Nursing researchers' concern about research activities during the COVID-19 pandemic: A secondary analysis of longitudinal survey data in Japan.

The coronavirus disease (COVID-19) pandemic has negatively affected research activities across various fields. This study aimed to determine nursing researchers' concerns about research activities during the COVID-19 pandemic in Japan and subsequent changes brought on by it. For this study, we conducted descriptive statistics and text mining analyses using data from two surveys conducted by the Japan Academy of Nursing Science (JANS) in the early days of the pandemic (first survey: mid-2020) and after 2 years (second survey: early 2022). Concerns about research activities were observed in 89% and 80% of the nursing researchers in the first and second surveys, respectively. Furthermore, concerns about "Difficulty in collecting research data" and "Content and quality of your research" were stronger in the second survey. Text mining analyses revealed that in the first survey, they were concerned about environmental changes and restrictions when proceeding with research during the COVID-19 pandemic, which was unfamiliar at the time. In the second survey, after overcoming environmental changes in the early stages of the pandemic, nursing researchers' concerns shifted to anxiety about the future, such as concerns about degree acquisition, employment and career advancement, and research results. The current study highlights various concerns among nursing researchers regarding research activities that have evolved over time during the pandemic. Academic societies must flexibly construct support measures for nursing researchers when a new infectious disease occurs. Such measures should be sensitive to the prevailing social circumstances and the evolving needs of researchers.

Unguided Computer-Assisted Self-Help Interventions Without Human Contact in Patients With Obsessive-Compulsive Disorder: Systematic Review and Meta-analysis.

BACKGROUND: Computer-assisted treatment may reduce therapist contact and costs and promote client participation. This meta-analysis examined the efficacy and acceptability of an unguided computer-assisted therapy in patients with obsessive-compulsive disorder (OCD) compared with a waiting list or attention placebo. OBJECTIVE: This study aimed to evaluate the effectiveness and adherence of computer-assisted self-help treatment without human contact in patients with OCD using a systematic review and meta-analysis approach. METHODS: Randomized controlled trials with participants primarily diagnosed with OCD by health professionals with clinically significant OCD symptoms as measured with validated scales were included. The interventions included self-help treatment through the internet, computers, and smartphones. We excluded interventions that used human contact. We conducted a search on PubMed, Cochrane Central Register of Controlled Trials, EMBASE, World Health Organization International Clinical Trials Registry Platform, and ClinicalTrials.gov, as well as the reference lists of the included studies. The risk of bias was evaluated using version 2 of the Cochrane risk-of-bias tool for randomized trials. We calculated the standardized mean differences for continuous outcomes and risk ratios for dichotomous outcomes. The primary outcomes were short-term improvement of OCD symptoms measured by validated scales and dropout for any reason. RESULTS: We included 11 randomized controlled trials with a total of 983 participants. The results indicated that unguided computer-assisted self-help therapy was significantly more effective than a waiting list or psychological placebo (standard mean difference -0.47, 95% CI -0.73 to -0.22). Unguided computer-assisted self-help therapy had more dropouts for any reason than waiting list or psychological placebo (risk ratio 1.98, 95% CI 1.21 to 3.23). However, the quality of evidence was very low because of the risk of bias and inconsistent results among the included studies. The subgroup analysis showed that exposure response and prevention and an intervention duration of more than 4 weeks strengthen the efficacy without worsening acceptability. Only a few studies have examined the interaction between participants and systems, and no study has used gamification. Most researchers only used text-based interventions, and no study has used a mobile device. The overall risk of bias of the included studies was high and the heterogeneity of results was moderate to considerable. CONCLUSIONS: Unguided computer-assisted self-help therapy for OCD is effective compared with waiting lists or psychological placebo. An exposure response and prevention component and intervention duration of more than 4 weeks may strengthen the efficacy without worsening the acceptability of the therapy. TRIAL REGISTRATION: PROSPERO (International Prospective Register of Systematic Reviews) CRD42021264644; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=264644.

