The association between experience of COVID-19-related discrimination and psychological distress among healthcare workers for six national medical research centers in Japan.

BACKGROUND: Discrimination is an important determinant of negative mental health outcomes. This study determined the association between the experience of COVID-19-related discrimination and psychological distress among healthcare workers (HCWs) in Japan. METHODS: This cross-sectional study conducted a health survey among 5703 HCWs of six national medical and research centers in Japan from October 2020 to March 2021. COVID-19-related discrimination was defined either when participants or their family members were badmouthed or when they felt discriminated against in some way. We used the Kessler Psychological Distress Scale (K6) to assess the presence of severe psychological distress (≥ 13 points). We used logistic regression models to examine the association between discrimination and psychological distress. We also identified factors associated with discrimination. RESULTS: Of the participants, 484 (8.4%) reported COVID-19-related discrimination and 486 (8.5%) had severe psychological distress. HCWs who were female vs. male (adjusted odds ratio [AOR] = 1.41, 95% confidence interval [CI] = 1.28-1.55), had high vs. low viral exposure (AOR = 2.31, 95% CI = 1.81-2.93), and worked for 11 or more hours/day vs. 8 or less hours/day (AOR = 1.42, 95% CI = 1.35-1.49) were more likely to have experienced COVID-19-related discrimination. The AOR (95% CI) of severe psychological distress was 1.83 (1.29-2.59) among those who experienced discrimination. In the stratified analysis by sociodemographic and job-related factors, all the interactions did not reach statistical significance (p for interaction > 0.20). CONCLUSION: Experience of COVID-19-related discrimination was associated with severe psychological distress among HCWs. During the pandemic, effective measures should be taken to prevent the development of negative mental health outcomes in HCWs who experience discrimination.

Association of COVID-19-related discrimination with subsequent depression and suicidal ideation in healthcare workers.

Previous cross-sectional studies showed that COVID-19-related discrimination against healthcare workers was linked to depression. However, no study has examined the longitudinal association that allows causal interpretations. This prospective cohort study aimed to examine whether COVID-19-related discrimination at baseline is associated with depression and suicidal ideation several months later. Data were collected from October 2020 to July 2021. Multivariable logistic regression was performed. Fixed effects models were used to control for the effect of hospitals (Level 2 variable). Adjustments also included age, sex, living alone, alcohol consumption, exercise, BMI, working hours, comorbidity, and frontline worker status (Level 1 variables). Multiple sensitivity analyses were conducted to examine if the results substantially changed and were robust to unmeasured confounding. Multiple imputation for missing data was conducted via chained equations. As the final sample, 2862 healthcare workers without depression at baseline were studied. A total of 269 individuals (9.4%) experienced COVID-19-related discrimination. Depression was suggested in 205 participants (7.2%), and suicidal ideation in 108 participants (3.8%). In the adjusted models, COVID-19-related discrimination was significantly associated with subsequent depression (OR = 2.18, 95% CI = 1.39 to 2.90) and suicidal ideation (OR = 2.07, 95% CI = 1.22 to 3.50). Multiple sensitivity analyses verified the results. COVID-19-related discrimination results in depression and suicidal ideation in healthcare workers. Interventions to prevent such discrimination against healthcare workers, e.g., anti-discrimination campaigns, are crucial during the COVID-19 pandemic.

[Text-mining of children's answers to national web-survey questions on parental status during COVID-19].

