[A case of isolated pulmonary valve infective endocarditis in a 78-year-old woman].

A 78-year-old woman was admitted to our hospital with lumbago. Her activities of daily living had previously been completely independent. However, she developed temporary chills in January 2009, that improved without treatment, but recurred on February 7, 2009 in association with left lumbago and loss of appetite. She was then referred to our hospital with a disturbance of consciousness and high fever on February 14. A blood test performed on admission revealed an elevated inflammatory response, coagulation disorder and low platelet count, and abdominal computed tomography demonstrated findings suggestive of pyogenic spondylitis. The patient was therefore admitted and treated with antibiotic therapy; however, she died on day 8 due to complications of disseminated intravascular coagulation. An autopsy showed isolated pulmonary valve endocarditis. The patient's history was later found to include regular dental treatment, and the same Streptococcus group G was detected in cultures of the sputum, blood and vegetation. It is important to interview patients regarding their history of dental treatment, particularly elderly individuals with fever of unknown origin.

Users' Perspective on Revised Simple Simulator for Calculating Nutritional Food Stocks in Preparation for Large-scale Disasters.

OBJECTIVE: In 2020, Japan's Ministry of Health, Labour and Welfare developed an Excel workbook entitled "Simple Simulator for calculating nutritional food stocks in preparation for large-scale disasters." In September 2021, it was modified as the "Revised Simulator" to plan food stockpiles in normal times and post-disaster meals. This study aimed to further improve the Revised Simulator. METHODS: Eight group interviews were conducted with 12 public health dietitians, 9 disaster management officers, and 2 public health nurses from September to November 2021. They provided nutritional support during previous disasters or prepared for predicted future disasters. Qualitative analysis was conducted on interview transcriptions, then the Revised Simulator was improved based on their feedback. RESULTS: The Revised Simulator was improved to the "Simulator for calculating nutritional food stocks and meals for large-scale disasters" with significant changes such as adding specific tags in the food list to denote long shelf life and elderly-friendly foods, as well as displaying bar graphs to visualize the required and supplied amounts of energy and nutrients. CONCLUSIONS: The Revised Simulator was upgraded for planning and assessing stockpiles and meals in ordinary conditions and emergencies. This study will contribute to enhancing the quality and quantity of food supplies during disasters.

Revision of "Nutritional Reference Values for Feeding at Evacuation Shelters" and Model Menus: A Qualitative Study.

OBJECTIVE: In 2011, the Japanese government issued nutritional reference values for energy; protein; vitamins B1, B2, and C; and salt to deal with poor meal quality in evacuation shelters. Because they were not widely used owing to their impracticality, the authors had examined the values according to the experience-based opinions of public health dietitians. Furthermore, we developed a usage tool containing a model menu that meets these values. This study aimed to confirm the usability of these revised values and model menus and collect ideas for improvement. METHODS: We conducted 8 semi-structured group interviews with 12 dietitians, 9 disaster management officers, and 2 public health nurses in local governments supposed to have been affected by a large-scale disaster. RESULTS: New reference values were highly evaluated by most participants. Interviewees said that model menus were helpful for evacuees or disaster officers who are unfamiliar with nutrition because they show combinations of food items that meet the reference values instead of the amounts of energy and nutrients. To improve their understanding, it was suggested that food items be categorized by staples, main dishes, and side dishes, encouraging them to complete these three components of a balanced diet. Because it was difficult to meet all the reference values in the immediate aftermath of the disaster, it was suggested that the time-dependent priority of each nutrient and model menus that supply the nutrient should be shown by disaster phases along with the assumed availability of utility for cooking in each phase. CONCLUSION: The new reference values were feasible to meet during emergencies. Although model menus were also appreciated, further improvements were necessary for better understanding.

Pulmonary focal fibrosis associated with microscopic arterio-venous fistula manifesting as focal ground-glass opacity on thin-section CT.

