[RECOMMENDATION FOR ITCH ASSESSMENT FROM THE ATOPIC ITCH CONSENSUS MEETING (AICOM)].

BACKGROUND: Itch is the most troublesome symptom of atopic dermatitis, and it is important to assess it appropriately for optimal treatment. We discussed issues regarding itch and the most appropriate methods of assessment at the Atopic Itch Consensus Meeting (AICOM), attended by physicians and researchers with expertise in itch treatment and research. METHODS: The AICOM participants prepared a draft consensus statement that addressed the most appropriate itch assessment methods for age groups <2 years, 2-6 years, 7-14 years, and ≥15 years. Consensus was defined as agreement by ≥80% of the participants. RESULTS: Votes were cast by 20 participants (8 dermatologists, 7 pediatricians, and 5 researchers), and a consensus on the best current methods of itch assessment was reached with 95% agreement. For infants and preschool children, because subjective evaluation is difficult, a checklist for itch assessment was developed for caregivers. CONCLUSION: For itch assessment, we recommend subjective evaluation by the patient using a rating scale. For infants and preschoolers, evaluation should be done by the caregiver using a checklist, combined with objective evaluation (of skin lesions, for example) by a physician. We anticipate that more objective itch assessment indices will be established in the future.

[ANTIMICROBIAL ALLERGY ASSESSMENT DURING PREGNANCY FOR APPROPRIATE ANTIMICROBIAL USE AT DELIVERY].

BACKGROUND: Avoidance of suspect drugs based solely on a history of drug allergy is detrimental to disease outcomes. Many antimicrobial allergy labels are not usually true allergy. Some studies have demonstrated that antimicrobial allergy assessments can be safely performed on pregnant women. The purpose of this study was to examine the usefulness of antibiotic allergy assessment during pregnancy in Japan. METHODS: We reviewed pregnant women who reported antimicrobial allergies and were referred to the allergy center. Allergists conducted an interview and skin test and selected antibiotics that could be used at delivery. RESULTS: Twenty-four pregnant women were referred to as having antimicrobial allergies. Most of the suspected antimicrobials were cephalosporin (13 cases, 52%) and penicillin (9 cases, 36%). Five women were ruled out only by our interviews. Of the remaining 20 cases, 10 were immediate type, 6 were non-immediate type, and 4 were unknown. All 21 pregnant women who needed antimicrobials were able to use the first-line drugs (ß-lactam antimicrobials) at the time of delivery. No surgical site infections or allergic reactions were observed. CONCLUSION: Pregnant women with antimicrobial allergy labels could be evaluated by antimicrobial allergy assessment during pregnancy, and first-line antimicrobials were safely and properly used at delivery.

Dietary supplement use in elementary school children: a Japanese web-based survey.

BACKGROUND: A variety of dietary supplements are commercially available. However, the efficacy and safety of dietary supplement use in children are not well established. Understanding dietary supplement use is important for developing public health policy regarding dietary supplements. This study aimed to investigate the types of dietary supplements used and characteristics of dietary supplement users among Japanese elementary school children. METHOD: We conducted a cross-sectional web-based questionnaire study. Dietary supplement use, socio-demographics, and health-related behaviors were assessed through mother-reported questionnaire. Types of dietary supplements were identified based on ingredient using product barcodes and brand names. Multivariate logistic regression analysis was conducted to investigate the socio-demographics and health-related behaviors associated with supplement use. RESULTS: Among 4933 children, 333 (6.8%) were identified as dietary supplement users. The most common supplement was amino acids or protein (1.4%), followed by n-3 fatty acids or fish oil (1.0%), probiotics (1.0%), multivitamins (0.9%), multivitamin-minerals (0.8%), and botanicals (0.8%). Overall, any dietary supplement use was significantly associated with the highest frequency of sports participation (odds ratio [OR], 2.58; 95% confidence interval [CI], 1.65-4.02), highest household income (OR, 1.87; 95% CI, 1.13-3.10), highest maternal educational level (OR, 1.82; 95% CI, 1.31-2.52), and male sex (OR, 1.38; 95% CI, 1.09-1.75). The highest frequency of sports participation was significantly associated with higher odds of use of amino acids or protein (OR, 6.06; 95% CI, 1.78-20.6) and multivitamins (OR, 3.56; 95% CI, 1.11-11.5), compared to the lowest frequency of sports participation. CONCLUSION: This study showed that Japanese children primarily use non-vitamin, non-mineral supplements. Non-vitamin, non-mineral supplements should thus be included in future studies aimed at monitoring dietary supplement use. We also found that dietary supplement use in children was associated with sports participation. Guidelines for dietary supplement use for children, in particular sport participants, are needed.

Determinants of Alcohol Consumption in Women Before and After Awareness of Conception.

