Prenatal risk factors of indoor environment and incidence of childhood eczema in the Japan Environment and Children's Study.

The quality of indoor environment is a risk factor for early childhood eczema and atopic dermatitis; however, its influence during pregnancy on childhood eczema in Japan has not been investigated. In this study, we aimed to determine the indoor environmental factors that are associated with eczema in children up to 3 years of age, using national birth cohort data from the Japan Environment and Children's Study (JECS). Information on indoor environments and eczema symptoms until 3 years of age was collected using self-administered questionnaires to the mothers. A total of 71,883 and 58,639 mother-child pairs at 1.5- and 3-years-old, respectively, were included in the former analyses. To account for prenatal indoor risk factors, 17,568 (1.5-years-old) and 7063 (3-years-old) children without indoor mold and/or ETS exposure were included in the final analysis. A higher mold index, gas heater use, parquet flooring use, and frequent insecticide use showed significantly increased risks for childhood eczema up to 3 years of age. These associations were consistent after stratification analysis among children whose parents did not have a history of allergies. The updated WHO guidelines on indoor air quality should be implemented based on recent findings regarding the effects of prenatal exposure to indoor dampness on health effects of children further in life, including asthma, respiratory effects, eczema, and other immunological effects.

Health Effects of Electrolyzed Hydrogen Water for the Metabolic Syndrome and Pre-Metabolic Syndrome: A 3-Month Randomized Controlled Trial and Subsequent Analyses.

We studied the effect of three months' use of electrolyzed hydrogen water (EHW, Electrolyzed Hydrogen Water conditioner produced by Nihon Trim Co., Ltd.) on metabolic and pre-metabolic syndrome groups. This research was carried out jointly by Susaki City; Nihon Trim Co., Ltd.; and Kochi University as part of a local revitalization project with health as a keyword. A randomized, placebo-controlled, double-blind, parallel-group trial was conducted to evaluate the clinical impact of EHW on participants who suffered from metabolic syndrome or pre-metabolic syndrome. EHW was produced via electrolysis using a commercially available apparatus (Nihon Trim Co., Ltd., Osaka, Japan). During exercise, oxidative stress increases, and active oxygen species increase. In this study, we examined 181 subjects with metabolic syndrome or pre-metabolic syndrome. Among the group that drank EHW for 3 months, those who also engaged in a high level of physical activity showed a significant difference in waist circumference reduction. Although no significant difference was observed, several positive results were found in the participants who engaged in a high level of physical activity. Urinary 8-OHdG, urinary nitrotyrosine, HbA1c, and blood glucose levels increased in the filtered water (FW) group but decreased in the EHW group. High-sensitivity CRP increased less in the EHW group. 8-Isoprostane decreased more in the EHW group. In subgroup analysis, the EHW group showed a significantly greater reduction in waist circumference than the FW group only when controlled for high physical activity. Based on the result, we suggest that, among participants in the study who suffered from metabolic syndrome and pre-metabolic syndrome in which the level of active oxygen species is said to be higher than in healthy subjects, the group that consumed EHW and also engaged in a high level of physical activity experienced a suppressed or reduced increase in active oxygen species.

Clustered Cystic Changes in Long-Term Follow-Up Thin-Section Computed Tomographic Findings in Fibrotic Nonspecific Interstitial Pneumonia.

Objectives: The purpose of this study was to retrospectively assess cystic changes in findings on follow-up CT scans of patients with fibrotic nonspecific interstitial pneumonia (NSIP). Methods: The initial and last high-resolution CT scans of 58 patients with pathologically proven fibrotic NSIP were evaluated retrospectively. The median follow-up periods were 48 months (range, 12-183 months). The pattern, extent, and distribution of abnormal CT findings were compared with findings in the same region on previous and subsequent CT scans with a focus on cystic lesions. Results: Cystic lesions in a cluster were shown in 16 patients (28%) with fibrotic NSIP on the last CT scans. Focal clustered cysts were found in 5 cases and diffuse clustered cysts were seen in 11 cases. Focal clustered cysts mimicked honeycombing seen in usual interstitial pneumonia (UIP). Diffuse cysts were uniform in size in 7 of the 11 cases. Traction bronchiectasis in a cluster was seen in 3 of the 7 cases. The clustered cystic changes on CT during the course of NSIP mainly consisted of traction bronchiectasis and bronchiolectasis. Conclusions: Long-standing NSIP did not form honeycombing. The clustered cysts in patients with fibrotic NSIP were mainly remodeling of bronchiectasis.

Association of a low chest-to-head circumference ratio with breech or transverse lie: the Japan Environment and Children's Study.

