Reevaluating hikikomori and challenging loneliness assumptions in Japan: A cross-sectional analysis of a nationwide internet sample.

Introduction: Loneliness in Japan, accentuated by demographic challenges and the hikikomori phenomenon (extreme social withdrawal), has raised concerns. This study critically examines loneliness dynamics, questioning assumptions embedded in hikikomori classifications. The term "hikikomori," originally signifying prolonged home stay, requires nuanced exploration, especially regarding outgoing behaviors' relationship with loneliness. Objectives: Investigating the intricate connection between outgoing behaviors and loneliness, this study questions the effectiveness of existing hikikomori classifications. Aiming to understand if these classifications accurately represent the loneliness spectrum across age groups, the research emphasizes the significance of comprehending loneliness dynamics amid societal challenges. The study explores an array of factors influencing loneliness, including demographics, mental health, and outgoing behaviors, advocating for a reassessment of assumptions linked to hikikomori classifications. Methods: This secondary analysis employed data from a nationwide Internet addiction survey conducted in July 2012. A sample of 623 participants, representative of Japanese internet users aged 16 and above, underwent factor analysis. Loneliness was assessed using the UCLA Loneliness Scale, and exposure variables included demographic, mental health, outgoing behaviors, and lifestyle factors. Statistical analyses encompassed descriptive statistics, one-way ANOVA, chi-square tests, and logistic regression. Results: Significant differences were observed in loneliness scores based on sex, age, marital status, employment, and outgoing behaviors. Mental health factors, including dissatisfaction with life and romance, life stress, and psychological distress, emerged as strong contributors to loneliness. The study challenges existing hikikomori classifications, suggesting they may not fully encapsulate the loneliness experiences of individuals engaged in routine school or work activities. Conclusion: Findings underscore the need for a reevaluation of hikikomori, emphasizing loneliness as a complex and multifaceted issue in Japan. The study advocates for nuanced strategies to address loneliness, considering diverse demographic vulnerabilities. Limitations include the pre-pandemic sample and potential unmeasured confounding factors.

Corrigendum: Reevaluating hikikomori and challenging loneliness assumptions in Japan: A cross-sectional analysis of a nationwide internet sample.

[This corrects the article DOI: 10.3389/fpsyt.2024.1323846.].

The Impact of Cirrhosis on Outcomes of Patients Admitted With Diabetic Ketoacidosis: A Nationwide Study.

Introduction Diabetic ketoacidosis (DKA) is the most common acute hyperglycemic emergency in people with diabetes mellitus (DM). Cirrhosis is a consequence of chronic inflammation that is followed by hepatic fibrosis. It has been noted that cirrhosis is associated with an increased risk of developing type II DM due to altered glucose homeostasis. The prognostic value of DM in cirrhotic patients has been studied before and was found to be associated with lower survival. However, the risk of mortality and adverse events in cirrhotic patients admitted with DKA needs further evaluation. The aim of this study is to compare outcomes in patients with cirrhosis admitted to the hospital with DKA compared to non-cirrhotic patients. Methods The data for this study were extracted from the National Inpatient Sample (NIS) 2016-2019. The NIS was queried for all patients who had a discharge diagnosis of DKA. Patients with cirrhosis were identified and subclassified into compensated and decompensated cirrhosis using the International Classification of Diseases 10th revision, Clinical Modification (ICD-10-CM) codes. Patients without cirrhosis were the control group. ICD-10-CM codes that have been validated for cirrhosis were utilized. The primary outcome was in-hospital mortality. Secondary outcomes were hospital charges, length of stay (LOS), and in-hospital complications, including shock, mechanical ventilation, and acute kidney injury (AKI) requiring dialysis. Results We included 1,098,875 hospitalizations with a discharge diagnosis of DKA. Overall, 9,190 patients had compensated cirrhosis and 4,355 had decompensated cirrhosis. Cirrhotic patients had overall worse outcomes compared to non-cirrhotics. Decompensated cirrhotics had the highest mortality (11.26%; 95% confidence interval [CI]: 9.36% to 13.49%) compared to compensated cirrhotics (3.54%; 95% CI: 2.79% to 4.48%) and non-cirrhotics (2.15%; 95% CI: 1.89% to 2.43%). Similarly, decompensated cirrhotics also had the highest LOS, total charges, and in-hospital complications among the groups. On multivariate analysis, decompensated cirrhosis, rather than compensated cirrhosis, was an independent predictor of higher mortality (adjusted odds ratio [AOR]: 2.30; 95% CI: 1.81 to 2.92), LOS (regression coefficient: +1.82 days; 95% CI: +1.19 to +2.44 days), hospital charges (regression coefficient: +$28,497; 95% CI: +$18,107 to +$38,887), shock (AOR: 2.31; 95% CI: 1.68 to 3.18), mechanical ventilation (AOR: 1.91; 95% CI: 1.58 to 2.29), and AKI requiring dialysis (AOR: 2.31; 95% CI: 1.68 to 3.18). Conclusion This study showed that patients with decompensated liver cirrhosis who were admitted with DKA had the worst in-hospital outcomes. Additionally, only decompensated cirrhosis was an independent predictor of worse outcomes. Decompensated cirrhotics who develop DKA should be approached with more caution with a probable lower threshold for intensive care unit admission for a higher level management.