Objectives　Behavior at school has been restricted due to infection control during the COVID-19 pandemic. This study aimed to clarify children's opinions by examining the structure of their text responses to open-ended web survey questions, as well as how they differed to the psychological and socio-economic status of their parents.Method　From September to October 2020, approximately six months after the temporary closure of schools in Japan due to COVID-19, 2,111 respondents (elementary, junior high, and high school students) answered a questionnaire on "The third wave of CORONA-CODOMO project" website. The text data of 1,140 students who provided free-text answers to open-ended questions such as, "what are you concerned about and what do you want to say?" (comments) and "how should I get them to understand?" (proposals) were analyzed. Results were stratified by parental demographics such as age, employment status, the Kessler Psychological Distress Scale (K6), and financial status. The text mining assessed the frequency of word appearances, analyzed characteristic words, and showed a term network (word-relationship diagram).Results　The total number of lines (number of respondents) of comments and proposal texts were 531 and 1,017, respectively, and the average line length (number of characters) was 21.5 and 31.5, respectively. In the dependency relations frequency analysis, the actions of proposals and comments such as "speaking-listening", "event-disappearing", and "mask-removing" appeared. In the word network, words such as "moving" and "speaking" formed a strong co-occurrence network to "I", which had the largest node in proposals, while "COVID-19" in the comments strongly co-occurred with "end+?" (predicate attribute: question) and "I+want to disappear" (predicate attribute: aspirations). According to the parent attributes, in the proposals, the characteristic words (complementary similarity measure) were "talk" (35.9) in the employed group, "talk" (26.6) in the K6 lower score group, and "understand+not" (23.5/17.3, predicate attribute: negation) in the K6 higher score group/bad economic status. In the comments, it was "COVID-19" (28.1, 27.5) in the employed group and the high mental health group.Conclusions　While children displayed discomfort and fear of COVID-19 when asked about proposals, the children were willing to talk directly, also, they wanted someone to listen to them. The characteristics of the proposals in their answers were "I don't know" in both the high mental burden group and the bad economic status group of the parents.

Japanese school children's intake of selected food groups and meal quality due to differences in guardian's literacy of meal preparation for children during the COVID-19 pandemic.

In 2020, a state of emergency (SOE) was enforced by the Japanese government, which included temporary school closures with the aim of overcoming COVID-19 spread, which prevented access to school lunches. We evaluated the relationship between meal quality and guardians' literacy of meal preparation for a nationally representative sample of 1107 Japanese schoolchildren (aged 10-14 years) before, during, and after the SOE on the basis of 7 questions scored using a 5-point Likert scale. The guardians' literacy of meal preparation for children was divided into quartiles, with Q1 and Q4 including participants with the lowest and highest scores on food literacy, respectively. School lunch menu was handed out monthly to each household by their classroom teacher. The consumption of (i) meat, fish, or eggs and (ii) vegetables at least twice a day indicated "well-balanced dietary intake", which was less frequent in all four quartiles, especially for Q1 and Q2, during compared to before the SOE. The relative risk increases (95% CI) were Q1: -40.6% (-41.4% to -39.8%; p < 0.001), Q2: -34.0% (-34.7% to -33.3%; p < 0.001), Q3: -13.1% (-13.8% to -12.4%; p < 0.001), and Q4: -15.3% (-16.0% to -14.7%; p < 0.001), adjusted for sex, age, BMI, equivalent income adjusted for the number of household members, and educational level of parents. The interaction p was <0.001 for Q1-3 vs. Q4. Guardians with low total scores were significantly more likely to have less time, mental capacity, and financial ability to prepare meals after the SOE. Therefore, schoolchildren's meal quality deteriorated during the SOE, particularly among those with guardians with low food literacy even after adjustment for household income level and guardians' educational level.

COVID-19 vaccine literacy and vaccine hesitancy among pregnant women and mothers of young children in Japan.

BACKGROUND: Delays in the spread of vaccination have been recognized as an urgent public health issue in the context of the COVID-19 pandemic. Vaccine literacy (VL) is a critical determinant of vaccine uptake; however, little is known about VL among pregnant women and mothers of young children. METHODS: We analyzed data from a nationwide, cross-sectional internet survey in Japan on VL and vaccine hesitancy, conducted with 1,639 pregnant women and 5,688 mothers of young children who had given birth after July 2019, between July 24 and August 30, 2021. RESULTS: Vaccine hesitancy was observed in 51.1 % of pregnant women and 31.9 % of mothers of young children. The risk of vaccine hesitancy was significantly higher among pregnant women with lower interactive/critical skills (risk ratio [RR] 2.10, 95 % confidence interval [CI] 1.59, 2.78, p < 0.001), although functional skills did not significantly correlate with vaccine hesitancy. For mothers of young children, we found a significantly higher risk of vaccine hesitancy among those with low VL functional skills (RR 1.38, 95 % CI 1.19, 1.61), p < 0.001) and low interactive/critical skills (RR 1.29, 95 % CI 1.10, 1.50, p = 0.001). CONCLUSIONS: Our findings suggest that aiding individuals to correctly evaluate vaccine-related information is critical for improving vaccine acceptance rates among both pregnant women and mothers of young children. Meanwhile, improving the comprehensibility of communication toolkits may be important for women with children but have a limited effect among pregnant women.

Emotional Exhaustion of Burnout Among Medical Staff and Its Association With Mindfulness and Social Support: A Single Center Study During the COVID-19 Pandemic in Japan.

