Nutritional intake and metabolic parameters of Japanese university students with and without obesity: Sex-specific differences.

OBJECTIVE: To establish effective methods of obesity prevention among young adults, we analyzed the relationship between obesity-related food intake and metabolic factors in Japanese university students. METHODS: We performed a cross-sectional analysis of nutrient intake information and metabolic parameters among 1,206 Gifu University students categorized by body mass index. RESULTS: The overweight/obesity rate was significantly higher in males. Additionally, among males, the intake of protein, potassium, magnesium, phosphorus, iron, zinc, all lipids/fats, and all metabolic parameters including blood sugar, hemoglobin A1c, uric acid, alanine aminotransferase, aspartate aminotransferase, low-density lipoprotein, high-density lipoprotein, triglycerides, and blood pressure significantly differed between the obese and non-obese groups. However, the same comparison among females revealed no significant differences in nutrient intake and significant differences in only half of the parameters. Among males, energy intake from protein and fat was significantly higher in the obese group, while the percentage of total energy intake from carbohydrates and fat was lower and higher, respectively, among females in the obese group. CONCLUSIONS: Overeating of protein and fat in males and unbalanced nutrition in females are sex-specific characteristics of Japanese university students with obesity, and metabolic abnormalities in students with obesity are more remarkable in males than in females.

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.

Causal beliefs regarding schizophrenia and help-seeking behaviors among patients with schizophrenia and family caregivers attending psychiatric clinics in Cambodia.

Schizophrenia often follows a chronic or recurrent course, placing an immense burden on patients and their families. Mental health services in Cambodia are still highly limited, thus there is a major treatment gap. It is common that people consult traditional healers (Kru Khmer) and monks. In this culture, people who receive psychiatric medical treatment are expected to exhibit higher mental health literacy, but little is known about this factor. In this study, we interviewed 59 patients with schizophrenia and 59 family caregivers attending psychiatric clinics in Cambodia. Through qualitative analysis using a thematic analysis approach, we extracted eight themes of causal beliefs regarding schizophrenia: (1) spiritual beliefs, (2) cultural symptoms, (3) physical problems, (4) heredity, (5) substance abuse, (6) traumatic events, (7) stress in human relationships or in one's social environment, and (8) socioeconomic position. We found that "thinking too much" (kit chroeun) and "worrying too much" (prouy / barom chroeun), cultural idioms of distress, were recognized as causal factors of schizophrenia by both parents and family caregivers. Some participants were aware of the possible causal factors in light of the latest psychiatry findings, such as genetic factors and childhood trauma. Our data show that causal beliefs are not a decisive factor in shortening the duration of untreated psychosis (DUP). In Cambodia, where the treatment for schizophrenia is pluralistic, we suggest that it is crucial to embed the meaning of psychiatric treatment into local meaning worlds for better help-seeking behaviors.

Mental health literacy survey among Cambodia's urban and rural populations: Results from a vignette-based population survey.

BACKGROUND: Although there are effective methods for the treatment and management of various mental illnesses, some individuals still do not seek psychiatric treatment. Various factors could affect this reluctance toward treatment, one of which is the public's lack of mental health literacy. This survey aimed to measure and compare mental health literacy in Cambodia's urban and rural areas. METHOD: Tours were held to hold seminars that provided information about mental health in the health centers around Phnom Penh (PP) and Siem Reap (SR), and a survey was conducted on mental health literacy for the participants before the seminar at each location. Anthony Jorm's vignette of psychosis (young adult) and Angermeyer's questionnaire were used. After the participants were classified into the "agree group" and "disagree group" for each item, the answers for each item given by the participants in PP and SR were compared using the chi-square test and the odds rate was calculated. RESULTS: The participants in SR were more likely to give reasons such as inherited causes, economic problems, stress at work, or family problems as the cause of schizophrenia. The percentage of these beliefs about schizophrenia was relatively lower in PP than in SR. Regarding attitudes toward schizophrenia, the participants in SR were more likely to have negative views and predict negative prognoses than the participants in PP. As for participants' feelings about schizophrenia, the participants in SR reacted more strongly than those in PP. Even though the participants in SR reacted more negatively, they were sympathetic toward individuals with schizophrenia. CONCLUSION: Overall, the participants in the SR group were more likely to have negative attitudes toward schizophrenia than those in the PP group. These results support our hypothesis that mental health literacy represents the maturity of community mental health in a targeted area.

