Status of school health programs in Asia: National policy and implementation.

BACKGROUND: The WHO's Health Promoting Schools (HPS) framework is based on an understanding of the reciprocal relationship between health and education, and the need to take a holistic approach to health promotion in schools. We aim to clarify the degree to which the HPS framework is reflected in the national policies of eight target countries and the issues surrounding its successful implementation. METHODS: Date were collected through two expert workshops with participants from eight Asian countries: Cambodia, China, Japan, Korea, Lao PDR, Nepal, the Philippines, and Thailand. In the first workshop, data collected on national policy were mapped against the HPS framework. From this, key issues were identified, and follow-up data collection was conducted in each country for a second workshop. RESULTS: We identified a policy shift toward the HPS framework in six out of the eight countries. Neither Japan nor Korea had changed their national policy frameworks to reflect an HPS approach; however, in the latter, model programs had been introduced at a local level. We identified various barriers to successful implementation, especially in relation to mental health and wellbeing. CONCLUSION: Given the recent shift toward the HPS approach in six out of the eight countries in this study, there is a need to conduct research to assess the impact of this framework on the health and wellbeing of students and school staff. At the same time, we call for more dialog in the context of Japan to explore the possible benefits of introducing the HPS framework into schools.

Health screening system to ensure children's health and development in Japan.

BACKGROUND: The establishment of health screening systems for children is important, however, such systems are not always well-established in developing countries. This study aimed to improve child health screening systems in developing countries by analyzing the factors that contribute to enabling continuous and proper screenings at various governmental levels in Japan. METHODS: We reviewed the history of child health and development screening systems in Japan and examined factors that enabled their regular and nationwide implementation. RESULTS: We identified the six enabling factors: (i) the existence of relevant laws and regulations in health and education systems for health checkups, (ii) mandated and detailed conditions for health checkups within both school and community health, (iii) the provision of guidelines and manuals for health checkups, (iv) a sufficient number of professionals to carry out the health checkups, (v) clear criteria for evaluating and interpreting the checkup results, and (vi) understanding among teachers, children, and guardians of the importance of health checkups. CONCLUSION: We proposed the following six requirements to the governments in developing countries for establishing their own health screening programs: (i) a clear description of the need for regular and continuous health checkups in the relevant laws, regulations, and policies, (ii) mandate as essential activity and detailed requirements of the screening activities, (iii) provision of relevant manuals for health workers and teachers, (iv) provision of enough well-trained professionals and a training system, (v) studying growth and development curves for children, and (vi) promoting understanding among stakeholders about the importance of health checkups.

Association of blood cadmium levels in pregnant women with infant birth size and small for gestational age infants: The Japan Environment and Children's study.

BACKGROUND: There is growing evidence of an association between cadmium (Cd) and unfavorable birth outcomes. The effect of Cd exposure on anthropometric measures at birth or small for gestational age (SGA) infants in a large, nationwide Japanese cohort remains to be clarified. OBJECTIVES: To analyze the association between maternal blood Cd levels at different sampling times and sex-dependent infant birth size, weight, body length, chest, and head circumferences, in addition to SGA. METHODS: Data of 17,584 pregnant women in the Japan Environment and Children's Study were analyzed for anthropometric measurements. For SGA determination, 13,969 cases of vaginal delivery were analyzed after excluding infants born by cesarean section. Maternal blood Cd levels were categorized into quartiles (Q1-Q4), and the Q1 was used as a reference. Multiple linear regression analysis was performed for anthropometric measurements, and multiple logistic regression analysis was used to investigate the association of maternal blood Cd levels with the risk of SGA. RESULTS: Birth weight tended to decrease according to the increase in quartiles of blood Cd levels (15.63 g decrease [95% confidence level (CI): -33.26, 2.01] for Q4). The overall analysis revealed no decreases in body length and head and chest circumference, but subgroup analysis revealed that chest circumference tended to decrease according to the increase in quartiles in the female sex/third-trimester stratification (0.16 cm decrease [95% CI: -0.32, 0.00] for Q4). SGA risk was also higher and paralleled the increase in blood Cd levels associated with the female sex/third-trimester group (Odds Ratio 1.90 [95% CI: 1.23, 2.94] for Q4). CONCLUSION: Our results provide further evidence of sex-specific health risks associated with Cd exposure in early life in a large Japanese pregnancy cohort.

