the fathers themselves, were often not associated with lower parenting stress among mothers. We also could not observe a consistent trend on the findings related to the influences on fathers, due to the limited number of studies. We observed that assessment of paternal involvement in childcare was inconsistent across studies included in this review.Conclusion　With more social pressure for fathers to be actively involved in childcare, public interest for the influence would be heightened. For future studies, better ways of assessing the quantity and content of paternal involvement in childcare need to be discussed.

Validation of the parent version of the Strengths and Difficulties Questionnaire (SDQ) to screen mental health problems among school-age children in Mongolia.

BACKGROUND: Child and adolescent mental health problems are urgent health issues in low- and middle-income countries. To promote child and adolescent mental health services, simple validated screening tools are helpful. In Mongolia, the Strengths and Difficulties Questionnaire (SDQ), an internationally used child and adolescent mental health screening tool for children aged 4-17, was translated but not yet validated. To use the questionnaire appropriately, validation is necessary. METHODS: Children at 4th year at elementary school (community sample) and children visited psychiatric outpatient service (clinical sample) were recruited and their parental version of the SDQ was compared. The discriminating ability of the parental version of the SDQ was examined using Receiver Operating Characteristics (ROC) analysis on the SDQ total difficulties score. The area under the ROC curve (AUC) was used as a measure. Cut-off score was determined by normative banding that categorizes children with the highest 10% score range as abnormal and the second highest 10% as borderline following the original method; this cut-off score was compared with the cut-off score candidates with good balance between sensitivity and specificity using ROC analysis. RESULTS: We included 2301 children in the community sample, and 429 children in the clinical sample. Mean age was 9.7 years (SD 0.4, range 8.3-12.0) among the community sample and 10.4 years (SD 3.8, range 4.0-17.8) among the clinical sample. The mean total difficulties score was 12.9 (SD 4.8) among the community sample and 20.4 (SD 6.2) among the clinical sample. A total of 88.8% of the community sample and 98.8% of the clinical sample answered the SDQ. Using ROC analysis, the AUC was 0.82 (95% confident interval 0.80-0.85), which meant moderate discriminating ability. Using normative banding, the borderline cut-off score was 16/17 and abnormal cut-off score was 19/20. For cut-off scores of 16/17 and 19/20, sensitivity was 71.9 and 53.8% and specificity was 78.5 and 90.5%, respectively. The cut-off score candidates by ROC analysis were 16/17 and 17/18. CONCLUSIONS: The parental version of the SDQ had moderate discriminating ability among Mongolian school-age children. For the screening of mental health problems among community children, cut-off score of 16/17 is recommended.

Use of antipyretics for preventing febrile seizure recurrence in children: a systematic review and meta-analysis.

The efficacy of antipyretics for preventing febrile seizure recurrence has been reported by a recent study, and the results might overturn previous evidence. We systematically reviewed the efficacy of antipyretics in the prevention of febrile seizure recurrence in children focused on the timing of its administration. We searched the Medline, Embase, and Cochrane Central Register of Controlled Trials databases for randomized and quasi-randomized trials and prospective non-randomized studies of aged up to 60 months, diagnosed with febrile seizure, who were treated with antipyretics. Data were extracted from eight studies. Only one study reported that antipyretics prevented the recurrence of febrile seizures within the same fever episode (9.1% in the acetaminophen group vs. 23.5% in the control group, p < 0.01). Four studies found no evidence for the efficacy of antipyretics in preventing febrile seizure recurrence in distant fever episodes (odds ratio, 0.92; 95% confidence interval, 0.57-1.48, for two randomized controlled studies).Conclusion: This review provides very limited support for the use of antipyretics in preventing febrile seizure recurrence within the same fever episode and no evidence for its use in distant fever episodes. New studies are required to evaluate this topic further and determine whether the effectiveness of antipyretics is based on intervention timing. What is Known: • Reviews of prophylactic drug management among febrile seizure children found that antipyretics had no significant benefits. • Recent data suggest that antipyretics are effective in preventing febrile seizures. What is New: • Weak evidence suggests a possible role in preventing febrile seizure recurrence within the same fever episode. • There is clearly no role for antipyretic prophylaxis in preventing febrile seizures during distant fever episodes.

Genetic Structure in Japanese and Thai Populations of the Japanese Sparrowhawk Accipiter gularis.

The Japanese sparrowhawk Accipiter gularis is a small raptor that breeds in Northeast Asia. The species consists of the widespread and mostly migratory subspecies A. g. gularis that is common in East Asia, including Japan, and the resident and endangered subspecies A. g. iwasakii which inhabits the Ryukyu and Yaeyama Islands in Okinawa, southern Japan. Given the minimal knowledge about the migration of the species, in this study we sought to compare the genetic variation of the populations breeding in Japan with those migrating through Southeast Asia. We sequenced 761 bp of mitochondrial DNA Control Region from each of 21 A. gularis collected during the breeding season in Japan and from 20 individuals intercepted on migration in Thailand. We detected 26 haplotypes among the 41 individuals which differed significantly between Japan and Thailand. Migrants in Thailand were presumed to have originated from a wide area in Eastern Eurasia. The phylogenetic and network analyses demonstrated that the haplotypes of all A. g. gularis detected in Japan were genetically close. Moreover, the Okinawa haplotypes of A. g. iwasakii were clustered with moderate genetic variation. The information presented here can be used towards implementing future conservation actions.

The effectiveness of exercise intervention for academic achievement, cognitive function, and physical health among children in Mongolia: a cluster RCT study protocol.

BACKGROUND: Many studies have demonstrated positive effects of physical activity on children's health such as improved cardiorespiratory function and decreased obesity. Physical activity has also been found to have positive effects on academic achievement and cognitive function. However, there are few high quality RCT studies on this topic at present and the findings remain controversial. METHODS: This protocol describes cluster randomized controlled trials assessing the impact of school-based exercise intervention among children in Mongolia. The intervention consists of 3-min sessions of high intensity interval training combined with music implemented two times a week at school during study periods. The participants are children in the fourth grade in public elementary schools in the Sukhbaatar district in Ulaanbaatar, Mongolia. The participants are cluster randomized by school and allocated either to the intervention or control group. The primary outcome is academic achievement. Secondary outcomes are obesity/overweight, physical fitness function, lifestyle, mental health, and cognitive function. DISCUSSION: This cluster-RCT is designed and implemented to assess the effectiveness of exercise intervention on academic achievement, cognitive function, and physical and mental health among school-age children in Mongolia. This study will provide evidence to promote physical activities among children in low- and middle- income countries. TRIAL REGISTRATION: UMIN: UMIN000031062 . Registered on 1st February 2018.