OBJECTIVES: We examined the socio-demographic and behavioral factors associated with alcohol consumption before and after pregnancy awareness in pregnant women. METHODS: This cross-sectional study included 91,828 pregnant women in a nationwide Japanese birth cohort study from 2011 to 2014. Alcohol consumption before and after pregnancy awareness, and sociodemographic behavioral characteristics were assessed through self-reported questionnaires. Determinants of alcohol consumption were investigated using logistic regression. RESULTS: Prevalence of alcohol consumption before and after pregnancy awareness was 50.0% and 2.8%, respectively. Most women consumed low to moderate levels of alcohol. Before pregnancy awareness, high educational level (odds ratios [OR] 1.11, 95% confidence interval [CI] 1.07 to 1.15), high household income (OR 1.16, 95% CI 1.09 to 1.24), and smoking (OR 1.77, 95% CI 1.65 to 1.90) were significantly associated with increased odds of alcohol consumption. After pregnancy awareness, older age (OR 1.73, 95% CI 1.54 to 1.94) and smoking (OR 5.57, 95% CI 4.88 to 6.37) were significantly associated with increased odds of alcohol consumption, and high education level (OR 0.72, 95% CI 0.64 to 0.81) and high household income (OR 0.75, 95% CI 0.63 to 0.89) were significantly associated with decreased odds of alcohol consumption. CONCLUSION: A half of women consumed alcohol before pregnancy awareness. Guidelines recommend abstinence from alcohol consumption in pregnant women for precaution, although influence of low to moderate levels of prenatal alcohol exposure on the fetus is inconclusive. Social-demographic characteristics differed between women who consumed alcohol before pregnancy awareness and women who continued alcohol after pregnancy awareness.

Clinical Utility of the Modified Pulmonary Index Score as an Objective Assessment Tool for Acute Asthma Exacerbation in Children.

INTRODUCTION: The Modified Pulmonary Index Score (MPIS) was developed as an objective assessment tool for acute asthma exacerbation in children. Although it is considered reliable, there are no known studies of its clinical utility. The objective of this study was to evaluate the validity of the MPIS for children with acute asthma in a clinical setting. METHODS: In this retrospective study conducted between July 2009 and June 2011 using electronic medical records at the emergency department of a single pediatric medical center in Tokyo, Japan, the MPIS was recorded for patients with acute asthma at initial assessment and after treatment with an inhaled beta-agonist. We evaluated the responsiveness and predictive validity of the MPIS using disposition as an outcome. RESULTS: A total of 2242 patients were assessed using the MPIS (median age, 3 years; 71.2% patients were 5 years or younger). The mean (SD) MPIS at initial assessment was 7.1 (3.6) and was significantly higher for the admission group than for the non-admission group (9.9 [2.9] vs. 5.9 [3.1]; P < 0.001). The receiver operator characteristic curve of the initial MPIS for hospital admission demonstrated moderate predictive ability (area under the curve, 0.83). An MPIS reduction of 3 or more indicated a clinically significant change when the MPIS at initial assessment was between 6 and 10 (risk ratio for admission [95% CI], 0.41 [0.28-0.60]; P < 0.001). CONCLUSION: The MPIS demonstrated good concurrent validity, predictive validity, and responsiveness in a wide range of clinical settings.

Assessment of Autistic Traits in Children Aged 2 to 4½ Years With the Preschool Version of the Social Responsiveness Scale (SRS-P): Findings from Japan.

The recent development and use of autism measures for the general population has led to a growing body of evidence which suggests that autistic traits are distributed along a continuum. However, as most existing autism measures were designed for use in children older than age 4, to date, little is known about the autistic continuum in children younger than age 4. As autistic symptoms are evident in the first few years, to address this research gap, the current study tested the preschool version of the Social Responsiveness Scale (SRS-P) in children aged 2 to 4½ years in clinical (N = 74, average age 40 months, 26-51 months) and community settings (N = 357, average age 39 months, 25-50 months) in Japan. Using information obtained from different raters (mothers, other caregivers, and teachers) it was found that the scale demonstrated a good degree of internal consistency, inter-rater reliability and test-retest reliability, and a satisfactory degree of convergent validity for the clinical sample when compared with scores from diagnostic "gold standard" autism measures. Receiver operating characteristic analyses and the group comparisons also showed that the SRS-P total score discriminated well between children with autism spectrum disorder (ASD) and those without ASD. Importantly, this scale could identify autistic symptoms or traits distributed continually across the child population at this age irrespective of the presence of an ASD diagnosis. These findings suggest that the SRS-P might be a sensitive instrument for case identification including subthreshold ASD, as well as a potentially useful research tool for exploring ASD endophenotypes. Autism Res 2017, 10: 852-865. © 2017 International Society for Autism Research, Wiley Periodicals, Inc.

A Comparison of Self-Rated and Female Partner-Rated Scales in the Assessment of Paternal Prenatal Depression.