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.

Lingering effects of COVID-19 on the mental health of first-year university students in Japan.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic is continuing unabated in Japan, as of October 2021. We aimed to compare first-year university students' psychological distress before the pandemic in 2019, during the pandemic in 2020, and one year after the onset of the pandemic, in 2021. METHODS: The study conducted online surveys over three years from April to May each year. Participants were 400 first-year students in 2019, 766 in 2020, and 738 in 2021. We examined differences in scores on the Counseling Center Assessment of Psychological Symptoms-Japanese version (CCAPS-Japanese) between the three years using a one-way analysis of variance, and differences in the CCAPS-Japanese critical items using chi-squared test and residual analysis. RESULTS: The average scores on the Depression and Generalized Anxiety subscale in 2021 were significantly higher than those in 2020, but remained the same as in 2019. The Academic Distress subscale score in 2020 was the worst compared to 2019 and 2021. Meanwhile, the number of students who experienced severe suicidal ideation increased year by year from 2019 to 2021. CONCLUSION: The mean mental health of first-year university students worsened after the onset of the COVID-19 pandemic, and recovered to the pre-pandemic level over the next two years. However, the number of high-risk students with suicidal ideation continued to increase. A system is required for early detection and support for students at high risk of mental health issues.

Pembrolizumab-related cholangitis with multiple fatal liver abscesses after endoscopic biliary drainage: a case report and review of the literature.

A 60-year-old male with cStage IVB lung cancer was treated with pembrolizumab. However, after five courses of pembrolizumab, he developed pembrolizumab-related cholangitis. Imaging studies showed enlargement and diffuse wall thickening of the gallbladder and mild dilation of the bile ducts without any obvious obstruction. As the patient experienced severe abdominal pain, we suspected bile stasis and performed biliary drainage. However, his condition did not improve, and he developed multiple liver abscesses and died during immunosuppressive therapy. Our case suggests that in ir-cholangitis, the indication and method of endoscopic retrograde cholangiopancreatography should be carefully judged.

Psychotropic drug use rate among detention house residents and association with the category of the crimes in Japan.

AIM: The White Paper on Crime 2019 from the Japanese Ministry of Justice reported that the percentage of crimes committed by people with mental disabilities was only 1.0%. In contrast, the findings of a statistical survey of correctional facilities reported that 15.1% of the prisoners were diagnosed with a mental illness. This study aimed at clarifying the relationship between mental illness and crime among suspects in a detention house and explaining this large gap. METHODS: Criminal suspects who were newly admitted in the Gifu detention house in Japan were eligible for the study. The status of psychotropic drug use was investigated, and its relationship with age, sex, offense history, and type of crime was analyzed. Newly prescribed medications in detention houses or police stations were excluded. RESULTS: In total, 26.5% of the residents in a detention house used psychotropic drugs. The psychotropic drug use rate was 16.7% (excluding the sleeping pill use rate). The use rates of sleeping pills, anxiolytics, antidepressants, and antipsychotics were 22.6%, 11.1%, 3.0%, and 9.6%, respectively. Psychotropic drug use was high in illicit drug users and low in suspects for immigration violence. Psychotropic drug use was higher among female suspects, suspects in their 40s and 50s, and suspects with a multiple crime history. Anxiolytic (17.0%) and antipsychotic (11.9%) use rates were high among suspects for violence. CONCLUSION: In total, 26.5% of the subjects used psychotropic drugs. Psychotropic drug use was high in illicit drug users and low in suspects for immigration violence.

The effect of remote learning on the mental health of first year university students in Japan.

We examined the effects of the coronavirus disease 2019 (COVID-19) pandemic on first-year Japanese university students' mental health by comparing current year's survey results with previous year's results. Accordingly, an online survey was conducted on first-year Gifu University students from April 20 to May 31, 2020. Study results revealed that, despite the emergence of the COVID-19 pandemic, the number of "high-risk" students and the depression level were lower among the 2020 first-year students compared to previous year's students. However, the 2020 first-year students experienced high academic distress since they had to adapt to an unfamiliar e-learning environment.

Non-communicable Disease among Homeless Men in Nagoya, Japan: Relationship between Metabolic Abnormalities and Sociodemographic Backgrounds.