Low Bone Mineral Density in Elite Female Athletes With a History of Secondary Amenorrhea in Their Teens.

OBJECTIVE: To determine whether secondary amenorrhea during teenage years influences bone mineral density (BMD) in female athletes in their 20s. DESIGN: Original research. SETTING: Japan Institute of Sports Sciences. PARTICIPANTS: Two hundred ten elite female athletes older than 20 years were included in the study. MAIN OUTCOME MEASURES: Information on the participants' past (ie, during their teenage years) and current menstrual cycle, training time, history of stress fractures, and blood tests for hormones received was obtained. Bone mineral density of the lumbar spine was evaluated by dual-energy x-ray absorptiometry; low BMD was defined as a Z-score ≤-1. We investigated the correlation factors for low BMD in athletes in their 20s by univariable and multivariable logistic regression analysis. RESULTS: A total of 39 (18.6%) female athletes had low BMD. Secondary amenorrhea in their teens [odds ratio (OR), 7.11, 95% confidence interval (CI), 2.38-21.24; P < 0.001] and present body mass index (BMI) (OR, 0.56, 95% CI, 0.42-0.73; P < 0.001) were independent correlation factors for low BMD in the multivariable logistic regression analysis. The average Z-score for those with secondary amenorrhea in their teens and 20s, secondary amenorrhea in their 20s only, and regular menstruation was -1.56 ± 1.00, -0.45 ± 1.21, and 0.82 ± 1.11 g/cm, respectively. CONCLUSIONS: Secondary amenorrhea for at least 1 year during teenage years in female athletes and BMI at present was strongly associated with low BMD in their 20s.

Relationship between tartrate-resistant acid phosphatase 5b and stress fractures in female athletes.

BACKGROUND: Approximately 10% of female athletes have a history of stress fractures, which most commonly occur between the ages of 16 and 17 years old. PURPOSE: We investigated whether tartrate-resistant acid phosphatase 5b (TRACP-5b), which is a bone resorption marker, can serve as a valid predictor of stress fractures in female athletes in their teens and 20s. METHODS: Three hundred and sixteen elite female athletes were recruited between 2013 and 2015. Serum TRACP-5b and various hormones were examined in blood samples. The serum TRACP-5b level was compared between athletes with and without stress fractures within 3 months after the initial collection of their blood samples. RESULTS: The 316 athletes were divided into two age groups: 13-19 years old and 20-29 years old. Thirty-six athletes (11.4%) experienced new stress fractures within 3 months after the initial collection of their blood samples. The median serum TRACP-5b level was significantly higher in teenage athletes with new stress fractures than in teenage athletes without new stress fractures. In univariate logistic regression analysis, the Z-score of serum TRACP-5b was a significant predictive factor of stress fractures in teenage athletes only (odds ratio: 1.87; 95% CI: 1.31-2.66; P < 0.0012). CONCLUSION: For teenage female athletes, TRACP-5b is a predictor of the risk of stress fractures, and measuring TRACP-5b levels may be useful to prevent stress fractures.

Risk factors of stress fractures due to the female athlete triad: Differences in teens and twenties.

BACKGROUND: The female athlete triad (Triad), defined by the American College of Sports Medicine as low energy availability (LEA) with or without disordered eating, menstrual dysfunction, and low bone mineral density (BMD), is associated with stress fractures and athletes aged 16-17 years are most susceptible. PURPOSE: To examine whether the Triad increases the risk of stress fractures, athletes were assigned to a "teenage" group and a "20s" group. METHODS: This prospective study enrolled 390 elite female athletes and was conducted from 2012 to 2016 at Japan Institute of Sports Sciences. Blood concentrations of various hormones were examined, and BMD was measured at the lumbar spine and throughout the whole body using dual-energy X-ray absorptiometry. LEA was defined as body weight ≤85% of the ideal body weight for teenage athletes, or BMI ≤17.5 for athletes in their 20s. Low BMD was defined as a BMD Z-score of <-1.0 in the lumbar spine and the whole body. RESULTS: Among 390 athletes enrolled, 36 developed new stress fractures within 3 months of registration. The risk for stress fractures due to the Triad in teenage athletes was higher than for athletes in their 20s. In teenage female athletes, secondary amenorrhea, low BMD for the whole body, and a low ratio of actual body weight to ideal body weight increased the risk for stress fractures by 12.9 times, 4.5 times, and 1.1 times, respectively. CONCLUSION: To prevent stress fractures in female athletes with the Triad, age of athletes should be taken into consideration.