Maternal depression has been widely studied but paternal depression is often overlooked. Depression in men is generally more difficult to detect as the symptoms are not apparent. Furthermore, Japanese couples tend to suppress their real emotions to avoid confrontation. We aimed to investigate the reliability and validity of the K6, K10 and PHQ-9 in assessing the mental health status of men when used by their pregnant partners, as well as the prevalence of paternal prenatal depression in a Japanese study sample. A total of 136 couples participated in this study. The prevalence of paternal prenatal depression reported by the men themselves was higher compared to that reported by their female partners (K6, 10.3 %; K10, 6.6 %; PHQ-9, 3.7 % vs. K6-FP, 2.2 %; K10-FP, 1.5 %; PHQ-9-FP, 0 %, respectively). Mental health issues in men may not be accurately rated by their female partners, suggesting the importance of self-rating and direct consultation.

Education, but not occupation or household income, is positively related to favorable dietary intake patterns in pregnant Japanese women: the Osaka Maternal and Child Health Study.

Although a large body of epidemiologic data accumulated in Western countries show that individuals with a higher socioeconomic position consume higher quality diets, information on such socioeconomic differences in the diets of non-Western populations, including Japanese, is absolutely lacking. This cross-sectional study examined the association of socioeconomic position with dietary intake in a group of pregnant Japanese women. Subjects were 1002 Japanese women during pregnancy. Socioeconomic position was assessed by education, occupation, and household income. Dietary intake was estimated using a validated, self-administered, comprehensive diet history questionnaire. Education was associated positively with intake of protein; total n-3 and marine-origin n-3 polyunsaturated fatty acids; dietary fiber; cholesterol; potassium; calcium; magnesium; iron; vitamins A, D, E, and C; and folate 9 and inversely with that of carbohydrate. No associations were seen between education and intake of total fat; saturated, monounsaturated, and total and n-6 polyunsaturated fatty acids; alcohol; or sodium. Regarding food, higher education was associated with a higher intake of vegetables, fish and shellfish, and potatoes and lower intake of rice. Education was not associated with intake of bread, noodles, confectioneries and sugars, fats and oils, pulses and nuts, meat, eggs, dairy products, or fruit. For occupation, housewives had a higher intake of dietary fiber, magnesium, iron, vitamin A, folate, and pulses and nuts than working women. Household income was not associated with any nutrient or food examined. In conclusion, education, but not occupation or household income, was positively associated with favorable dietary intake patterns in a group of pregnant Japanese women.

Monetary Diet Cost is Associated with not only Favorable but also Unfavorable Aspects of Diet in Pregnant Japanese Women: The Osaka Maternal and Child Health Study.

While several observational studies in European countries have shown that higher monetary diet cost is associated with healthier diets, information on the relationship of cost to diet quality in other countries is sparse, including Japan. This cross-sectional study examined the association between monetary diet cost and dietary intake in a group of pregnant Japanese women. Subjects were 596 pregnant Japanese housewives. Dietary intake was estimated using a validated, self-administered, comprehensive diet history questionnaire. Monetary diet cost was calculated using retail food prices. Values of monetary diet cost and nutrient and food intake were energy-adjusted using the density method. Monetary diet cost was associated positively with the intake of protein, total fat, saturated fatty acids, dietary fiber, cholesterol, sodium, potassium, calcium, magnesium, iron, vitamins A, D, E, C, and folate, and inversely with that of carbohydrate. For foods, cost was associated positively with the intake of potatoes, pulses and nuts, fish and shellfish, meat, dairy products, vegetables, and fruits, and inversely with that of rice and bread. No association was seen for noodles, confectioneries and sugars, fats and oils, or eggs. Cost was also associated inversely with dietary energy density. In conclusion, monetary diet cost was associated with not only favorable aspects of diet, including a higher intake of dietary fiber, key vitamins and minerals, fruits, and vegetables and lower dietary energy density, but also unfavorable aspects, including a higher intake of fat and sodium and lower intake of carbohydrate and rice, in a group of pregnant Japanese women.

[Development of quality of life assessment scale for caregivers of asthmatic children (QOLCA-24)].

PURPOSE: We developed the health related QOL questionnaire which is specific for a caregiver of an asthmatic child, who has been treated based on JPGL (Japanese Pediatric Guideline for the Treatment and Management of Asthma). METHOD: Based on the answers collected anonymously or with interviews concerning caregivers' quality of life influenced by having children with asthma, the multiple choice secondary questionnaire was made. Through psycho-analytic procedures of the data from secondary survey 24-item questionnaire (QOLCA-24) has been developed. RESULT: Factor analysis revealed 11 factor structure of QOLCA-24. Internal consistency (cronbach alpha) of whole 24 items was 0.942. kappa value which showed repetition plasticity was 0.27-0.53. The responsiveness associated with change of symptoms were significant in the items of factor 1 (Fear of asthma attack) and factor 7 (Job related burden of the caregiver). The score of most factors in QOLCA-24 were correlated with score of each item in SF-8. CONCLUSION: QOLCA-24 is thought to be useful as a tool to evaluate QOL of caregivers with asthmatic children.