BACKGROUND: Focal ground-glass opacity (GGO) on thin-section computed tomography (CT) may be seen in atypical adenomatous hyperplasia (AAH), adenocarcinoma in situ that has recently been renamed from bronchioloalveolar carcinoma (BAC) and various benign conditions. CASE PRESENTATION: We report a case of pulmonary focal fibrosis associated with microscopic arterio-venous fistula (AVF), which showed a focal area of GGO on thin-section CT. The patient was a 58-year-old woman with a GGO on thin-section CT which had increased in size over the period of 2 years. Slightly dilated vessels and thickened interlobular septa were also noted around the GGO. It was diagnosed preoperatively as adenocarcinoma in situ and a partial lung resection by video-assisted thoracic surgery (VATS) was performed. Pathological examination yielded a diagnosis of focal fibrosis associated with microscopic AVF. CONCLUSION: We speculate that the focal fibrosis was produced by a prolonged congestion due to the AVF and that the dilated vessels and thickening of interlobular septa on thin-section CT related to the AVF. Microscopic AVF may be one of the etiologies of focal fibrosis showing focal GGO on thins-section CT. Dilated vessels and thickened interlobular septa around the GGO might offer a clue to the diagnosis of this disease entity. In addition, it should be noted that focal fibrosis may increase in size.

Validity and reproducibility of food photographic estimation for evaluating meals in evacuation shelters.

Objective: The primary goal was to evaluate the validity of food photographic estimation for nutritional assessment compared with weighed food record (WFR). Methods: We evaluated the validity and reproducibility of photographic estimation of foods provided in evacuation shelters. We analyzed 35 meals served at 12 shelters in Kumamoto Prefecture in Japan, affected by a heavy rain disaster in 2020. In this context, we compared 21 senior students' portion size estimation by food photographs to WFR. In addition, we assigned five meals for each of the 21 senior students, and the same meal photograph was estimated by three students to test reproducibility. Results: No statistically significant difference was detected between the two methods regarding energy, the total grams of meal, the protein, and vitamins B1, B2, and C, except for salt. In addition, the students who never self-cooked underestimated the total grams. Conclusion: Food photographic estimation could simplify the nutritional assessment in evacuation shelters. However, unclear photographs and food items served by weight could weaken the estimation accuracy. According to previous studies and the applied postestimation questionnaire, photographs taken from specified angles and reference food photobooks for portion size estimation may improve accuracy.

Nutritional Intake Differences in Combinations of Carbohydrate-Rich Foods in Pirapó, Republic of Paraguay.

A national strategy for obesity prevention has been promoted in Paraguay, reflecting the situation where half of adults and 23.4% of children (under 5 years old) are overweight. However, the detailed nutritional intake of the population has not yet been studied, especially in rural areas. Therefore, this study aimed to identify obesity-causing factors in Pirapó by analyzing the results from a food frequency questionnaire (FFQ) and one-day weighed food records (WFRs). From June to October 2015, 433 volunteers (200 males and 233 females) completed the FFQ with 36 items and one-day WFRs. Body mass index (BMI) positively correlated with the consumption of sandwiches, hamburgers, and bread and with age and diastolic blood pressure, although pizza and fried bread (pireca) had a negative correlation in males (p < 0.05). BMI positively correlated with systolic blood pressure, whereas it negatively correlated with the consumption of cassava and rice in females (p < 0.05). The FFQ revealed that fried food with wheat flour was consumed once a day. WFRs showed that 40% of meals consisted of two or more carbohydrate-rich dishes, significantly higher in energy, lipids, and sodium than those containing only one carbohydrate-rich dish. These results imply that less oily wheat dish consumption and healthy combinations of dishes should be considered for obesity prevention.

Meal plans for meeting the reference values using food items available in shelters.