A Yolk Sac Larger Than 5 mm Suggests an Abnormal Fetal Karyotype, Whereas an Absent Embryo Indicates a Normal Fetal Karyotype.

OBJECTIVES: It is very hard to estimate an abnormal or normal fetal karyotype in miscarriage before surgery. We investigated whether the abnormal fetal karyotype in early miscarriage could be estimated by comprehensive ultrasonographic findings by a multivariate analysis. METHODS: One hundred fifty-one patients with early miscarriage (<12 weeks' gestation) were selected in our hospital. The clinical characteristics were compared between pregnant women carrying a fetus with an abnormal karyotype and those with a normal one, and the size and configuration of the gestational sac, yolk sac, and embryo at diagnosis of early miscarriage were also evaluated. RESULTS: The rate of abnormal fetal karyotypes was 66.2 % (100 of 151). A maternal age older than 35 years (odds ratio, 3.2; 95% confidence interval, 1.4-7.4; P = .005), yolk sac larger than 5 mm (odds ratio, 6.2; 95% confidence interval, 2.2-22.7, P < .001), and absent embryo (odds ratio, 0.40; 95% confidence interval, 0.16-0.95; P = .038) were independent markers for predicting an abnormal fetal karyotype by multiple logistic regression analysis. CONCLUSIONS: At the point of early miscarriage diagnosis, a yolk sac larger than 5 mm suggests an abnormal fetal karyotype, whereas an absent embryo indicates a normal fetal karyotype.

In which preterm labor-patients is intravenous maintenance tocolysis effective?

AIM: We evaluated whether maintenance tocolysis (intravenous ritodrine hydrochloride and/or magnesium sulfate) was effective in cases of spontaneous preterm labor with intact membranes. METHODS: One hundred and thirty preterm labor patients who reached 36 weeks of gestation by maintenance tocolysis were selected. Immediate delivery (ID) after ceasing maintenance tocolysis was defined as an 'effective case'. The correlated factors between ID and no immediate delivery (NID) were statistically analyzed. RESULTS: Thirty-six patients delivered < two days after ceasing maintenance tocolysis (27.7%) and were defined as effective cases. Multiple logistic regression analysis revealed that amniotic fluid interleukin-8 at admission (≥ 2.3 ng/mL; odds ratio [OR] 5.6, 95% confidence interval [CI] 2.1-17.6; P < 0.001), pre-pregnancy body mass index (≤ 21.4; OR 5.3, 95% CI 2.0-16.2; P < 0.001) and cerclage (OR 3.6, 95% CI 1.1-11.8; P = 0.028) were independent factors correlated with ID (< 2 days). CONCLUSION: Maintenance tocolysis may be effective in limited cases with mild intra-amniotic inflammation, in lean women and in cerclage cases. Maintenance tocolysis should be ceased in cases without these clinical factors when clinical symptoms disappear.

Association of serum adiponectin with asthma and pulmonary function in the Japanese population.

Conflicting findings have been reported regarding the role of adiponectin in asthma. The aim of this study was to evaluate the association of adiponectin with pulmonary functions and asthma in the Japanese population. First, among a general population that participated in a previous study (group 1), we selected 329 subjects after excluding those with asthma, chronic obstructive pulmonary disease, and a smoking history and examined the associations of the serum total adiponectin levels with pulmonary functions. In a second cohort (group 2) consisting of 61 asthmatic patients and 175 control non-asthmatic subjects, we examined the associations between asthma and the levels of total, high (HMW), middle (MMW) and low (LMW) molecular weight adiponectin isoforms as well as the ratio of each isoform to total adiponectin level. Although the total adiponectin levels were not significantly different between the asthmatic and control subjects in group 2, the levels were significantly and positively associated with the forced expiratory volume in 1 s after adjustments for confounding factors (P < 0.05) in women in group 1. In group 2, the LMW adiponectin level was significantly higher and the MMW/total adiponectin ratio was significantly lower among the asthmatic subjects than among the control subjects after adjustments for confounding factors in both sexes (P < 0.05). The present study showed that a low total adiponectin level may lead to airway narrowing compatible with asthmatic airways in women, and higher LMW adiponectin levels and lower MMW/total adiponectin ratio are significantly associated with current asthma in both sexes.