Background: Although higher rates of burnout have been reported during the COVID-19 pandemic, the contribution of the modifiable factors is lesser-known. We investigated how the risk of emotional exhaustion was associated with mindfulness skills and social support in a single medical center in Japan. Methods: We conducted a cross-sectional web survey on mental health for all staff of a national medical hospital from February to March 2021. We examined the association between self-rated emotional exhaustion and levels of mindfulness and social support using multivariate logistic regression. Results: Of the 830 participants, signs of emotional exhaustion were observed in 261 (31%) individuals. Among those highly exposed to the virus at work, individuals with low levels of mindfulness and social support had significantly higher odds of emotional exhaustion [OR 3.46 (95% CI; 1.48-8.09), OR; 3.08 (95% CI; 1.33-7.13), respectively] compared to those with high levels. However, among those not highly exposed to the virus, individuals with both low and moderate levels of mindfulness had significantly higher odds of emotional exhaustion. [OR 3.33 (95% CI; 2.22-5.00), OR; 2.61 (95% CI; 1.73-3.94), respectively]. Conclusion: We found that factors associated with emotional exhaustion differed by exposure to SARS-CoV-2. Building mindfulness skills can help reduce the high burden placed on the staff. Additionally, increasing social support may be useful especially for workers highly exposed to SARS-CoV-2.

Children's daily lives and well-being: Findings from the CORONA-CODOMO survey 1st wave.

BACKGROUND: The coronavirus disease 2019 pandemic has changed people's lives dramatically. Few data on the acute effects of the pandemic on children's daily lives and well-being have been published to date. This study aimed to capture its effects on Japanese children during the first peak of the outbreak. METHODS: We conducted a web-based, anonymous cross-sectional survey targeting Japanese children aged 7-17 years and parents/guardians of children aged 0-17 years. Eligible individuals were invited to participate in the survey from April 30 to May 31, 2020. This self-report questionnaire examined daily life and behaviors, psychological symptoms, well-being, quality of life, and positive parenting or abusive behaviors at the very beginning of the outbreak. RESULTS: A total of 2,591 children and 6,116 parents/guardians participated in our survey. Sixty-two percent of children reported screen time exceeding 2 h. Twenty percent of children reported abusive behaviors by family members. Nine in ten parents/guardians of school-aged children reported that their child had at least one acute stress symptom in the past month. Average mental health subscale scores from KINDLR questionnaire on quality of life were lower than the national average for all grades. Nearly half of parents/guardians refrained from seeking medical care for the child's symptoms. CONCLUSIONS: The COVID-19 pandemic had serious acute impacts on Japanese children's daily lives, well-being, family relationships, and health-care utilization, including some impacts that are potentially long-lasting; thus, proactive interventions and services are needed, as well as longitudinal surveys.

The coronavirus disease 2019 pandemic and the rights of the child in Japan.

BACKGROUND: Few studies have used direct reports by children to assess how the rights documented in the United Nations Convention on the Rights of the Child (CRC) have been affected during the pandemic of coronavirus disease 2019 (COVID-19). METHODS: Data were obtained from the CORONA-CODOMO Survey, a web-based survey conducted from April to May 2020 in Japan, targeting children aged 7-17 and parents/guardians of children aged 0-17. We focused on self-reports from children, including two open-ended questions asking their needs and opinions. The results were analyzed according to the five categories of rights defined by the CRC: education, health, safety, play, and participation. RESULTS: Among the 2,591 children who participated in the survey, 1,292 children (49.9%) answered at least one of the two open-ended questions. The most frequent concern was COVID-19 infecting members of their families (78.2%), followed by the inability to see their friends (74.3%). There were 1,523 direct comments from children. The comments covered a wide range of the rights in the CRC, including reopening of schools, disparities in education, access to health information, alternatives for playing and seeing friends, and needs for participation and being heard. Few comments were related to safety whereas a certain proportion of children were victimized within households. CONCLUSIONS: Our results suggest that the rights outlined in the CRC have been restricted during the COVID-19 pandemic. Health and educational professionals working with children and policymakers should introduce the rights-based approach to protect the best interests of children during and after the pandemic.

Abusive and positive parenting behavior in Japan during the COVID-19 pandemic under the state of emergency.

