Mobile health technology as a solution to self-control problems: The behavioral impact of COVID-19 contact tracing apps in Japan.

RATIONALE: Mobile technology has been widely utilized as an effective healthcare tool during the COVID-19 pandemic. Notably, over 50 countries have released contact-tracing apps to trace and contain infection chains. While earlier studies have examined obstacles to app uptake and usage, whether and how this uptake affects users' behavioral patterns is not well understood. This is crucial because uptake can theoretically increase or decrease behavior that carries infection risks. OBJECTIVE: The goal of this study is to evaluate the impact of app uptake on the time spent out of home in Japan. It tests four potential underlying mechanisms that drive the uptake effect: compliance with stay-at-home requirements, learning about infection risk, reminders, and commitment device. METHOD: We use unique nationwide survey data collected from 4,379 individuals aged between 20 and 69 in December 2020 and February 2021 in Japan. Japan has features suitable for this exercise. The Japanese government released a contact tracing app in June 2020, which sends a warning message to users who have been in close contact with an infected person. We conduct a difference-in-differences estimation strategy combined with the entropy balancing method. RESULTS: App uptake reduces the time spent out of home. Sensitivity analysis shows that it cannot be explained by unobserved confounders. Importantly, the impact is large even among users who have not received a warning message from the app, and even larger for those with poor self-control ability. Furthermore, individuals' self-control ability is negatively associated with the uptake decision, supporting our hypothesis that the apps serve as a commitment device. CONCLUSIONS: It may be beneficial to encourage citizens to uptake contact tracing apps and other forms of commitment devices. This study also contributes to the literature on mobile health (mHealth) by demonstrating its efficacy as a commitment device.

Cross-country evidence on the role of national governance in boosting COVID-19 vaccination.

BACKGROUND: Frequent mutations of the COVID-19 virus, such as the Delta and Omicron variants, have prolonged the pandemic. Rich countries have approved the booster shots (3rd doses) of vaccine, but this causes further delay of vaccination in developing countries. This raises the risk of further mutations, which may lower the efficacy of currently available vaccines. As herd immunity by universal vaccination is essential to end the pandemic, the COVID-19 Vaccine Global Access (COVAX) facility has been established to provide developing countries with subsidized vaccines. However, a critical issue is that the developing countries also need to effectively deploy vaccines to citizens. Although this argument suggests positive effects of good national governance on vaccination coverage, to the best of our knowledge, there is no cross-country evidence on the role of national governance in increasing the coverage of COVID-19 vaccines among citizens. The goal of this study was to examine the association between the national governance and vaccination coverage among developing countries. METHODS: Using cross-country data, an ordinary least squares regression was conducted to examine the association between the national governance index and three outcomes: (1) the number of days until the administration of the first dose in the country since December 2019, (2) the number of doses per 100 citizens as of the end of July 2021, and (3) the selection of approved vaccine manufacturers. The results were compared between the model including all countries and the model excluding the member countries of Organisation for Economic Co-operation and Development (OECD). RESULTS: A one standard deviation increase in the national governance index was associated with 9.1 days (95%CI: -15.76, -2.43) earlier administration of vaccines in the country, and a 12.1 dose increase (95%CI: 4.76, 19.34) per 100 citizens. These associations were larger in the non-OECD sample. The results also indicated the role of governance in the selection of the administered vaccines. CONCLUSION: The provision of subsidized vaccines alone is not sufficient to control the spread of infection in developing countries; logistical and administrative support should also be offered, especially in countries with poor governance. TRIAL REGISTRATION: Not applicable.

Vaccination and altruism under the COVID-19 pandemic.

OBJECTIVES: The goal of this study is to examine the role of altruism and sensitivity to public shame in individuals' willingness to pay for a COVID-19 vaccine. STUDY DESIGN: We apply expected utility theory to predict the role of individuals' altruism and public shame in the willingness to pay for vaccines. Subsequently, we test the prediction by using a unique cross-sectional survey. METHODS: We use online survey data collected from those aged 30-49 in Japan between June 18th and 25th, 2020 (n = 1686). The selection of respondents follows quota sampling with regard to age group, gender, and prefecture of residence. We employ an ordinary least square (OLS) model to regress respondents' willingness to pay for a hypothetically-effective vaccine for COVID-19 on binary indicators of altruism and sensitivity to public shame, as well as socio-demographic characteristics. RESULTS: The willingness to pay for the vaccine is higher among those with stronger altruistic concerns and sensitivity to shaming. CONCLUSION: Voluntary vaccinations may be inefficient, because the uptake of vaccines could be low for selfish individuals who often violate social distancing requirements. To improve the efficiency of vaccine uptake, some interventions, such as nudges and a vaccine passport, may be needed.