Evolution of Public Opinion on COVID-19 Vaccination in Japan: Large-Scale Twitter Data Analysis.

BACKGROUND: Vaccines are promising tools to control the spread of COVID-19. An effective vaccination campaign requires government policies and community engagement, sharing experiences for social support, and voicing concerns about vaccine safety and efficiency. The increasing use of online social platforms allows us to trace large-scale communication and infer public opinion in real time. OBJECTIVE: This study aimed to identify the main themes in COVID-19 vaccine-related discussions on Twitter in Japan and track how the popularity of the tweeted themes evolved during the vaccination campaign. Furthermore, we aimed to understand the impact of critical social events on the popularity of the themes. METHODS: We collected more than 100 million vaccine-related tweets written in Japanese and posted by 8 million users (approximately 6.4% of the Japanese population) from January 1 to October 31, 2021. We used Latent Dirichlet Allocation to perform automated topic modeling of tweet text during the vaccination campaign. In addition, we performed an interrupted time series regression analysis to evaluate the impact of 4 critical social events on public opinion. RESULTS: We identified 15 topics grouped into the following 4 themes: (1) personal issue, (2) breaking news, (3) politics, and (4) conspiracy and humor. The evolution of the popularity of themes revealed a shift in public opinion, with initial sharing of attention over personal issues (individual aspect), collecting information from news (knowledge acquisition), and government criticism to focusing on personal issues. Our analysis showed that the Tokyo Olympic Games affected public opinion more than other critical events but not the course of vaccination. Public opinion about politics was significantly affected by various social events, positively shifting attention in the early stages of the vaccination campaign and negatively shifting attention later. CONCLUSIONS: This study showed a striking shift in public interest in Japan, with users splitting their attention over various themes early in the vaccination campaign and then focusing only on personal issues, as trust in vaccines and policies increased. An interrupted time series regression analysis showed that the vaccination rollout to the general population (under 65 years) increased the popularity of tweets about practical advice and personal vaccination experience, and the Tokyo Olympic Games disrupted public opinion but not the course of the vaccination campaign. The methodology developed here allowed us to monitor the evolution of public opinion and evaluate the impact of social events on public opinion, using large-scale Twitter data.

Naturalistic outcome of nurse-led psychological therapy for mental disorders in routine outpatient care: A retrospective chart review.

This study aimed to investigate the clinical effectiveness of nurse-led cognitive/behavioral therapy (CBT) in Japanese routine outpatient care. We retrospectively collected data from 100 cases with mental disorders who had received nurse-led CBT. Results demonstrated that CBT provided by nurses led to significant improvements in quality of life and other clinical outcomes during the intervention period (all p < 0.001). Among participants who received optional follow-up, these improvements were well-maintained. This real-world evidence of nurse-led CBT bridges the research-practice gap, and will encourage frontline nurses and motivate institutional/organizational leaders, academic/professional societies, and policymakers to employ empirically-supported psychotherapeutic techniques in routine nursing care.

Support nursing researchers' need from academic societies during COVID-19: A cross-sectional survey.

The activities of nursing researchers have been constrained by the COVID-19 pandemic. Therefore, this study aimed to investigate the types of support and related factors that nursing researchers hope to receive from academic societies during the pandemic and to obtain suggestions for the role of academic societies in supporting nursing researchers and expanding research. An online survey was conducted with 1532 Japan Academy of Nursing Science members. The survey included 19 items of potential support from the society during the COVID-19 pandemic as well as open-ended questions. Data were analyzed statistically and qualitatively. For 9 of the 19 items, over 50% of respondents reported that they "needed" or "very much needed" support. Multivariate analysis results showed that younger respondents and those with family members requiring care were significantly more likely to report needs for some items. In the open-ended comments, there were several suggestions for activities, including "Lobbying for revision of regulations on research implementation." Nursing researchers expressed needs for support that reflect their demographic characteristics and situations, including collaboration across organizations and securing research-promotion and skill-development opportunities online.