BACKGROUND: The Coronavirus Disease 2019 (COVID-19) pandemic has changed the lives of children and parents, raising concerns about child maltreatment. OBJECTIVE: We examined the prevalence of abusive parenting behavior during the pandemic of the COVID-19 and its relations with physical, psychological, and social factors and positive parenting behavior. PARTICIPANTS AND SETTING: An online survey was performed during the COVID-19 state of emergency in Japan. Participants were 5344 parents of children aged 0-17 years. METHODS: We conducted an anonymous online survey using multiple platforms, including websites of child-related organizations and social networking services (SNS). Multiple logistic regression analyses were performed to identify factors associated with abusive behavior. RESULTS: One-fifth of parents reported abusive behaviors, whereas over 80% of parents reported positive parenting behaviors (e.g., empathizing with a child). Abusive parenting behaviors were associated with longer screen time (6+ hours per day: OR, 1.44; 95%CI, 1.05-1.98), poor maternal mental health (K6 = 13+: OR, 2.23; 95%CI, 1.71-2.89), and the occurrence of domestic violence (OR, 4.54; 95%CI, 3.47-5.95). Positive parenting behaviors, especially showing empathy, were associated with lower risks of abusive behaviors (OR, 0.51: 95%CI, 0.39-0.66). CONCLUSIONS: Positive parenting behavior is essential to the prevention of child maltreatment during the COVID-19 pandemic.

[Effectiveness of an educational video about infant crying on prevention of shaken baby syndrome among pregnant Japanese women and their partners].

Objectives　Previous studies have shown that educating new mothers or pregnant women about infant crying, may prevent shaken baby syndrome (SBS). However, no studies in Japan have examined the effectiveness of educational materials during pregnancy. This study aims to determine whether pregnant women and their partners improve their knowledge about infant crying and SBS, after watching an educational video created by the Ministry of Health, Labour, and Welfare.Methods　The study was conducted from April 1, 2013, to March 31, 2014, in 46 municipalities nationwide. Pregnant women and their partners, who participated in prenatal classes, watched the educational video and responded to pre- and post-questionnaires that included questions about: the characteristics of parents and family, and knowledge about infant crying and SBS. Out of the 4769 respondents who completed the questionnaires, responses of 4647 respondents with knowledge about infant crying and SBS were analyzed. We asked six questions about infant crying, such as "When an infant cries it is always a sign that something is wrong", and two questions about SBS, such as "Shaking a baby is a good way to help a baby stop crying" using a 4-point Likert scale (0-3 points). The total scores were calculated and placed within the range of 0 to 100, where higher scores indicated better knowledge. These scores were then compared for the pre- and post-conditions. Furthermore, a stratified analysis was performed based on respondents' characteristics and a regression analysis was conducted to examine the differences in knowledge categorized by these characteristics.Results　The scores displayed a significant increase in knowledge about infant crying and SBS by 17.5 points (95% CI; 17.1-17.9) and 6.8 points (95% CI; 6.3-7.2) respectively, after watching the educational video. The results of the stratified analysis found that the effect of the intervention did not differ depending on characteristics such as age, sex, education, and prevalence of depression. Furthermore, our regression analysis on the scores of knowledge about infant crying and SBS found that the increases in knowledge were more pronounced among males and couples having their first child. Increase in knowledge about infant crying was more pronounced among those who were not depressed, while increase in knowledge about SBS was more pronounced among those who answered "unexpected but happy" for their feelings about pregnancy.Conclusion　The educational video on infant crying and shaken baby syndrome was effective in increasing knowledge about infant crying and SBS among couples during pregnancy, regardless of their characteristics.

Depressive symptoms, anxiety, and quality of life of Japanese women at initiation of ART treatment.

Assisted reproductive technology (ART) treatment accounted for 6% of total births in 2017 and is increasing which places Japan among the top worldwide in number of treatments performed. Although ART treatment patients often experience heavy physical and psychological burden, few epidemiologic studies have been conducted in Japan. We examined mental health and health-related quality of life (QOL) among women at early stages of treatment. We recruited 513 women who have initiated ART treatment, either in-vitro fertilization or intracytoplasmic sperm injection, from four medical facilities in the Tokyo area and through web-based approaches. At baseline, we collected socio-demographic information and assessed depressive symptoms, anxiety, and QOL. Descriptive analyses were performed overall and stratified by factors such as age. Mild depressive symptoms or worse, assessed with Quick Inventory of Depressive Symptoms, were observed among 54% of participants. Mean score for State-Trait Anxiety Inventory was 52 with a standard deviation of 11 for the state, and 39% were categorized as high anxiety. QOL results, assessed with SF-12, showed the same negative tendency for social functioning and role (emotional), while general health and physical functioning were consistent with the national average. Young participants appeared to suffer mentally more than older participants (p < 0.01 for depressive symptoms). Our findings suggest that patients may be at high risk of depressive symptoms, high anxiety, and low QOL even from the early stages of ART treatment.