Variations in Early-Stage Responses to Pandemics: Survey Evidence from the COVID-19 Pandemic in Japan.

During the initial phase of pandemics, swift behavioral responses by individuals, such as social distancing, can temper the speed and magnitude of further infections. However, individual choices in this period are often made in the absence of reliable knowledge and coordinated policy interventions, producing variation in protective behaviors that cannot be easily deduced from that in later periods. Using unique monthly panel survey data, we examine variations in the association between changes in infections and risky behavior, particularly the frequencies of face-to-face conversations and dining out, between January to March 2020. We find that the increase in confirmed cases is negatively associated with the likelihood of these behaviors. However, high school graduates are less responsive than university graduates. We provide evidence that this can be attributed to their lower perception of infection risk, while we cannot fully rule out the roles of income opportunity costs. These results point to the benefits of interventions incorporating nudges to raise individuals' risk perceptions during the initial phase of pandemics. We also discuss the potential efficacy of such interventions in later periods of pandemics. Supplementary Information: The online version contains supplementary material available at 10.1007/s41885-021-00103-5.

Social media infodemics and social distancing under the COVID-19 pandemic: public good provisions under uncertainty.

This debate examines the impact of infodemics - an over-abundance of information - on social distancing during the COVID-19 pandemic. Because of its external effects, social distancing behavior (SDB) shares fundamental properties with public goods, whose potential for undersupply has been examined extensively in the social sciences. Although the negative effects of infodemics have been emphasized by governments and international organizations, theoretical models suggest that infodemics may work as a mitigation mechanism. That is, infodemics may enhance people's SDBs. Based on original survey data, we show that media exposure can positively increase SDB. We conclude by discussing two public health implications. First, the media plays an important role in motivating SDB. Second, even if infodemics can increase SDB, we must be wary of their ability to pose other, non-negligible dangers.

Prosociality and the Uptake of COVID-19 Contact Tracing Apps: Survey Analysis of Intergenerational Differences in Japan.

BACKGROUND: To control the COVID-19 pandemic, it is essential to trace and contain infection chains; for this reason, policymakers have endorsed the usage of contact tracing apps. To date, over 50 countries have released such apps officially or semiofficially, but those that rely on citizens' voluntary uptake suffer from low adoption rates, reducing their effectiveness. Early studies suggest that the low uptake is driven by citizens' concerns about security and privacy, as well as low perceptions of infection risk and benefits from the usage. However, these do not explore important generational differences in uptake decision or the association between individuals' prosociality and uptake. OBJECTIVE: The objective of our study was to examine the role of individuals' prosociality and other factors discussed in the literature, such as perceived risk and trust in government, in encouraging the usage of contact tracing apps in Japan. We paid particular attention to generational differences. METHODS: A web-based survey was conducted in Japan 6 months after the release of a government-sponsored contact tracing app. Participants were recruited from individuals aged between 20 and 69 years. Exploratory factor analyses were conducted to measure prosociality, risk perception, and trust in government. Logistic regression was used to examine the association between these factors and uptake. RESULTS: There was a total of 7084 respondents, and observations from 5402 respondents were used for analysis, of which 791 respondents (14.6%) had ever used the app. Two factors of prosociality were retained: agreeableness and attachment to the community. Full-sample analysis demonstrated app uptake was determined by agreeableness, attachment to the community, concern about health risks, concern about social risks, and trust in the national government; however, important differences existed. The uptake decision of respondents aged between 20 and 39 years was attributed to their attachment to the community (odds ratio [OR] 1.28, 95% CI 1.11-1.48). Agreeable personality (OR 1.18, 95% CI 1.02-1.35), concern about social risk (OR 1.17, 95% CI 1.02-1.35), and trust in national government (OR 1.16, 95% CI 1.05-1.28) were key determinants for those aged between 40 and 59 years. For those aged over 60 years, concerns about health risks determined the uptake decision (OR 1.49, 95% CI 1.24-1.80). CONCLUSIONS: Policymakers should implement different interventions for each generation to increase the adoption rate of contact tracing apps. It may be effective to inform older adults about the health benefits of the apps. For middle-age adults, it is important to mitigate concerns about security and privacy issues, and for younger generations, it is necessary to boost their attachment to their community by utilizing social media and other web-based network tools.