BACKGROUND: We have suggested "Revised Nutritional Reference Values for Feeding at Evacuation Shelters" (Revised RV) as a daily nutritional recommendation for meals served at evacuation shelters where poor diets had been reported. Since there are no meal examples to satisfy the Revised RV, our objectives were, for the future meal provision, to develop nutritionally adequate meal plans using the foods served at shelters in the past and to examine if the Revised RV could be met by changing combination of foods available. METHODS: In this case study using secondary data, we analyzed food weights of 86 meals served and recorded at 12 shelters after the heavy rains in July 2020. We obtained these data from Kumamoto Prefecture that was damaged and asked us dietary assessment for nutrition assistance. Foods were classified into 3 types according to the check mark in the record sheets: food aid (commercial packaged food), boxed meal, and hot meal service. We counted serving frequency of each food and analyzed nutritional differences by their combinations. Menus were devised by choosing foods that were served more frequently or were more nutritious among those served at shelters. The target values for one meal were set at 1/3 of the Revised RV for energy, protein, vitamins B1, B2, and C, and salt. RESULTS: None of the meals served in the shelters satisfied the target. We created 2 menus using food aid only: (#1 curry doughnut, milk with long shelf-life, and orange jelly) and (#2 salmon rice ball, ham and cheese sandwich, and vegetable juice); 1 menu by combination of boxed meal and food aid: (#3 boxed meal and vegetable juice); and 2 menus by combination of hot meal service and food aid: (#4 chicken meatball soup, packaged tofu, soy sauce, preprocessed white rice, and bottled green tea) and (#5 bamboo shoots rice, chicken and vegetable miso soup, and bottled green tea). Planned menus generally contained more energy, protein, and vitamins and less salt than the meals served. Their vitamin C contents were especially higher. CONCLUSION: Nutritionally adequate meals could be planned by changing the combination of foods available in shelters.

Usefulness of Simple Meal Screening Using Dietary Assessment Sheets for Evacuation Shelters.

To maintain the health of evacuees, meals provided at emergency shelters should be monitored and improvement measures should be taken where necessary. Time and human resources are limited during devastating disasters; thus, the authors have developed the Dietary Assessment Sheets for Evacuation Shelters. This study examines whether the quality of meals can be assessed using simple check items on the Dietary Assessment Sheets.A total of 28 Dietary Assessment Sheets for 98 meals provided 16-19 days after the heavy rains in Kumamoto in July 2020 at 12 shelters were used in the analysis. Dietitians working for shelters were requested to fill the Dietary Assessment Sheets and food record sheets provided by the Prefectural Government. If any subitem was checkmarked, it was considered "checked," and if left blank, it was considered "not checked" and divided into categorical groups. Based on the food record sheets and meal photos, contents of energy, protein, and vitamins B1, B2, and C were calculated for each meal. Energy and nutrient contents were compared between the categorical groups.The study revealed that nutritionally poor meals were characterized as those comprising only "Grain dishes," those that were not "Boxed meals," and those involving "Self-Defense Forces," "Dietitians," or "Others." Their energy, protein, and vitamin B1, B2, and C content was significantly lower than that of meals with marks on other checkboxes in the same category.Shelters that provide these meals should be given priority for nutrition assistance due to their poor diets. The results imply that the Dietary Assessment Sheets could serve as a simple tool to determine the shelters that require nutritional assistance.

Time spent in home meal preparation affects energy and food group intakes among midlife women.

Time spent in meal preparation may be indicative of the healthfulness of meals and therefore with weight status. The purpose of this study was to examine the association between amount of time spent preparing meals and meal food group and nutrient content by meal occasion (breakfast, lunch, and dinner) among 1036 midlife women. Participants completed a 1-day food record and eating occasion questionnaires for each meal occasion. ANCOVA was used to identify possible associations. Approximately half of the participants reported spending <5 min preparing breakfast and lunch, and <20 min preparing dinner. Less time spent preparing breakfast was associated with lower energy and fat intakes (p<0.0001), while less time spent preparing lunch and dinner was associated with lower vegetable and sodium intakes (p<0.0001). There were no apparent differences in the association between time spent preparing meals and meal content by weight status. Nutrition education should encourage home meal preparation while stressing the selection of healthier options. The differing associations by meal occasion suggest that interventions should be tailored according to meal type.

Attitudes toward using "Simple simulator for calculating nutritional food stocks in preparation for large-scale disasters" among local governmental personnel and public health dietitians in Japan: An explanatory mixed methods study.