Psychological distress and living conditions among Japanese single-mothers with preschool-age children: An analysis of 2016 Comprehensive Survey of Living Conditions.

BACKGROUND: The early life period provides a critical foundation for child health and development, and mothers exert great influence as primary caregivers. Previous studies have shown that single-motherhood is associated with negative child outcomes. In Japan, few studies have addressed the situation faced by single-mothers with young children, such as living conditions and mental health issues. METHODS: We utilized nationwide data from the Comprehensive Survey of Living Conditions (2016), collected by the Japanese Ministry of Health, Labour and Welfare and compared mothers from single-mother households with those from two-parent households, with further subdivision by intergenerational cohabitation. Socio-demographic characteristics, lifestyle habits, psychological distress, subjective health status, and stress were examined. RESULTS: We observed that single-mothers without intergenerational cohabitation seemed to experience harsh living conditions compared to other types of households. Severe psychological distress was observed in 11% of single-mothers without cohabitation compared with 6% among single-mothers with cohabitation and 4% among mothers of two-parent households. Multivariate analysis adjusting for demographic variables showed about a two-fold increased risk of severe psychological distress (OR=2.34, 95% CI: 1.71-3.22) associated with single-mothers without intergenerational cohabitation compared to mothers from two-parent household without cohabitation. Single-mothers without cohabitation tended to smoke and drink alcohol frequently and seemed sleep-deprived. LIMITATIONS: Due to the cross-sectional design, we could not make inference on causality. CONCLUSIONS: Our study highlighted needs for targeted support for single-mothers without intergenerational cohabitation. Efforts in public health and other related fields may present opportunities to reduce negative intergenerational impacts of adversities among socially vulnerable families.

Age-Dependent and Seasonal Changes in Menstrual Cycle Length and Body Temperature Based on Big Data.

OBJECTIVE: To evaluate the effects of age and season on menstrual cycle length and basal body temperature (BBT). We also examined the effects of climate on cycle length and BBT, taking into account Japanese geographic and social characteristics. METHODS: In this retrospective cohort study, we analyzed data from 6 million menstrual cycles entered into a smartphone application from 310,000 females from 2016 to 2017. Only those who entered more than 10 cycles in 2 years were included. Generalized estimation equations were used to adjust for confounding factors and for within-person correlations of multiple records. Multiple regression analysis was conducted, with age, external average temperature, precipitation amount, and sunshine hours as confounding factors. RESULTS: The mean menstrual cycle length increased from age 15-23 years, subsequently decreased up to age 45 years, and then increased again. Average follicular phase body temperature showed no significant age-dependent changes, but luteal phase body temperature gradually increased up to 29 years and then stabilized and started to decrease after age 42 years. A significant association between external temperature and body temperature (follicular and luteal phase) was observed, though menstrual cycle length did not show such an association. CONCLUSION: These results, derived from data self-entered into a smartphone application, revealed underrecognized age-dependent and seasonal changes in menstrual cycle length and BBT, which will contribute to a better understanding of female reproductive health in the modern world.

Association of Infertility Treatment with Perception of Infant Crying, Bonding Impairment and Abusive Behavior towards One's Infant: A Propensity-Score Matched Analysis.

BACKGROUND: Although previous qualitative studies suggested the link between infertility treatment and negative emotions towards infants, few empirical population-based studies have investigated the association of infertility treatment with the perception of infant crying, bonding impairment, and abusive behavior towards one's infant. METHODS: Women who participated in a four month health-checkup program in Aichi Prefecture, Japan (n = 6590) were asked to a complete a questionnaire that included infertility treatment history, perception of infant crying, maternal-infant bonding impairment assessed by the Mother to Infant Bonding Scale Japanese version, and abusive behavior towards one's infant. Outcomes were dichotomized, and a conditional logistic regression was applied, using the propensity score match for infertility treatment exposure adjusted for known covariates. RESULTS: A total of 690 participants (11.1%) reported infertility treatment history, and 625 cases were matched. We found that mothers with infertility treatment history were 1.36 times more likely to perceive a higher frequency of infant crying (95% confidence interval (CI):1.05-1.78), but no association with maternal-infant bonding impairment (odds ratio (OR): 1.18; 95% CI: 0.81-1.72) and abusive behavior towards the infant (OR: 0.82; 95% CI: 0.49-1.36). CONCLUSIONS: Infertility treatment may be associated with the perception of a higher frequency of infant crying, but it is not associated with bonding impairment and abusive behavior. Further longitudinal study is needed to replicate the findings.