The bright and dark sides of social media usage during the COVID-19 pandemic: Survey evidence from Japan.

The spread of misinformation on the internet regarding the COVID-19 pandemic, such as unproven or fake cures, has been a serious concern. However, the extent to which social media usage affects individuals' health behavior, particularly when reliable information is scarce, is not well understood. This study evaluates the impact of social media usage on individuals' responses to the COVID-19 pandemic, such as demand for necessities and social distancing. We conduct an original online survey of 1804 Japanese respondents in March 2020. Japan is suitable because it confirmed COVID-19 cases earlier than most other countries. Scientific evidence about the coronavirus and protective measures was scarce in the initial pandemic phase, despite the spread of unconfirmed rumors. Our analysis focuses on the usage of Twitter, Facebook, and Instagram. We use the entropy balancing method to control for heterogeneity in observed characteristics between social media users and non-users. The results show that while users are more likely to maintain social distancing practices, they are also more likely to take measures whose reliability is not scientifically confirmed, such as eating fermented soybeans. Although previous studies emphasize the negative effects of social media, our results suggest that it has both bright and dark sides.

Therapeutic potential of Chinese prescription Kangen-karyu for patient with lifestyle-induced metabolic syndrome.

We report a case of a 65-year-old patient with hypertension, dyslipidemia, type 2 diabetes, chronic kidney disease, and hyperuricemia, who showed an improvement in lifestyle-induced metabolic syndrome on the administration of 7.5 g of Kangen-karyu extract per day for 6 months. The levels of serum total cholesterol, low-density lipoprotein-cholesterol, and triglycerides were decreased. The systolic/diastolic blood pressure was decreased following administration. Other parameters such as estimated glomerular filtration rate, creatinine, uric acid, aspartate transaminase, alanine aminotransferase, γ-glutamyl transpeptidase, and creatine phosphokinase were improved by the administration of Kangen-karyu extract. At that time, the physical and subjective symptoms had partially disappeared. We present evidence supporting the use of Kangen-karyu extract against metabolic syndrome.

The Validation of the Wheat Gluten ELISA Kit.

Background: It is important to analyze the presence of wheat/gluten in food to avoid wheat allergy or celiac disease. Objective: The Wheat/Gluten ELISA kit was developed to measure total wheat protein or gluten content in wheat, barley, and rye cereals as raw materials, and processed foods. Validation as to whether this kit is suitable for quantifying total wheat protein/gluten was carried out. Methods: The Wheat/Gluten ELISA kit was designed as a sandwich ELISA based on antigliadin polyclonal antibody. Selectivity, interference study, matrix study including incurred food, robustness, stability, and lot-to-lot consistency studies were conducted for the Wheat/Gluten ELISA kit. Incurred matrix studies were also conducted in an independent laboratory. Results: The analysis of 38 different substances revealed no cross-reactivity above the LOQ except for oats. Recoveries of the spiked samples were mostly in the range of 75-140%, including an independent laboratory result. The LOD of the ELISA was found to be 0.02-0.16 mg/kg. Robustness testing proved that extraction time and incubation time of first reaction and enzyme reaction had no significant influence on quantified value. The stability at 2-8°C was found to exceed 12 months. Good lot-to-lot consistency was observed. Conclusions: The Wheat/Gluten ELISA kit showed good analytical performance in the quantitative analysis of total wheat protein/gluten in the identified food products using the AOAC Performance Tested Method(s)SM program. Highlights: The Wheat/Gluten ELISA kit was validated and showed good analytical performance in the quantitative analysis of total wheat protein/gluten in food.

Japanese Food Allergen Labeling Regulation: An Update.

The Japanese food allergen labeling regulation was designed to match real Japanese food allergy circumstances and also to be enforced effectively; thus, (1) regulated food allergens were selected by prevalence and seriousness according to food allergy surveys in Japan; (2) the detection criterion for ELISA monitoring, 10 µg food allergen protein/g (or mL) food, was set up as the threshold value to regulate commercial prepackaged foods; and (3) official food allergen analytical methods, which can determine the threshold value accurately, were developed. These three points are distinctive from other countries. Furthermore, as an on-going project, the regulation has been amended according to food allergy circumstances and requirements of society. This paper presents recent changes regarding the Japanese food allergen labeling regulation. To date, the Japanese food allergen labeling regulation has been enforced for more than 15 years and seems to be working effectively. Now would be an opportune time to review the regulation for its next level of development.