The Japanese Ministry of Health, Labour and Welfare compiled an Excel sheet - "Simple simulator for calculating nutritional food stocks in preparation for large-scale disasters" (Simulator). We examined the level of recognition and use of the Simulator by local governments and identified the points for its improvement. In stage 1, we surveyed local government personnel who participated in the "Workshop for nutrition assistance during large-scale disasters" held in November 2020 (n = 458; 313 responded) with an online questionnaire on the use of the Simulator and associated issues. Stage 2 involved group interviews with 15 public health dietitians who had been involved in food assistance during past natural disasters to identify points for improving the Simulator and the problems with food assistance during natural disasters. In stage 1, 233 responders (74.4%) confirmed their awareness of the existence of the Simulator. While 85 individuals (36.6%) used the Simulator, 63 individuals (74.1%) confirmed that they would use it in the future to plan and evaluate local government stocks. In stage 2, multiple comments regarding the Simulator's applicability and improvement in a realistic situation were collected. In order for the administrative staff in charge of disaster management to understand the nutritional importance of stockpiling main/side dishes, it was suggested that specific combinations of foods that meet the required amounts should be shown and that visualization using food products and the number of people covered by stockpiled foods may be easier to understand than pure nutritional values.

Revising "Nutritional Reference Values for Feeding at Evacuation Shelters" According to Nutrition Assistance by Public Health Dietitians Based on Past Major Natural Disasters in Japan: A Qualitative Study.

It is important to provide nutritionally adequate food in shelters to maintain the health of evacuees. Since the Great East Japan Earthquake in 2011, Japan's Ministry of Health, Labour and Welfare has released the "Nutritional Reference Values for Evacuation Shelters" (Reference Values) after every major natural disaster. There is clear evidence, however, that the Reference Values have only been used infrequently. This study aims to revise these guidelines to include the actual situation in the affected areas and the feasibility of the endeavor. This qualitative study uses group interviews with local government dietitians to propose revisions to Japan's Reference Values. These revisions include the following: issuing Reference Values within 1 week of a disaster, showing one type of values for meal planning for each age group, showing the minimum values of vitamins, upgrading salt to basic components, creating three phases of nutrition (Day 1, Days 1-3, and After Day 4), stipulating food amounts rather than nutrient values, and creating a manual. Local government officials could use the Reference Values as guidelines for choosing food reserves, and dietitians could use them while formulating supplementary nutrition strategies for a model menu in preparation for disasters.

Prolonged Maternal and Child Health, Food and Nutrition Problems after the Kumamoto Earthquake: Semantic Network Analysis of Interviews with Dietitians.

Infants need sufficient nutrients even during disasters. Only qualitative descriptive analysis has been reported regarding nutritional problems of mothers and children after the Kumamoto earthquake, and non-subjective analysis is required. This study examined issues concerning maternal and child health, food and nutrition after the Kumamoto earthquake using automatic computer quantitative analysis from focus group interviews (FGIs). Study participants (n = 13) consisted of dietitians in charge of nutrition assistance of infants in affected areas. The content of the interviews was converted into text, nouns were extracted, and co-occurrence network diagram analysis was performed. In the severely damaged area, there were hygienic problems not only in the acute phase but also in the mid-to-long-term phase. "Allergy" was extracted in the surrounding area in the acute and the mid-to-long-term phase, but not in the severely damaged area as the acute phase issue. In the surrounding area, problems have shifted to health and the quality of diet in the mid-to-long-term phase. This objective analysis suggested that dietary problems for mothers and children after disaster occurred also in the mid-to-long-term phase. It will be necessary to combine the overall trends obtained in this study with the results of qualitative descriptive analysis.

[Educational effects of a single distribution of a leaflet on alcohol and pregnancy among female university students].