Effectiveness of an Educational Video in Maternity Wards to Prevent Self-Reported Shaking and Smothering during the First Week of Age: A Cluster Randomized Controlled Trial.

This study aimed to investigate whether watching an educational video on infant crying and the dangers of shaking and smothering within 1 week after delivery at maternity wards reduces self-reported shaking and smothering, at a 1-month health checkup. A cluster randomized controlled trial, stratified by area and hospital function, was employed in 45 obstetrics hospitals/clinics in Osaka Prefecture, Japan. In the intervention group, mothers watched an educational video on infant crying and the dangers of shaking and smothering an infant, within 1 week of age, during hospitalization at maternity wards, without blinding on group allocation. Control group received usual care. A total of 4722 (N = 2350 and 2372 for intervention and control group, respectively) mothers who delivered their babies (still birth and gestational age < 22 weeks were excluded) between October 1, 2014, and January 31 were recruited. Outcomes were self-reported shaking and smothering behaviors, knowledge on infant crying and shaking, and behaviors to cope with infant crying, assessed via a questionnaire at a 1-month health checkup. In all, 2718 (N = 1078 and 1640) responded to the questionnaire (response rate: 58.3%), and analytic sample size was 2655 (N = 1058 and 1597 for intervention and control group, respectively). Multilevel analysis was used to adjust for correlation within the cluster. Prevalence of shaking was significantly lower in the intervention group (0.19%) than in the control group (1.69%). Intention-to-treat analysis showed an 89% reduction in the reported prevalence of self-reported shaking (OR: 0.11, 95% CI: 0.02-0.53) due to watching the educational video. However, self-reported smothering behavior showed no significant reduction (OR: 0.66, 95% CI: 0.27-1.60). No side effects were reported. Watching an educational video on infant crying and the dangers of shaking and smothering within 1 week after delivery at maternity wards reduced self-reported shaking at 1 month of age. UMIN Clinical Trial Registry UMIN000015558.

Effectiveness of using an educational video simulating the anatomical mechanism of shaking and smothering in a home-visit program to prevent self-reported infant abuse: A population-based quasi-experimental study in Japan.

BACKGROUND: A video that simulates the anatomical mechanism of shaking the infant head, which may have a stronger impact on the viewer, and a tool to prevent self-reported smothering in response to crying, has never been investigated. OBJECTIVE: To investigate whether watching an educational video at home visit at 2 months postpartum on infant crying and the dangers of shaking and smothering reduces self-reported shaking and smothering behaviors at 4 months postpartum. METHOD: In a quasi-experimental study in A city in Japan, the video intervention was implemented at home visits by a midwife, public health nurse or trained volunteers when babies were 2 months old. At the 4-month health checkup, participants received a questionnaire about the video, self-reported shaking and smothering behaviors and other covariates. The impacts of watching the video and self-reported shaking or smothering were analyzed using multiple logistic regression. RESULTS: In total, 5961 caregivers provided valid response for this study (valid response rate: 73.8 %). In the adjusted model, those who watched the video were 74 % less likely to shake their infants (odds ratio (OR): 0.36, 95 % confidence interval (CI): 0.21-0.64), 43 % were less likely to smother their infants (OR: 0.57, 95 % CI: 0.37-0.89), 52 % were less likely to shake or smother (OR: 0.48, 95 % CI: 0.33-0.69) their infants. CONCLUSION: The educational video on infant crying and the dangers of shaking and smothering, with anatomical mechanism of shaking, may halve the risk of self-reported shaking and smothering at 4 months of age.

Municipality-Level Checklist to Promote Parental Behaviors Related to Prevention of Unintentional Injury in Young Children: A Multilevel Analysis of National Data.