Effect of preterm birth on growth and cardiovascular disease risk at school age.

BACKGROUND: Low birthweight is associated with increased risk for cardiovascular disease (CVD) in later life, but whether premature birth is also a risk factor for CVD has not been fully determined. The aim of this study was to investigate the relationship between gestational age and risk factors for CVD at school age. METHODS: Using medical check-up data of school children, the relationship between gestational age and height, weight, body mass index, blood pressure, and lipid profiles at ages 9 and 12 years were investigated in children born preterm and admitted to neonatal intensive care unit at birth (n = 182; 115 boys and 67 girls). These data were also compared between preterm small for gestational age (SGA) children and preterm appropriate for gestational age (AGA) children. RESULTS: Gestational age was positively associated with height, and inversely associated with systolic blood pressure at school age. Preterm SGA children were significantly shorter and lighter at 9 and 12 years of age compared with preterm AGA children, but there were no significant differences in any CVD risk factors between the groups. CONCLUSIONS: In preterm infants, a shorter duration of gestation is associated with higher systolic blood pressure at school age.

Differences in health literacy related to gestational weight gain and children's birth weight according to maternal nativity status in the Japan Environment and Children's Study (JECS): a longitudinal cohort study.

OBJECTIVES: We examined literacy related to healthy gestational weight gain (GWG) in immigrant and native Japanese mothers and determined whether it is associated with children's birth weight. DESIGN: Longitudinal cohort study. SETTING: As the baseline survey in the Japan Environment and Children's Study (JECS), mothers completed self-administered questionnaires distributed by hand during pregnancy. The self-administered questionnaires used in this study were distributed by mail 6 months after delivery. Children's birth weight, actual GWG and any complications during delivery were recorded by obstetricians collaborating with JECS. PARTICIPANTS: Of 97 452 mothers who consented to participate in the JECS during pregnancy between January 2011 and March 2014, 67 953 were included in this study after exclusions for multiple births, multiple instances of consent by the same pregnant woman, miscarriages/stillbirths or withdrawal from the study within 3 years after participating. In total, 324 immigrant mothers and 963 native Japanese mothers were selected by propensity score matching for analysis. PRIMARY AND SECONDARY OUTCOME MEASURES: Data were collected on maternal literacy related to healthy GWG at the baseline survey, and data on actual GWG and children's birth weight were collected by obstetricians. The associations of knowledge about healthy GWG and mothers' actual GWG with maternal nativity status were examined using a χ2 or Student's t-test. RESULTS: More native Japanese mothers than immigrant mothers knew the appropriate GWG and reason the for needing to know this. Actual GWG was significantly higher among the immigrant mothers, but was within the recommended range. The low birthweight (LBW) incidence was significantly higher among the native mothers. CONCLUSIONS: Immigrant mothers to Japan had less knowledge about appropriate GWG, but their actual GWG was appropriate and they delivered fewer LBW infants than native Japanese mothers. These findings may indicate the presence of other protective factors for pregnancy or delivery among immigrant mothers.

Content analysis of health-related subjects in the K12 school curricula of Japan, Indonesia, Philippines, Guam, Micronesia, Marshall Islands, Palau, and Fiji.

BACKGROUND: As a component of health promoting school, a school curriculum for health education was considered a fundamental. This survey aimed to identify the components of health-related topics and in which subjects were they taught. METHODS: Four topics were chosen: (i) hygiene, (ii) mental health, (iii) nutrition-oral Health, and (iv) environmental education related to global warming in Education for Sustainable Development (ESD). Before gathering the curricula from partner countries, school health specialists were gathered to discuss the appropriate components of a curriculum that required evaluation. The survey sheet was distributed to and answered by our partner in each country. RESULTS: About hygiene, individual practices or items that improve health-related were widely covered. However, items that imparted health-related education from an environmental perspective were not widely covered. About mental health, two types of country groups were identified. The first group included countries that taught mental health topics mainly as part of morals or religion; the second group included countries that imparted mental health topics mainly as part of health. The first group focused mainly on communication skills or coping methods. The second group focused not only on communication and coping skill but also on basic knowledge of mental health. About nutrition-oral education, three types of country groups were identified. One group imparted nutrition-oral education mainly in terms of health or nutrition. Another group imparted this topic mainly in terms of morals, home economics, and social science. The third group was the intermediate group. About ESD, a solid structure for this topic was not identified in any country. Many items were taught as part of science, while some were taught as part of social studies. Climate change was the most commonly taught item across all countries. The items related to environment were relatively limited compared to those related to natural disasters. CONCLUSIONS: Overall, two different approaches were identified: the cultural-based approach, which promotes healthy behaviors as moral codes or community-friendly behaviors and the science-based approach, which promotes children's health through scientific perspectives. Policymakers should initially  consider the findings of this study while making decisions on which approach should be taken.