A harmonized immunoassay with liquid chromatography-mass spectrometry analysis in egg allergen determination.

Food allergy is a serious health issue worldwide. Implementing allergen labeling regulations is extremely challenging for regulators, food manufacturers, and analytical kit manufacturers. Here we have developed an "amino acid sequence immunoassay" approach to ELISA. The new ELISA comprises of a monoclonal antibody generated via an analyte specific peptide antigen and sodium lauryl sulfate/sulfite solution. This combination enables the antibody to access the epitope site in unfolded analyte protein. The newly developed ELISA recovered 87.1%-106.4% ovalbumin from ovalbumin-incurred model processed foods, thereby demonstrating its applicability as practical egg allergen determination. Furthermore, the comparison of LC-MS/MS and the new ELISA, which targets the amino acid sequence conforming to the LC-MS/MS detection peptide, showed a good agreement. Consequently the harmonization of two methods was demonstrated. The complementary use of the new ELISA and LC-MS analysis can offer a wide range of practical benefits in terms of easiness, cost, accuracy, and efficiency in food allergen analysis. In addition, the new assay is attractive in respect to its easy antigen preparation and predetermined specificity. Graphical abstract The ELISA composing of the monoclonal antibody targeting the amino acid sequence conformed to LC-MS detection peptide, and the protein conformation unfolding reagent was developed. In ovalbumin determination, the developed ELISA showed a good agreement with LC-MS analysis. Consequently the harmonization of immunoassay with LC-MS analysis by using common target amino acid sequence was demonstrated.

Survey of Thai Commercial Food Products That Have Been Reported to Contain No Wheat, Rye, Barley, or Gluten According to Their Labels.

Celiac disease (CD) and gluten-related disorders are significant health and social issues in Western countries, and CD individuals need to exclude gluten from their diets. The adverse health impacts of CD have extended to Asian countries in which CD was not a problem previously. Thai commercial food products that do not contain wheat, rye, barley, or gluten on their labels were surveyed as to whether they were suitable for CD individuals by examining the absence of gluten or the presence of gluten <20 ppm. In Thailand, ELISA tested for gluten content in 129 commercial food products that contained neither wheat, rye, barley, nor gluten on their labels. One hundred nineteen of these 129 products included <20 ppm gluten, and 10 products contained >20 ppm gluten. Surprisingly, four products showed gluten levels >1%. In these 10 products, wheat presence was confirmed by PCR analysis. Our survey suggests that CD individuals can consume most of the examined Thai food products, and the survey showed the potential of these Thai products as new diets for CD patients so as to expand the limited food choices from different food cultures, and ultimately to improve the quality of life for all CD individuals globally. The appropriate gluten management strategies need to be implemented by Thai food manufacturers to ensure accurate labeling and to protect the safety of consumers with CD.

Food allergen analysis for processed food using a novel extraction method to eliminate harmful reagents for both ELISA and lateral-flow tests.

Enzyme-linked immunosorbent assay (ELISA) is commonly used to determine food allergens in food products. However, a significant number of ELISAs give an erroneous result, especially when applied to highly processed food. Accordingly, an improved ELISA, which utilizes an extraction solution comprising the surfactant sodium lauryl sulfate (SDS) and reductant 2-mercaptoethanol (2-ME), has been specially developed to analyze food allergens in highly processed food by enhancing analyte protein extraction. Recently, however, the use of 2-ME has become undesirable. In the present study, a new extraction solution containing a human- and eco-friendly reductant, which is convenient to use at the food manufacturing site, has been established. Among three chemicals with different reducing properties, sodium sulfite, tris(3-hydroxypropyl)phosphine, and mercaptoethylamine sodium sulfite was selected as a 2-ME substitute. The protein extraction ability of SDS/0.1 M sodium sulfite solution was comparable to that of SDS/2-ME solution. Next, the ELISA performance for egg, milk, wheat, peanut, and buckwheat was evaluated by using model-processed foods and commercially available food products. The data showed that the SDS/0.1 M sulfite ELISA significantly correlated with the SDS/2-ME ELISA for all food allergens examined (p < 0.01), thereby establishing the validity of the SDS/0.1 M sulfite ELISA performance. Furthermore, the new SDS/0.1 M sulfite solution was investigated for its applicability to the lateral-flow (LF) test. The result demonstrated the successful analysis of food allergens in processed food, showing consistency with the SDS/0.1 M sulfite ELISA results. Accordingly, a harmonized analysis system for processed food comprising a screening LF test and a quantitative ELISA with identical extraction solution has been established. The ELISA based on the SDS/0.1 M sulfite extraction solution has now been authorized as the revised official method for food allergen analysis in Japan.