It hurts but I still need it: a qualitative investigation of post-event processing in social anxiety disorder.

BACKGROUND: It has been proposed that both positive and negative metacognitive beliefs sustain engagement in post-event processing (PEP). However, it is unknown: (1) whether individuals with social anxiety disorder (SAD) actually derive the benefits from PEP that they expect; (2) if this is not the case, how their positive beliefs are maintained; and (3) if they are aware of the counterproductive effects of PEP, why they still perform PEP. AIMS: To explore the phenomenology of the processes involved in PEP from the perspective of SADs, in order to address the research questions above. METHOD: Twenty-one participants suffering from SAD received individual semi-structured interviews. Transcripts were analysed using thematic analysis. RESULTS: Analysis revealed three main themes: (1) 'Only, safe and useful way to improve myself': SADs feel the need to improve their social performance, and they believe that PEP is the only, safe, and private way to do so, which is an underlying motive for them to do PEP; (2) 'It hurts more than helps me': however, through PEP, they do not seem to obtain the benefit that they expect, or only find a variety of counterproductive outcomes; (3) 'Better safe than sorry': they sometimes find makeshift solutions to improve their social performance during PEP, which may maintain their PEP as a form of intermittent reinforcement. They weigh up such costs and benefits, and choose to perform PEP while feeling conflicted about PEP. CONCLUSIONS: The results suggest that: (1) SADs rarely obtain the benefits from PEP that they expect; (2) their positive metacognitive beliefs are maintained by solutions they sometimes find during PEP; and (3) SADs choose to perform PEP while feeling conflicted; while PEP ironically maintains and exacerbates negative self-beliefs/images, it is the only safe and useful way to improve their social performance. These findings support and expand on the theories of PEP.

Effectiveness of Internet-Delivered Computerized Cognitive Behavioral Therapy for Patients With Insomnia Who Remain Symptomatic Following Pharmacotherapy: Randomized Controlled Exploratory Trial.

BACKGROUND: In reality, pharmacotherapy still remains the most common treatment for insomnia. OBJECTIVE: This study aimed to examine the effectiveness of our internet-delivered computerized cognitive behavioral therapy (ICBT) program as an adjunct to usual care (UC) compared with UC alone in patients with insomnia who remain symptomatic following hypnotics. METHODS: We recruited 23 patients with insomnia who remained symptomatic following pharmacologic treatment including benzodiazepines, and we conducted an exploratory randomized controlled trial. The primary outcome was the Pittsburgh Sleep Quality Index (PSQI) at week 6 of the treatment. Secondary outcomes were sleep onset latency, total sleep time, sleep efficiency, number of awakenings, refreshment and soundness of sleep, anxiety by Hospital Anxiety and Depression Scale, depression measured by the Center for Epidemiologic Studies Depression Scale, and quality of life (QOL) measured by the EuroQol-5D. All parameters were measured at weeks 0 (baseline), 6 (postintervention), and 12 (follow-up). RESULTS: The adjusted mean reduction (-6.11) in PSQI at week 6 from baseline in the ICBT plus UC group was significantly (P<.001) larger than the adjusted mean reduction (0.40) in the UC alone group. Significant differences were also found in favor of ICBT plus UC for PSQI, sleep onset latency, sleep efficiency, number of awakenings, and depression at all assessment points. Refreshment, soundness of sleep, anxiety, and QOL improved by week 6 in ICBT plus UC compared with UC alone. There were no reports of adverse events in either group during the study. CONCLUSIONS: These results indicated that our 6-week ICBT program is an effective treatment adjunct to UC for improving insomnia and related symptoms even after unsuccessful pharmacotherapy. TRIAL REGISTRATION: University Hospital Medical Information Network Clinical Trials Registry: UMIN000021509; https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000023545 (Archived by WebCite at http://www.webcitation. org/75tCmwnYt).

Is modified brief assertiveness training for nurses effective? A single-group study with long-term follow-up.