Predictors of non-response to successive waves of surveys in the Japan Environment and Children's Study during the 3-year postpartum period: a longitudinal cohort study.

OBJECTIVES: We examined changes in factors related to non-response to successive waves of the nationwide birth cohort study, the Japan Environment and Children's Study (JECS), during the first 3 years after childbirth. DESIGN: Longitudinal cohort study. SETTING: As the baseline survey, mothers completed self-administered questionnaires distributed by hand during pregnancy or 1 month after delivery. The self-administered questionnaires that we used in this study were then distributed by mail every 6 months until the children were 3 years old, for a total of six times. PARTICIPANTS: Of 103 060 mothers who consented to participate in the JECS during pregnancy, 88 489 mothers were included in the study after excluding those with multiple births, miscarriages or stillbirths and those who withdrew from the study within 3 years after providing informed consent. PRIMARY AND SECONDARY OUTCOME MEASURES: Data were collected at the baseline survey on participants' socioeconomic status, medical history, health status, health-related behaviours and their children's health conditions and living situations. The strength of the impact of related factors and the prediction of response status were examined and compared using binominal logistic regression analysis. RESULTS: For all six follow-up questionnaire surveys, higher maternal age was strongly associated with providing a response. Factors that were strongly associated with mothers not providing a response were smoking after childbirth and having more children. The concordance rate of response status based on the presented model was about 70%, suggesting that the response status for the first 3 years after birth can be predicted from the information collected in the baseline survey. CONCLUSION: By identifying predictors of non-response from information obtained in baseline surveys, researchers may be able to reduce non-response to successive survey waves by issuing reminders, reviewing data collection methods and providing appropriate financial and/or non-financial incentives.

Provision of educational events and subsequent questionnaire response rates in a large-scale birth cohort study from Japan.

OBJECTIVES: We examined whether providing educational events for participants in a birth cohort study would increase the response rates of study questionnaires. DESIGN: Birth cohort study. SETTING: Questionnaires were distributed and returned by post twice in 1 year. We developed and implemented two educational sessions; a Baby Food lecture for mothers with children around 8 months old (analysis 1) and a Eurythmic session for mothers with children around 1 year and 8 months old (analysis 2). Mothers with children over the target ages were not invited (not-invited group). The invited participants were divided into three groups: those who did not apply to attend (not-applied group), those who applied but did not attend (applied group), and those who applied and attended (attended group). PARTICIPANTS: The participants were 5379 mother-child pairs registered with the Toyama Regional Center of the Japan Environment and Children's Study (JECS). OUTCOME MEASURE: The outcome measure was return of the JECS questionnaire for 1 year old sent out after the Baby Food lecture and the JECS questionnaire for 2 years old sent out after the Eurythmic session. The questionnaires were returned to us by post. RESULTS: The response rate for the attended group of the Baby Food lecture was 99.7%, and the odds ratio (OR) was significantly higher for this group than for the not-invited group (crude OR 24.54; 95% confidence interval (CI) 3.42 to 176.13; analysis 1). After the exclusion of participants who had previously attended the Baby Food lecture, the response rate for the attended group of the Eurythmic session was 97.8%, and the OR was significantly higher for this group than for the not-invited group (adjusted OR 5.66; 95% CI 1.93 to 16.54; analysis 2). CONCLUSION: Providing educational events that are appropriate to the age and needs of the participants may increase questionnaire response rates in birth cohort studies. TRIAL REGISTRATION NUMBER: UMIN 000030786.

Development and applicability of Hospital Survey on Patient Safety Culture (HSOPS) in Japan.