Objective To examine the degree of metabolic abnormalities and their association with the sociodemographic background or mental illness/cognitive disability among homeless men in Nagoya, Japan. Methods We interviewed 106 homeless men (aged 54.2±12.7 years) and measured their metabolic parameters. Mental illness and cognitive disability were diagnosed using the Mini-International Neuropsychiatric Interview and Wechsler Adult Intelligence Scale-III test, respectively. Associations between metabolic abnormalities and the sociodemographic background or mental illness/cognitive disability were analyzed. Results There were significant correlations of liver dysfunction (AST≥35 IU, ALT≥35 IU, γ-GTP≥75 IU), hypertension [systolic/diastolic blood pressure (BP) ≥140/90 mmHg], and dyslipidemia (HDL <40 mg/dL) with the history/duration of homelessness (over 2 times/year) and residence status (living on the streets). Although the mean body mass index (BMI), BP, HbA1c, and LDL in participants living in temporary residences were similar to those obtained from the general population data from National Health Nutrition Survey (NHNS) 2016, the systolic/diastolic BP in those living on the street was significantly higher than in the general population, and the HDL in those living in temporary residences was significantly lower than in those reported in the NHNS 2016 data. In the group with cognitive disability, the ALT, TG, and BMI values were significantly higher and the HDL level significantly lower in those living in temporary residences than in those living on the streets. Conclusion Stressful conditions while living on the streets may exacerbate hypertension and liver dysfunction, and unhealthy food habits when living in a temporary residence may exacerbate low HDL levels. In addition, an inability to self-manage due to cognitive disability may increase the ALT, TG, and BMI values. The provision of homeless people with the skills to sustain independent living conditions and ensure a healthy diet is required.

Quality of life and its social determinants for patients with schizophrenia and family caregivers in Cambodia.

Due to inadequate human and financial resource support, the development of mental health services in Cambodia has been undertaken by various non-governmental organizations (NGOs). Schizophrenia is the most common functional psychotic disorder, causing severe and chronic symptoms, and the programs provided by the NGOs should have enhanced the quality of life (QoL) of patients and their caregivers; however, epidemiological research, which is a driving force behind the recognition of mental health as a global public health concern, is lacking for schizophrenia in Cambodia. This study therefore aimed to create QoL evaluation questionnaires available in Khmer (the Cambodian language) for patients with schizophrenia and family caregivers, and to identify the social determinants and predictors of their QoL. This cross-sectional study recruited 59 patients and 59 caregivers attending three clinics operated by two NGOs: the Transcultural Psychosocial Organization (TPO) Cambodia and the Supporters for Mental Health (SUMH) Cambodia. We conducted linguistic validation of the Schizophrenia Quality of Life Questionnaire 18-item version (S-QoL 18) and the Schizophrenia Caregiver Questionnaire (SCQ), then analyzed correlations between the QoL dimensions and socio-demographic factors. The main findings of this study were as follows: 1) the newly created Khmer versions of S-QoL 18 and SCQ are relatively good psychometric tools that are suitable for research to identify patients' and caregivers' needs to improve their QoL; and 2) engaging in paid work or being of the post-Khmer Rouge generation results in higher QoL for patients, but having low household economic status or being affected by chronic disease leads to lower QoL for family caregivers. These findings are useful for enabling community mental health professionals and aid organizations to create programs to lessen the patient and caregiver burden in Cambodia. Further research is necessary to develop practical projects that will improve patients' and caregivers' QoL in various clinical settings in Cambodia.

Compulsory educational mental health support system in Japan.

Mental health problems among children present an important public health issue worldwide. Early detection, assessment, and support in schools might have a significant impact on mental health outcomes and child health and wellbeing. The purpose of this article is to show the mental health support system and its historical transition in Japan. In general, Japanese schools have a Yogo teacher (a school nurse) who works full time, as well as three types of mental health specialists who work part time: school counselors, advisors, and social workers. The regularity of visits from the three types of specialists depends on schools and regions. In general, school counselors visit schools more often than do other specialists, for approximately 4 h per week. The other specialists either visit the schools rarely or not at all because they are sometimes not hired. The strengths of the Japanese system included much provision of psychological consultations and a small budget compared to Western countries. Almost all school counselors are clinical psychologists with master's degrees who are skillful at handling students' mental problems. Moreover, they are capable of providing intensive psychological counseling in school settings in Japan. The weakness is that there is no specialist available who supports students' academic or school life. General teachers take on the role of the Western countries' "school counselors." There are also few specialists who can be approached for social support compared to Western countries.