AIM: To evaluate the long-term effectiveness of modified brief assertiveness training (with cognitive techniques) for nurses. BACKGROUND: Most assertiveness training takes a long time to conduct; thus, briefer training is required for universal on-the-job training in the workplace. METHODS: In this single-group study, nurses received two 90-min training sessions with a 1-month interval between sessions. The degree of assertiveness was assessed by using the Rathus Assertiveness Schedule as the primary outcome, at four time points: pre- and post-training, 3-month follow-up and 6-month follow-up. RESULTS: A total of 33 nurses received the training, and the mean Rathus Assertiveness Schedule score improved from -14.2 (SD = 16.5) pre-training to -10.5 (SD = 18.0) post-training (p < .05). These improvements were maintained until the 6-month follow-up. The pre-post effect size of 0.22 (indicating small effect) was larger than the effect sizes ranging from -0.56 to 0.17 (no effect) reported in previous studies that used brief training. CONCLUSIONS: Modified brief assertiveness training seems feasible and may achieve long-term favourable outcomes in improving assertiveness among nurses. IMPLICATIONS FOR NURSING MANAGEMENT: The ease of implementation of assertiveness training is important because creating an open environment for communication leads to improved job satisfaction, improved nursing care and increased patient safety.

Development and evaluation of a modified brief assertiveness training for nurses in the workplace: a single-group feasibility study.

BACKGROUND: Effective communication has a great impact on nurses' job satisfaction, team relationships, as well as patient care/safety. Previous studies have highlighted the various beneficial effects of enhancing communication through assertiveness training programs for nurses. However, most programs take a long time to implement; thus, briefer programs are urgently required for universal on-the-job-training in the workplace. The purpose of this feasibility study was to develop and evaluate a modified brief assertiveness training program (with cognitive techniques) for nurses in the workplace. METHODS: This study was carried out as a single-group, open trial (pre-post comparison without a control group). Registered nurses and assistant nurses, working at two private psychiatric hospitals in Miyazaki Prefecture in Japan, were recruited. After enrolling in the study, participants received a program of two 90-min sessions with a 1-month interval between sessions. The primary outcome was the Rathus Assertiveness Schedule (RAS), with secondary measurements using the Brief Version of the Fear of Negative Evaluation Scale (BFNE) and the Brief Job Stress Questionnaire (BJSQ). Assessments were conducted at baseline and after a 1-month interval (pre- and post-intervention). RESULTS: A total of 22 participants enrolled in the study and completed the program. The mean total score on the primary outcome (RAS) significantly improved from -12.9 (SD = 17.2) to -8.6 (SD = 18.6) (p = 0.01). The within-group effect size at the post-intervention was Cohen's d = 0.24; this corresponds to the small effect of the program. Regarding secondary outcomes, there were no statistically significant effects on the BFNE or any of the BJSQ subscales (job-stressors, psychological distress, physical distress, worksite support, and satisfaction). CONCLUSIONS: This single-group feasibility study demonstrated that our modified brief assertiveness training for nurses seems feasible and may achieve a favorable outcome in improving their assertiveness. Further controlled trials with longer follow-up periods are required in order to address the limitations of this study.

Cognitive Behavioral Therapy for Patients with Social Anxiety Disorder Who Remain Symptomatic following Antidepressant Treatment: A Randomized, Assessor-Blinded, Controlled Trial.