BACKGROUND: Patient safety culture at healthcare organizations plays an important role in guaranteeing, improving and promoting overall patient safety. Although several conceptual frameworks have been proposed in the past, no standard measurement tool has yet been developed for Japan. METHODS: In order to examine possibilities to introduce the Hospital Survey on Patient Safety Culture (HSOPS) in Japan, the authors of this study translated the HSOPS into Japanese, and evaluated its factor structure, internal consistency, and construct validity. Healthcare workers (n = 6,395) from 13 acute care general hospitals in Japan participated in this survey. RESULTS: Confirmatory factor analysis indicated that the Japanese HSOPS' 12-factor model was selected as the most pertinent, and showed a sufficiently high standard partial regression coefficient. The internal reliability of the subscale scores was 0.46-0.88. The construct validity of each safety culture sub-dimension was confirmed by polychoric correlation, and by an ordered probit analysis. CONCLUSIONS: The results of the present study indicate that the factor structures of the Japanese and the American HSOPS are almost identical, and that the Japanese HSOPS has acceptable levels of internal reliability and construct validity. This shows that the HSOPS can be introduced in Japan.

[Which zoonoses should the general population be more awareness of ? Qualitative research targeted at veterinarians].

OBJECTIVES: The purpose of this study was to determine which zoonoses should the general population be more aware of. METHODS: We conducted qualitative research (Delphi method) on thirty veterinarians who were selected from the whole country. RESULTS: Twenty-four diseases were selected. The reasons for their selection were classified into three categories: "Amount of knowledge, attitude and behavior", "Clinicoepidemiologic characteristics" and "Social characteristics". More than half of the top ten zoonoses are those that are not transmitted from humans to humans, with rabies in the first place, avian influenza (with its high pathogenicity) in the second place and psittacosis in the third place. CONCLUSIONS: From the top ten diseases, it is considered that the prevention of animal-to-human transmission should be emphasized. In addition, from the reasons for the selection, it is suggested that it is necessary to review social characteristics, such as the inadequacy of quarantine and the insufficiencies of legal systems. As for the zoonoses that are transmitted from humans to humans, it will be indispensable in the future to widely spread information on zoonoses and enlighten the general population about them. It is thought that this survey can be a basis for selecting a zoonosis that should be given priority in enlightening the general population.

Association between maternal smoking history and congenital anomalies in children: Results from the Japan Environment and Children's Study.

We investigated the relationship between maternal smoking history and congenital anomalies in children. Drawing on data from the Japan Environment and Children's Study collected between January 2011 and March 2014, the smoking habits of pregnant women were categorized as "never smoked," "quit before pregnancy, "quit after pregnancy," and "full smoking." Of the 91 626 participants examined, a total of 2199 (2.4%) infants were born with any congenital anomalies. Logistic regression analysis was used to determine the odds ratio for congenital anomalies in each group based on maternal smoking history. No significant difference was seen between the full-smoking and never smoked groups in the odds ratios for congenital anomalies of the nervous system; the eyes, ears, face, and neck; the cardiovascular system; or the musculoskeletal system. However, in the full-smoking group, the odds ratios for trisomy (adjusted odds ratio, 2.14; 95% confidence interval, 1.15-3.97) and any congenital anomalies (adjusted odds ratio, 1.35; 95% confidence interval, 1.09-1.67) were significantly higher compared with the never smoked group. Our results indicate that continuing to smoke during pregnancy is associated with increased risk of trisomy and any congenital anomalies in the general Japanese population.

[Sick house syndrome: governmental actions and challenges].

Since the 1980s, sick house syndrome has become one of the major challenges in environmental health. In Japan in 1980, first governmental measures were taken to limit formaldehyde release from building materials. In 2003, the Building Standards Law and the Community Health Law were revised, and these laws clarified the responsibility of building companies, local governments and health officers in preventing sick house syndrome. Telephone survey results demonstrated the decrease in the prevalence of sick house syndrome between 2002 and 2006 in Tokyo and Sapporo. Knowledge about sick house syndrome enabling patients to better deal with the syndrome and stricter regulations seem to have contributed to the decrease in the prevalence of the syndrome. Questionnaire surveys carried out through regional health centers demonstrated that the number of possible sick house syndrome patients visiting regional health centers varied, possibly reflecting different local prevalences and needs. Most of the regional health centers had staff members who were able to measure in-house environments, but their ability to discuss on health-related issues was limited, and cooperation between the centers and healthcare organizations was not sufficient. Information about healthcare organizations that can treat patients with sick house syndrome and simple self-diagnostic tools were among the most often cited useful support needs. Establishment of a hub regional health center to construct a comprehensive consultation and referral system that can meet local needs in dealing with sick house syndrome is recommended.