Association between perceived environmental pollution and poor sleep quality: results from nationwide general population sample of 162,797 people.

OBJECTIVE/BACKGROUND: Perceived environmental pollution may play a significant role in understanding environmentally induced health-related symptoms. This study aimed to determine whether perceived environmental pollution is associated with poor sleep quality. METHODS: We conducted a cross-sectional study using data from a nationwide sample of 162,797 individuals aged ≥19 years from the 2018 Korea Community Health Survey. The Pittsburgh Sleep Quality Index was used for assessing sleep quality. Five types of perceived environmental pollutants involving air, water, soil, noise, and green space were assessed. We investigate the association between perceived environmental pollution and poor sleep quality. We also investigated whether an increasing number of perceived environmental pollutants magnified the odds of poor sleep quality. RESULTS: The prevalence of poor sleep quality was 42.7% (n = 69,554), and 15.6%, 10.1%, 11.9%, 23.0%, and 11.5% reported perceived environmental pollution concerning air, water, soil, noise, and green space, respectively. A perception of air, soil, or noise pollution was significantly associated with poor sleep quality. In addition, those perceiving a greater number of environmental pollutants had significantly higher odds of poor sleep quality. Notably, this association was magnified in individuals living in rural areas. CONCLUSIONS: Perceived environmental pollution was significantly associated with poor sleep quality. Our results suggest that a more comprehensive exposure to environmental pollution may not only have a worse effect on health outcomes including sleep quality.

Factors associated with poor sleep quality in the Korean general population: Providing information from the Korean version of the Pittsburgh Sleep Quality Index.

BACKGROUND: Recently, studies have been conducted to address the research gap in the understanding of poor-quality sleep and its relationship to health outcomes, through the evaluation of sleep quality. The aim of this study was to provide information regarding poor sleep quality based on a nationwide general population sample in Korea. METHODS: We conducted a cross-sectional study using data from a nationwide sample of 165,193 individuals (males: 44%) aged 19 years or older from the 2018 Korea Community Health Survey. The age range of the participants was 19-107 years (mean: 55.3 ± 17.5). The Korean version of the Pittsburgh Sleep Quality Index (PSQI) was used for assessing sleep quality. Poor sleep quality was defined as a total PSQI score of >5. RESULTS: The overall prevalence of poor sleepers was 41.0% (males: 35.6%; females: 46.2%). Poor sociodemographic status (illiteracy, low income, and unemployment), poor health behaviors (smoking, high-risk drinking, diabetes, hypertension, non-participation in walking, and obesity), and poor mental health (perceived poor health status, stress, depressive symptoms, and subjective cognitive decline) were all associated with poor sleep quality in both males and females. LIMITATIONS: As this study relies on self-reported and cross-sectional data, causal inferences cannot be made. CONCLUSIONS: Poor sleep quality is highly prevalent in females. In addition, poor socio-demographic status, poor health behaviors, and poor mental health were associated with poor sleep quality. The mechanisms underlying sex differences in sleep quality remain to be elucidated, and further studies are required to address this.