BACKGROUND: Although antidepressants are still a commonly used treatment for social anxiety disorder (SAD), a significant proportion of patients fail to remit following antidepressants. However, no standard approach has been established for managing such patients. This study aimed to examine the effectiveness of cognitive behavioral therapy (CBT) as an adjunct to usual care (UC) compared with UC alone in SAD patients who remain symptomatic following antidepressant treatment. METHODS: This was a prospective randomized open-blinded end-point study with two parallel groups (CBT + UC, and UC alone, both for 16 weeks) conducted from June 2012 to March 2014. SAD patients who remain symptomatic following antidepressant treatment were recruited, and a total sample size of 42 was set based on pilot results. RESULTS: Patients were randomly allocated to CBT + UC (n = 21) or UC alone (n = 21). After 16 weeks, adjusted mean reduction in the Liebowitz Social Anxiety Scale from baseline for CBT + UC and UC alone was -40.87 and 0.68, respectively; the between-group difference was -41.55 (-53.68 to -29.42, p < 0.0001). Response rates were 85.7 and 10.0% for CBT + UC and UC alone, respectively (p < 0.0001). The corresponding remission rates were 47.6 and 0.0%, respectively (p = 0.0005). Significant differences were also found in favor of CBT + UC for social anxiety symptoms, depressive symptoms, and functional impairment. CONCLUSIONS: Our results suggest that in SAD patients who have been ineffectively treated with antidepressants, CBT is an effective treatment adjunct to UC over 16 weeks in reducing social anxiety and related symptoms.

Effect of cognitive behavioral group therapy for recovery of self-esteem on community-living individuals with mental illness: Non-randomized controlled trial.

AIM: The aim of this study was to examine over a 12-month post-intervention period whether the participation of community-living individuals with mental illness in cognitive behavioral group therapy for recovery of self-esteem (CBGTRS) resulted in improved outcomes. METHODS: This was a non-randomized controlled trial. The participants were persons with mental illness who resided in communities in the Chugoku region of Japan. In total, 41 were assigned to an experimental group (CBGTRS intervention, 12 group sessions), and 21 to a control group. Outcome indices (self-esteem, moods, cognition, subjective well-being, psychiatric symptoms) were measured for the experimental group prior to intervention (T0), immediately post-intervention (T1), and at 3 (T2) and 12 (T3) months post-intervention. The control group was measured at the same intervals. RESULTS: For the experimental group, self-esteem scores at T1, T2, and T3 were significantly higher than at T0. Moods and cognition scores remained significantly low until T2. Scores for Inadequate Mental Mastery in the subjective well-being index had not decreased by T3. Confidence in Coping remained significantly high until T2. Psychiatric symptoms scores at T0, T1, T2, and T3 were significantly lower than at T0. The means and standard errors for self-esteem and Inadequate Mental Mastery increased until T3, and those for Tension-Anxiety, Depression-Dejection, and Confusion decreased until T2. CONCLUSION: From within-group trends and between-group differences in self-esteem, we conclude that CBGTRS may have a relatively long-term effect on self-esteem recovery. T2 is the turning point for moods and cognition; thus, follow-up is needed 3 months following the initial program.

The use of ultrasonography in education for undergraduate nursing students: A literature review.

AIM: The incorporation of ultrasonography into nursing practice is becoming more common, but how ultrasonography is used or applied in nursing student education is still unclear. This study aimed to review and synthesize relevant literature on the use of ultrasonography in education for undergraduate nursing students. METHODS: An electronic literature search was conducted in June 2022 (updated in June 2023) using MEDLINE, CINAHL, Scopus, and Ichushi-Web databases. Two researchers independently screened/assessed the eligibility of the studies, synthesized extracted data using a narrative synthesis (due to anticipated heterogeneity across studies), and evaluated the methodological quality of quantitative studies using the Medical Education Research Study Quality Instrument. RESULTS: Thirteen peer-reviewed articles were included in the review. All of the studies were conducted in high-income countries, and the majority of them employed an uncontrolled single-group design. Ultrasonography was used mainly for visualizing the vascular system to improve students' puncture skills, but it was also used with various other applications. The included studies were predominantly of moderate quality and heterogeneous, but all of them reported at least some benefits in nursing student education, such as enhancing knowledge and understanding of subcutaneous anatomical structures, and improving confidence in and/or skills of venipuncture and other visualization/assessment methods. CONCLUSIONS: This review provides a broad perspective and highlights the potential use of ultrasonography in education for undergraduate nursing students. Further research is needed to develop standardized teaching methods/curriculum and competency assessments in order to ensure minimum competency standards for students and to improve clinical outcomes for patients.