Effective school-based preventive interventions for alcohol use in Africa: a systematic review.

BACKGROUND: Despite recognition of the risks of alcohol use and importance of prevention from an early age, the effectiveness of school-based interventions in Africa has not been clarified. OBJECTIVE: We aimed to identify effective school-based alcohol use prevention interventions in Africa. METHODS: We searched eight databases for peer-reviewed articles published until February 3, 2019 that reported on randomized controlled trials, cluster randomized controlled trials, controlled clinical trials, pre-post quasi-experimental studies, cohort studies, and case-control studies. The full-texts of relevant studies were searched. RESULTS: Four of 2797 papers met our eligibility criteria. All reported interventions targeted secondary school students in South Africa and were incorporated in the school curriculum. The interventions comprised multi-component activities with participatory and peer educational methods, and applied modified programs originally developed in the US. However, intervention effects were inconsistent among studies, although the interventions tended to have a positive effect on non-drinkers at baseline, with stronger effects in girls. CONCLUSION: interventions had positive effects on students that were non-drinkers at baseline, especially girls. Although we could not find robust evidence that school-based interventions changed attitudes, frequency/quantity of drinking, and intentions to use alcohol, one intervention showed an increase in students' alcohol refusal self-efficacy.

Current situation and comparison of school mental health in ASEAN countries.

School-based mental health interventions are considered to have potential for the promotion of mental health in developing countries. We held a workshop to discuss the promotion of mental health in schools in southeast Asian countries. This review report aimed to summarize the current situation of school mental health in Association of Southeast Asian Nations (ASEAN) countries as reported by their representatives in this workshop. To summarize the current situation of ASEAN countries in relation to school mental health, we qualitatively analyzed the content of the discussions from four perspectives: (i) laws and regulations: (ii) mental health services; (iii) teacher training on mental health; (iv) mental health education for students. With regard to school mental health laws and regulations, this report could not provide clear conclusions because the laws were reported through the personal understanding of the public officers. Our results show that mental health services in schools are centered on professionals such as guidance counselors, although the coverage varied among the different ASEAN countries. Only Singapore conducted mental health training for teachers in a comprehensive way, and the number of people who were actually trained in other countries was very limited. Cambodia, Malaysia, Myanmar, Philippines, Singapore, and Thailand included mental health education for students in health education or life skills subjects.

Development of the Counseling Center Assessment of Psychological Symptoms-Japanese version: Pilot study.

There is currently no reliable and valid multidimensional instrument for measuring psychological symptoms among Japanese university students. The purpose of this pilot study was to translate the Counseling Center Assessment of Psychological Symptoms-62 (CCAPS-62) into Japanese and evaluate its validity and reliability. Following robust translation procedures, the CCAPS-Japanese was created. In the validation study, 2,758 undergraduate students from 11 universities (mean age = 19.08 ± 1.85 years) completed the CCAPS-Japanese. The results of confirmatory factor analysis supported the theoretical eight-factor structure model of the CCAPS-Japanese with the exclusion of seven items. The decision to retain/remove items was made by evaluating factor loadings and model fit indices while considering cultural equivalence and structural validity. Using the finalized 55-item CCAPS-Japanese, further analyses demonstrated that the eight subscales had acceptable to good internal consistencies (α = .61-.89). Thus, the tool's validity and reliability were established. The CCAPS-Japanese may be appropriate for assessing the psychological concerns of Japanese university students.

Correction: Relationship between non-communicable diseases and background characteristics among homeless people in Nagoya City, Japan.

[This corrects the article DOI: 10.1371/journal.pone.0219049.].

Relationship between non-communicable diseases and background characteristics among homeless people in Nagoya City, Japan.