A multi-laboratory evaluation of a clinically-validated incurred quality control material for analysis of allergens in food.

A dessert matrix previously used for diagnosis of food allergies was incurred with pasteurised egg white or skimmed milk powder at 3, 6, 15 and 30 mg allergen protein per kg of dessert matrix and evaluated as a quality control material for allergen analysis in a multi-laboratory trial. Analysis was performed by immunoassay using five kits each for egg and milk (based on casein) and six 'other' milk kits (five based on ß-lactoglobulin and one total milk). All kits detected allergen protein at the 3 mg kg(-1) level. Based on ISO criteria only one egg kit accurately determined egg protein at 3 mg kg(-1) (p=0.62) and one milk (casein) kit accurately determined milk at 6 (p=0.54) and 15 mg kg(-1) (p=0.83), against the target value. The milk "other" kits performed least well of all the kits assessed, giving the least precise analyses. The incurred dessert material had the characteristics required for a quality control material for allergen analysis.

Reliable enzyme-linked immunosorbent assay for the determination of coconut milk proteins in processed foods.

This study was designed to develop a novel sandwich enzyme-linked immunosorbent assay (ELISA) for the detection and quantification of coconut milk proteins in processed foods. The developed sandwich ELISA was able to detect coconut milk proteins from various coconut milk products and did not show any cross-reactivity with 41 of 42 kinds of popularly used food ingredients, thus reflecting great specificity for coconut milk proteins. In addition, the established ELISA is highly sensitive and allowed the detection of 0.31 µg/g of coconut milk protein in complex food matrices. This proposed assay could serve as a useful tool for the detection of the presence of hidden coconut milk proteins in processed foods.

Auditory MEG responses to removal of a tone in C major scale measured in a pair of reciprocal oddball schemes.

The C major scale was used either as frequent or as infrequent stimulus in the oddball auditory evoked field measurement where the other stimulus was constructed by removing one the tones in the scale. Multivariate statistical analysis was employed to judge whether there was a significant difference between the responses to complete and incomplete scales in each subject for each 'target' tone which was removed in an incomplete scale. Incomplete scales lacking, especially E, or B caused responses in both of the two oddball schemes but less significantly when used as frequent stimuli indicating that the complete major scale stored in the long term memory retained its influence as 'reference' stimulus even when presented with a smaller probability.

[Angina attack caused by 5-fluorouracil infusion--report of a case and review of the literature].

Cardiac toxicity of 5-fluorouracil (5-FU) has been rarely reported. We encountered a case of angina attack caused by 5-FU. A 58-year-old Japanese woman underwent sigmoidectomy for a sigmoid colon carcinoma with multiple liver metastases. Two months after surgery, she received chemotherapy comprising hepatic arterial infusion of 5-FU. During the 2nd chemotherapy session 7 days after the first, she complained of anterior chest pain. Her electrocardiograms showed elevations of the ST segment in almost all leads, confirming the diagnosis of angina pectoris. Soon after the third chemotherapy session the same type of attack occurred again. The close association of the attacks with 5-FU administration suggested that the angina might have been induced by 5-FU. Further attacks were avoided by discontinuing the 5-FU thereafter. The incidence of cardiac toxicity 5-FU has been reported to be 1.6-7.6%. Labianca et al. found 17 cases of 5-FU-associated cardiopathy, 15 of which were angina pectoris, out of 1,083 patients treated with the drug for various kinds of neoplasm. Analysis of 6 domestic cases including ours revealed that all patient lacked a previous history of cardiac disease except one who had an arrhythmia. There seemed to be no dose-dependent correlation with 5-FU-induced angina. Cardiac events were found even in the earlier phase of chemotherapy. Since 5-FU is widely used in the treatment of a number of gastrointestinal malignancies, one should bear in mind its cardiac toxicity, manifested as angina pectoris.