Successful remote treatment of a client with Hikikomori using internet-delivered cognitive therapy for social anxiety disorder: a case report.

Hikikomori (prolonged social withdrawal) has been discussed as a hidden worldwide epidemic and a significant social and healthcare issue. Social anxiety disorder is the most common psychiatric disorder preceding the onset of Hikikomori. Although studies exist suggesting the effectiveness of family-support interventions, little is known about psychotherapeutic approaches for Hikikomori individuals. Here, we present a case of Hikikomori wherein an internet-delivered cognitive therapy for social anxiety disorder (iCT-SAD) worked effectively in improving the client's social anxiety symptoms and social interaction behaviors. This case study demonstrates the principle that evidence-based psychological interventions focusing on social anxiety can be effective for clients with Hikikomori. Furthermore, the online mode of treatment delivery, along with a variety of relevant modules, may facilitate clients' engagement with treatment at home. The findings suggest that iCT-SAD might be a promising option for Hikikomori clients who have social anxiety problems, within the recommended stepped-intervention approach.

Research and Future Challenges for Disseminating Strengths-Based Nursing and Healthcare in Japan.

Strengths-Based Nursing and Healthcare (SBNH) has garnered attention in the field of psychiatric nursing in Japan, yet its adoption in other nursing sectors remains limited. Japan is currently facing the formidable challenge of a rapidly aging population and growing demand for healthcare and welfare services. To address these issues, a shift from hospital-based care to comprehensive community care is underway, underscoring the importance of nurses in community settings, where focusing on client strengths is essential. Therefore, this paper aims to present research and practical examples to advocate for the broader dissemination of SBNH in Japan.

Prediction models for the impact of the COVID-19 pandemic on research activities of Japanese nursing researchers using deep learning.

AIM: This study aimed to construct and evaluate prediction models using deep learning to explore the impact of attributes and lifestyle factors on research activities of nursing researchers during the COVID-19 pandemic. METHODS: A secondary data analysis was conducted from a cross-sectional online survey by the Japanese Society of Nursing Science at the inception of the COVID-19 pandemic. A total of 1089 respondents from nursing faculties were divided into a training dataset and a test dataset. We constructed two prediction models with the training dataset using artificial intelligence (AI) predictive analysis tools; motivation and time were used as predictor items for negative impact on research activities. Predictive factors were attributes, lifestyle, and predictor items for each other. The models' accuracy and internal validity were evaluated using an ordinal logistic regression analysis to assess goodness-of-fit; the test dataset was used to assess external validity. Predicted contributions by each factor were also calculated. RESULTS: The models' accuracy and goodness-of-fit were good. The prediction contribution analysis showed that no increase in research motivation and lack of increase in research time strongly influenced each other. Other factors that negatively influenced research motivation and research time were residing outside the special alert area and lecturer position and living with partner/spouse and associate professor position, respectively. CONCLUSIONS: Deep learning is a research method enabling early prediction of unexpected events, suggesting new applicability in nursing science. To continue research activities during the COVID-19 pandemic and future contingencies, the research environment needs to be improved, workload corrected by position, and considered in terms of work-life balance.

Latent Dirichlet allocation topic modeling of free-text responses exploring the negative impact of the early COVID-19 pandemic on research in nursing.