Serum soluble interleukin-2 receptor levels for screening for malignant lymphomas and differential diagnosis from other conditions.

The serum soluble interleukin 2 receptor (sIL2R) level is elevated in patients with most types of lymphoid neoplasms, and is also elevated in patients with solid tumors or reactive conditions, such as severe inflammation. To evaluate the diagnostic significance of sIL2R levels for the screening and differential diagnosis of lymphomas, data from 248 consecutive adult patients with suspected lymphoma were retrospectively analyzed in order to determine its diagnostic characteristics and the clinical parameters that affect diagnosis. In 133 patients with aggressive or indolent lymphomas or related neoplasms, the sIL2R level was higher (median: 920 U/ml, standard deviation: 7,312 U/ml) compared with that of 115 patients with other diagnoses (median: 520 U/ml, standard deviation: 727 U/ml), including solid tumors, infection, inflammation, and others. When the cutoff value of sIL2R was 1,104 U/ml, the specificity was 80%, at which point lymphoma was suspected. When the threshold levels were increased from 1,500 to 2,000 U/ml, the specificity increased from 87 to 93%, with the positive likelihood ratio increasing from 2.99 to 4.97, strongly suggesting the diagnosis of lymphoma. The receiver operating characteristic curve for prediction of lymphoma by sIL2R revealed that the area under the curve was 0.695. The curve was nearest to the left corner of the plot when the threshold was 1,946 U/ml; at this point, the sensitivity, specificity and positive likelihood ratio were 35%, 93% and 5.06, respectively. Multivariate analysis demonstrated that an age >46 years and lactate dehydrogenase level >173 U/l appeared to increase the risk of malignant lymphoma diagnosis. Although sIL2R appears to be a less specific marker for the screening of lymphomas, its detection at higher levels strongly suggests the diagnosis of lymphomas. Therefore, sIL2R may be more useful compared with any other parameter for lymphoma diagnosis, provided other false-positive conditions are taken into consideration.

Analysis of non-respondent pregnant women who were registered in the Japan Environment and Children's Study: a longitudinal cohort study.

OBJECTIVES: Non-response to questionnaires in a longitudinal study reduces the effective sample size and introduces bias. We identified the characteristics of non-respondent pregnant women, and compared them with respondents in the Japan Environment and Children's Study (JECS) during the gestational period. DESIGN: This was a questionnaire-based, longitudinal cohort study. SETTING: Questionnaires were provided by research coordinators to mothers at prenatal examinations (at obstetrics clinics) or by mail. Mothers were measured twice: during the first trimester and during the second/third trimester. PARTICIPANTS: Data were collected from the 10 129 participating mothers of the 10 288 children surveyed in the 2011 baseline JECS. We excluded responses from mothers who had a miscarriage or stillbirth; therefore, we analysed data from 9649 participants. PRIMARY AND SECONDARY OUTCOME MEASURES: Data concerning demographics, medical history, health characteristics, health-related behaviour and environmental exposure were collected via self-administered questionnaires. The response status of participants' partners and contact with their obstetrician were also examined. Multivariate logistic regression analysis was used to examine factors related to non-response. RESULTS: Response was associated with living with one's mother-in-law (ORs: 0.47, 95% CIs: 0.24 to 0.85), positive participation of participants' partner (OR: 0.25, 95% CI: 0.17 to 0.35) and multiple visits to the obstetrician (OR: 0.02, 95% CI: 0.02 to 0.03). Participants who had a medical history of allergic rhinitis, had body pain or drank alcohol had higher odds of responding (ORs: 0.68, 0.96 and 0.36, 95% CIs: 0.48 to 0.95 and 0.95 to 0.98 and 0.16 to 0.72, respectively); those exposed to secondary smoke had lower odds of responding (OR: 1.59, 95% CI: 1.12 to 2.23). CONCLUSIONS: The non-response rate decreased when participants reported health-related behaviour or characteristics. Obtaining the understanding of people around each participant might help increase response rates.