BACKGROUND: There are few reports that objectively show actual health conditions among the homeless or diagnoses of non-communicable diseases based on blood tests. This report discloses the actual data from blood tests and non-communicable diseases among the participants. Furthermore, associations between the test values for lifestyle-related disease and mental disorder/intellectual disability, as well as personal backgrounds of homeless people, were analyzed from the data gathered in the survey. METHODS: This study was performed in a rented meeting room close to Nagoya Station on November 2, 2014. Blood samples, physical measurements, blood pressure measurements intellectual faculties were measured. Physical/mental diseases were diagnosed by doctors. Fisher's exact test was performed to compare between subgroups (by participants' socio-demographic data or the presence of mental illness/cognitive disability) according to non-communicable disease test values, and to calculate the odds ratio. RESULTS: Abnormalities among participants in test values for non-communicable disease were as follows: hypoalbuminemia in one participant (0.9%), abnormalities in liver function in 22 participants (19.3%), decreased renal function in two participants (1.8%), dyslipidemia in 67 participants (58.8%), "a person whose impaired glucose tolerance cannot be ruled out" in 20 participants (17.5%), obesity in 33 participants (28.9%), thinness in five participants (4.3%), and hypertension in 60 participants (52.6%). Compared to the National health and nutrition survey 2015, non-communicable diseases of the homeless people were similar or slightly better than in the general population in Japan. Participants aged 20-39 years had a significant positive tendency of having liver function abnormality compared to ≥60 years old participants. There was no significant tendency with socio-demographic characteristics in dyslipidemia and "impaired glucose tolerance". CONCLUSION: It was found that the percentage of homeless people in Nagoya who showed abnormalities of lifestyle-related disease was similar or better than that of general population in Japan.

Prevalence of diabetes among homeless men in Nagoya, Japan: A survey study.

AIMS/INTRODUCTION: The diabetes status of homeless people has not been elucidated because of the limited access to this population. We carried out a survey of the prevalence of diabetes and prediabetes among homeless men in Nagoya, Japan, and assessed the associations between diabetes prevalence and sociodemographic characteristics. MATERIALS AND METHODS: Interviews relating to individuals' sociodemographic background, mental illness and cognitive ability, and blood sampling were carried out for 106 homeless men (mean age 54.2 ± 12.7 years). Diabetes, prediabetes and normoglycemia were diagnosed according to the individual's hemoglobin A1c level: ≥6.5%, 6.4-6.0% and ≤5.9%, respectively. Mental illness and cognitive disability were diagnosed using the Mini-International Neuropsychiatric Interview and Wechsler Adult Intelligence Scale-III, respectively. Associations between the prevalence of diabetes/prediabetes and mental illness/cognitive disability or sociodemographic background were analyzed using the χ2 -test. RESULTS: Seven (6.6%) and 12 (11.3%) participants were diagnosed as having diabetes and prediabetes, respectively, which was a similar trend to that of general populations in Japan National Health and Nutrition Survey data. There was a significant difference in the prediabetes prevalence between groups with and without a history of having social support; however, no significant associations were found between the diabetes/prediabetes prevalence and mental illness/cognitive ability or participants' sociodemographic background. CONCLUSIONS: The incidence of diabetes in Japanese homeless men was similar to that in the general population, and the prediabetes incidence was lower in the group with social support than in that without. Early intervention for preventing diabetes and social support that focuses on diabetes management is important for homeless people.

Factors that influence delaying initial psychiatric treatment in rural Cambodia: A pilot study.

BACKGROUND: The WHO reported the gap between the need for treatment and its provision is huge in low- and middle-income countries. It is estimated there are lots of burden to obtain treatment in these countries. This survey intended to show the delay of their first visit to a psychiatric department and the factors that influence the delay. To elucidate the factors affecting medical accessibility for people with mental illness, we propose the concept of duration of untreated mental illness (DUM), which is the duration between the onset or first symptom of mental illness and the first visit to a psychiatric department or clinic. METHODS: Participants were 109 Cambodian adults (18 years old and up) who had a psychiatric consultation in one of the following hospitals. We analyzed the relationships between DUM and patients' background; age, gender, economic status, education level, occupation, hospital access, and diagnosis. RESULTS: The average DUM of all participants was 34.8 ± 42.4 months, ranging from 0 to 240 There was no significant difference in DUM by difference in hospital, gender, age, hospital access, education level, occupation, or economic status. Only patient diagnosis was related to DUM. The DUM for patients with schizophrenia and epilepsy was long, while the DUM for patients with neurosis and substance use were short. CONCLUSION: To compare DUM with that of other low- and middle-income countries, DUM of our survey is extremely long. However, those reports were from urban areas within the low- and middle-income countries. We considered our report to include a very important sample showing the condition of psychiatric services in rural areas of low-income countries.