AIM: To derive latent topics from free-text responses on the negative impact of the pandemic on research activities and determine similarities and differences in the resulting themes between academic-based and clinical-based researchers. METHODS: We performed a secondary analysis of free-text responses from a cross-sectional online survey conducted by the Japan Academy of Nursing Science of its members in early 2020. The participants were categorized into two groups by workplace (academic-based and clinical-based researchers). Latent Dirichlet allocation (LDA) topic modeling was used to extract latent topics statistically and list important keywords/text associated with the topics. After organizing similar topics by principal component analysis (PCA), we finally derived topic-associated themes by reading the keywords/texts and determining the similarity and differences of the themes between the two groups. RESULTS: A total of 201 respondents (163 academic-based and 38 clinical-based researchers) provided free-text responses. LDA identified eight and three latent topics for the academic-based and clinical-based researchers, respectively. While PCA re-grouped the eight topics derived from the former group into four themes, no merging of the topics from the latter group was performed resulting in three themes. The only theme common to the two groups was "barriers to conducting research," with the remaining themes differing between the groups. CONCLUSIONS: Using LDA topic modeling with PCA, we identified similarities and differences in the themes described in free-text responses about the negative impact of the pandemic between academic-based and clinical-based researchers. Measures to mitigate the negative impact of pandemics on nursing research may need to be tailored separately.

Noncompliance with Hypertension Treatment and Related Factors among Kumamoto Earthquake Victims Who Experienced the COVID-19 Pandemic during Postearthquake Recovery Period.

Survivors of the Kumamoto earthquake of 2016 experienced the coronavirus disease (COVID-19) outbreak while carrying additional burdens that might bring inadequate coping. This cross-sectional survey aimed to identify untreated and interrupted consultations among those with hypertension and related factors and to identify the disaster's long-term effects. Of the 19,212 earthquake survivors who had moved to permanent housing, 7367 (4196 women and 3171 men, mean age 61.8 ± 17.3 years) completed a self-administered questionnaire. The prevalence of hypertension was 41.4%. The results of the logistic regression analysis with the significant independent variables in the bivariate analysis were: reduced income due to COVID-19 (AOR = 3.23, 95%CI = 2.27-4.58) and poor self-rated health (AOR = 2.49, 95%CI = 1.72-3.61) were associated with a risk of untreated or discontinued treatment. Moreover, living in rental, public or restoration public housing was also significantly associated with a higher risk of hypertension noncompliance (AOR = 1.92, 95%CI = 1.20-3.07; AOR = 2.47, 95%CI = 1.38-4.42; AOR = 4.12, 95%CI = 1.14-14.90). These results suggest that changes due to COVID-19, the extent of self-rated health and the type of permanent housing influence the hypertension consulting behaviour of earthquake survivors during recovery. It is crucial to implement long-term public support for the mental health, income and housing concerns of the survivors.

Japanese Society of Anxiety and Related Disorders/Japanese Society of Neuropsychopharmacology: Clinical practice guideline for social anxiety disorder (2021).

The development of clinical practice guidelines for social anxiety disorder began in March 2018 when the Joint Clinical Practice Guideline Development Committee for Anxiety and Obsessive-Compulsive Disorders was formed by the Japanese Society of Anxiety and Related Disorders and Japanese Society of Neuropsychopharmacology to jointly develop guidelines for anxiety and obsessive-compulsive disorders. Based on the universal concept of evidence-based medicine, three clinical questions (CQs) about pharmacotherapy and psychotherapy were developed for clinical guidelines for social anxiety disorder, panic disorders, and obsessive-compulsive disorder in accordance with the Minds "Manual for Guidelines Development 2017 by the Japan Council for Quality Health Care: CQ1-"What is the recommended pharmacotherapy for social anxiety disorder in adults?"; CQ2-"What is the recommended psychotherapy (psychological intervention) for social anxiety disorder in adults?"; and CQ3-"What are the recommendations regarding monotherapy and combination therapy for social anxiety disorder in adults in terms of pharmacotherapy and psychotherapy (psychological interventions)?" Summarized recommendations for social anxiety disorder in adults are selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitor for CQ1, cognitive behavioral therapy for CQ2, and there are no recommendations regarding monotherapy and combination therapy for CQ3. These were answered by considering the balance between benefits and harms based on systematic reviews of each. The aim of this brief guideline for the standard-of-care (i.e., medical treatment) for social anxiety disorder in adults (18 years and older) was to help "shared decision making," in which medical professionals, including physicians, and patients share scientific evidence to decide on a course of treatment.