OBJECTIVE: To evaluate the educational effects of a single leaflet distributed once without explanation of its content. METHODS: All the 58 seniors on a dietitian course and all the 81 students who took "health and nutrition" as their elective in a women's university in F Prefecture were recruited. They were assigned to intervention or control groups. Both groups were asked the following choice questions in a baseline survey: "What do you think about alcohol drinking during pregnancy?" "What do you suppose you yourself will do in the future?" and "Do you know about the fetal alcohol syndrome (FAS)?" One month later, a leaflet was distributed to the intervention group only. One week after the distribution, a second questionnaire was administered to both groups. The leaflet and the two questionnaires were distributed and collected during class with the help of teaching staff. The leaflet was made by a NPO and it recommended stopping drinking when planning to become pregnant. RESULTS: The participation rate was 83%. There were no significant associations between groups and grades, current drinking habit, and learning experience on this topic. Almost 80% of the intervention group read the leaflet. Change in their thinking about drinking during pregnancy before and after the intervention did not significantly differ between the two groups. Compared to 57 controls, 66 students who received the leaflet showed significant improved changes in their attitudes toward drinking during pregnancy and the knowledge about FAS. CONCLUSIONS: No significant change in their thinking about drinking during pregnancy could be due to the fact that, even before the intervention, nearly 80% of the students thought pregnant women must abstain from alcohol entirely. This might be related to the sample characteristics, since 75% of them were majoring in nutrition. The improvement in attitudes was considered to reflect the content of the leaflet. In the intervention group, the percentage of the students who chose the alternative of "I plan to stop drinking when I wish to get pregnant" increased as the leaflet recommended and more than half of them said they learned about FAS by this leaflet. To sum up, even a single distribution of a leaflet in a school setting had educational effects which improved attitude and knowledge. Since the current sample seemed to have particular knowledge and interest in health, it is now necessary to examine effects of the same approach in the general population.

Personnel Training Course for Businesses Regarding the Response to Stranded Persons Focusing on Vulnerable People from the Perspective of Business Continuity.

Businesses in urban areas have been required to accommodate stranded persons as temporary evacuation facilities during disasters. Regarding measures aimed at aiding stranded persons, aspects such as trust and the image of the business need to be considered. Therefore, in this study, a personnel training course was developed to smoothly take in stranded persons, and the outcomes of this training were evaluated by quizzes, entry sheets, and a questionnaire. This was a two-day and one-night course characterized by the use of role-play in which 20 participants experienced the series of processes that unfold during disasters, playing either the role of a stranded person or a facility member. This training included emergency food provision using real stockpiled food and accommodation training using actual bedding stored in a model facility. After the review, when the participants were taught the correct response for vulnerable people, their scores in the test regarding the points of caution in vulnerable people were significantly higher than those prior to the course, confirming that participants had acquired knowledge as a result. Furthermore, through training using real food and accommodation, the participants were able to understand victims' requirements by experiencing the need for satisfactory emergency rations and comfortable bedding.

Relationship between needs driving eating occasions and eating behavior in midlife women.

The purpose of this cross-sectional study was to determine the relationship between type of eating occasion based on need state segments experienced by 200 midlife women (46+/-6 years) and food group, nutrient, and energy intake. Women completed an Eating Occasion Questionnaire for 3 eating occasions over a 3-day period for which they maintained diet records. Cluster analysis segmented 559 eating occasions into six need states. Energy, total fat, and cholesterol consumption per occasion were highest in "routine family meal" occasions of which more than 60% were dinner and eaten at home with their children. The percentage of eating occasions in which fruits/vegetables were eaten was also highest in "routine family meal," followed by "healthy regimen." More than half of "indulgent escape" eating occasions occurred away from home and about one-third were experienced as a snack. Saturated fat and sweets intakes were the highest in the "indulgent escapes" occasions. Eating occasions experienced by women according to needs surrounding the occasion should be considered when developing tailored interventions to improve intake.

A Training Program to Enhance Disaster Preparedness of Group Companies in the Tokyo Metropolitan Area.

Many business continuity (BC) plans do not mention food and water for BC personnel. Moreover, the BC relies on the assumption that, during an emergency or crisis, employees' basic needs and personal hygiene are satisfied. Although no one can engage in BC without these supplies, literature regarding companies' disaster stocks for their employees is limited. We evaluated the current situation of companies' stockpiles of food and other supplies and what their employees thought about them after participating in a newly-developed overnight training program that allows the participants to experience situations that they would encounter in a disaster. Thirty-three employees from eight companies in Tokyo participated in the program. Seventy-five percent of the participants' companies had food stocks for three days as instructed by the Tokyo Metropolitan Government but, after eating four stock meals, 81.3% of the participants thought it would be better if this provision were improved. The stock rate for bedding was 62.5% but less than 30% of companies stocked both blankets and mats, as suggested by the Sphere Standards. There were several people who complained of sleeplessness and a poor physical condition the next morning and this could be an obstacle in the BC.