BACKGROUND: Unintentional injury is a major cause of morbidity and mortality among young children in developed countries. In this national study, we examined the role of municipality-level safety checklist implementation for reducing risky child-safety-related parental behaviors. METHODS: Nationwide data were collected to evaluate the impact of the Healthy Parents and Children 21 initiative of the Japanese government. Questionnaires related to safety checklist implementation were administered to a random sample of municipal offices and to parents at the child's routine 1.5-year health exam on parental behaviors related to child safety. Adjusting for municipality and individual-level variables, multilevel analysis was used to examine the relationship between municipality checklist implementation (4-month health exam) and six child-safety-related parental behaviors at the 1.5-year health exam. RESULTS: Families (n = 23,394) across 371 municipalities in Japan were included in this study; 5.6% of municipalities implemented a child safety intervention. Living in a municipality with a checklist intervention was associated with reduction in certain risk behaviors (not keeping tobacco/ashtray and candy out of the reach of infants, not using a car seat, not having a lock on bathing room door). However, after additionally taking into account municipality-level residual effects, only the "tobacco" behavior showed association with municipality of residence (Interval odds ratio, 0.25-0.94) and others were weak in the context of other potential municipality-level influences. CONCLUSIONS: A municipality-level intervention taking a checklist-based approach at the 4-month health exam in Japan appears to promote certain child safety behaviors in parents with children around 1.5 years of age.

[Effectiveness of an educational video on infant crying for prevention of shaken baby syndrome among Japanese caregivers of infants].

Objectives　Spreading awareness of shaken baby syndrome is considered to be essential in the prevention of infant deaths resulting from abuse. This study aimed to determine whether an educational video on infant crying, developed by the Ministry of Health, Labour and Welfare, was effective at increasing knowledge of infant crying and shaking among Japanese caregivers of infants aged under 1 year.Methods　We targeted caregivers who had infants aged under 1 year for intervention through health checkups and home visits in 29 municipalities across Japan from April 2013 to March 2014. The educational video on infant crying and danger of shaking and smothering was used as intervention. A questionnaire was administered to caregivers to assess their knowledge on infant crying and shaking prior to and after the intervention (N=1,444, response rate 93.8%). A sample of 1,232 caregivers was used for analysis, after excluding those who did not report the outcome of interest (i.e., knowledge on shaking or smothering) and demographics. In the analysis, pre- and post-test mean scores on crying knowledge scales and shaking knowledge scales (out of 100) were compared separately. Subgroup analysis and regression analysis were also conducted to examine whether the effect of the intervention varied by infant age, birth order, parent's sex, age, education, marital status, household income, grandparents' co-residence, postpartum depression, domestic violence during pregnancy, feelings about pregnancy, and resident area (urban/rural).Results　Scores on infant crying significantly increased by 12.4 points (95% confidence interval: 11.7-13.2), and those on shaking knowledge increased by 4.7 points (95% confidence interval: 3.9-5.6) after the caregivers had watched the educational video. Subgroup analysis confirmed that the effect of the intervention did not differ among the subgroups except shaking knowledge scores among those who were not married and those who experienced physical violence from their partner. A regression analysis on change in scores revealed that parents with higher education gained more knowledge on infant crying, and fathers and those not living with grandparents gained more knowledge on shaking than mothers.Conclusion　The educational video on infant crying was effective in increasing knowledge of infant crying and shaking, regardless of demographics of infants and parents and postnatal situation.

Chemicals, Nutrition, and Autism Spectrum Disorder: A Mini-Review.

The rapid increase of the prevalence of autism spectrum disorder (ASD) suggests that exposure to chemicals may impact the development of ASD. Therefore, we reviewed literature on the following chemicals, nutrient to investigate their association with ASD: (1) smoke/tobacco, (2) alcohol, (3) air pollution, (4) pesticides, (5) endocrine-disrupting chemicals, (6) heavy metals, (7) micronutrients, (8) fatty acid, and (9) parental obesity as a proxy of accumulation of specific chemicals or nutritional status. Several chemical exposures such as air pollution (e.g., particular matter 2.5), pesticides, bisphenol A, phthalates, mercury, and nutrition deficiency such as folic acid, vitamin D, or fatty acid may possibly be associated with an increased risk of ASD, whereas other traditional risk factors such as smoking/tobacco, alcohol, or polychlorinated biphenyls are less likely to be associated with ASD. Further research is needed to accumulate evidence on the association between chemical exposure and nutrient deficiencies and ASD in various doses and populations.