Association Between Caregiver's Perception of "Good" Dietary Habits and Food Group Intake Among Preschool Children in Tokyo, Japan.

Given that parents are mainly responsible for a preschooler's dietary management, they need to understand a child's diet. However, few studies have examined the association between parental perception of a preschool child's "good" dietary habits and actual food intake. We conducted a cross-sectional study investigating whether a child's food intake would differ depending on the caregiver's perception of their child's dietary habits among 4-year-old nursery school children at Adachi City, Tokyo, Japan. Children's dietary data were collected using the brief-type self-administered diet history questionnaire for children Aged 3-6 Years (BDHQ3y), while caregivers' perceptions of their child's dietary habits (good, normal, and poor) were inquired (N = 136). The percentage of caregivers who perceived their child's dietary habit as good, normal, and poor was 41.2, 40.4, and 18.4%, respectively. Multiple linear regression analysis revealed that children whose caregivers perceived their diet as poor showed lower intakes of vegetables [ß = -48.7, 95% confidence interval (CI): -86.1 to -11.2], beans (ß = -13.2, 95% CI: -26.1 to -0.3), and fish and shellfish (ß = -9.2, 95% CI: -17.5 to -1.0) and higher intakes of fat and oil (ß = 1.7, 95% CI: 0.4 to 3.1), confectionaries (ß = 11.9, 95% CI: 3.6 to 20.3), and soft drinks (ß = 31.2, 95% CI: 3.5 to 59.0) compared to children whose caregivers perceived their diet as good (all measures are in g/1,000 kcal per day). No significant difference was observed in other food groups, such as dairy products, an important source of protein and calcium for children. The current study may therefore guide future nutritional education programs for parents of preschool children.

Local Governments' Disaster Emergency Communication and Information Collection for Nutrition Assistance.

We examined local governments' disaster emergency communication and information collection and distribution systems. Postal surveys were conducted for all prefectures, cities with public health centers, and specified districts in Tokyo Metropolis in 2005 and 2013. Municipalities were included in the 2013 survey only. The response rate for the 2013 survey was 71.2% (n = 1272). Thirty-six prefectures, 41 cities with health centers, and 16 specified districts in Tokyo Metropolis answered both surveys. A majority of respondents (88.8% in 2005 and 92.1% in 2013) of respondents reported that disaster management radio broadcasting was written into their local disaster management plans, guidelines, or manuals as the main communication tool. The proportion of respondents using computer networks (41.6-60.7%) and cell phones (email) (40.4-62.9%) had significantly increased between the surveys. It was also found that municipalities that had been previously affected by disasters (39.6%) were more likely to have systems to collect information from shelters and affected communities than those without any experience (24.3%), and prefectures that had been previously affected by disasters were more likely to have food supply damage reporting systems (36.4%) than those without such experience (3.3%).

BMI for age references for Japanese children--based on the 2000 growth survey.

This study is done to develop an age and sex-specific BMI standard for Japanese children, and to determine the age and sex specific cut off points for overweight and obesity. A population-based analysis of BMI data from a national survey conducted in the year 2000; 14,113 preschool children, 72,380 children attending kindergartens, 270,720 attending elementary schools, 225,600 attending lower secondary schools and 126,900 attending upper secondary schools. BMI centile curves and cut-off points for overweight and obesity were determined following Cole's method. Compared with the BMI reference in the CDC 2000 standards, the reference for boys was almost the same, while for girls the width of percentile curves was larger in the CDC reference. The cut-off points for overweight or obesity were different from that of Cole's (2000) because of the difference in ethnicity. The results can be used for the assessment of overweight or obesity in Japanese children.