OBJECTIVE: We examined whether the chest-to-head circumference ratio at birth was associated with breech presentation and transverse lie. We also described the obstetric management of such pregnancies in the Japan Environment and Children's Study (JECS). METHODS: We performed a cross-sectional evaluation of data collected between January 2011 and March 2014 in a nationwide prospective birth cohort study, the JECS. We analyzed 83,822 non-anomalous singletons born at 34-41 weeks' gestation to mothers with no history of previous cesareans or uterine surgery. We defined low, normal (reference group), and high chest-to-head circumference ratios as <10th percentile, 10th to 90th percentiles, and >90th percentile, respectively. Logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (95% CIs) for breech presentation and transverse lie. The timing and mode of delivery of such pregnancies were examined. RESULTS: Breech presentation was recorded in 2.6% and transverse lie in 0.2%. A low chest-to-head circumference ratio was associated with increased rate of breech presentation (5.2%; adjusted OR 2.36, 95% CI: 2.10-2.65) and transverse lie (0.3%; adjusted OR 2.33, 95% CI: 1.50-3.60), whereas a high ratio was linked to reduced breech presentation (1.1%; adjusted OR 0.51, 95% CI: 0.39-0.66). Subgroup analysis of children delivered by cesarean (n = 7971) showed a similar association, albeit with slightly reduced strength for breech presentation. Eighty-three percent of breech births and 46.3% of transverse lie births occurred at 37-38 weeks' gestation. Cesarean section was performed in 96.8% of breech presentations and 63.4% of transverse-lie ones. CONCLUSIONS: These findings imply that the fetal chest-to-head circumference ratio may influence presentation at birth.

Association between eating habits during adolescence and gestational diabetes: data from the Japan environment and children's study.

Purpose: It is difficult to change pre-pregnancy eating habits, yet establishing healthy eating habits before pregnancy is important for preventing gestational diabetes mellitus (GDM). This study aimed to examine whether the weight-loss behavior of avoiding between-meal and midnight snacking in teenagers is associated with a reduction in the risk of subsequent GDM. Methods: We used a dataset (jecs-an-20,180,131) from a nationwide, prospective birth cohort study, the Japan Environment and Children's Study (JECS). We included 89,227 (85.7% of the total) mother-infant pairs with live births. Participants in their second or third trimester were asked to report their weight-loss behavior during their teenage years. The prevalence of GDM was investigated. Differences in maternal characteristics were examined using chi-square tests. Crude and adjusted logistic regression models were constructed to assess the associations of various maternal characteristics with the weight-loss behavior of avoiding between-meal and midnight snacking during teenage years. Results: A total of 2,066 (2.3%) participants had GDM. Weight-loss behavior in teenagers was associated with a decreased risk of GDM. Among participants with normal weight or overweight prior to pregnancy, the adjusted odds ratios were 0.79 (95% confidence interval, 0.70-0.89) and 0.82 (95% confidence interval, 0.69-0.98), respectively. Conclusions: The results suggest that teenage weight-loss behaviors, such as avoiding between-meal and midnight snacking, are associated with a decreased risk of developing GDM. Supplementary Information: The online version contains supplementary material available at 10.1007/s40200-023-01294-2.

Teenage and young adult pregnancy and depression: findings from the Japan environment and children's study.

Teenage pregnancy increases the threat of depression because of its many factors. Pregnancy during young adulthood may also have several risk factors for depression compared to older pregnancies. However, data on depression in young adult pregnancies are lacking. This study investigated the association between teenage and young adult pregnancy and depression. Data from the Japan Environment and Children's study was used as a nationwide multicenter prospective cohort study. A multivariate logistic regression was performed to investigate the association between age groups (14-19, 20-24, 25-29, 30-34, ≥ 35 years) and depression, adjusted for behavioral and sociodemographic characteristics. Depression was assessed using the Kessler Psychological Distress Scale. In total, 96,808 pregnant women responded to the questionnaire. Teenage (14-19 years) and young adult (20-24 years) pregnancy were associated with an increased risk of depression compared to older pregnancy (≥ 35 years) (teenage: OR 4.28, 95% confidence interval, CI [3.24-5.64]; young adult: OR 3.00, 95% CI [2.64-3.41]). After adjusting for covariates, the magnitude of the risk of depression was attenuated. However, teenage and young adult pregnancy remained at a significantly increased risk of depression compared to older pregnancy (teenage: OR 2.38, 95% CI [1.77-3.21]; young adult: OR 2.14, 95% CI [1.87-2.46]). Our findings indicate that teenage and young adults' pregnancy are at an increased risk of depression compared to older pregnancy. These findings suggest prioritizing teenage and young pregnant women for prevention and interventions related to depression.

Comparison of emergency transport for acute alcohol intoxication before and after the coronavirus disease 2019 pandemic: A retrospective observational study.

The ongoing coronavirus disease 2019 (COVID-19) pandemic has had a broad effect on social, economic, educational, and political systems. We investigated the effect of COVID-19 on emergency transportation due to acute alcohol intoxication in the Kochi Prefecture in Japan, a region with high alcohol consumption. This retrospective observational study was conducted using the data of 62,138 patients from the Kochi-Iryo-Net database, Kochi Prefecture's emergency medical and wide-area disaster information system. Chi-square tests and multiple logistic regression analyses were performed to examine the association between emergency transportation and alcohol intoxication. This analysis compared the monthly number of transportations during 2019 (as reference) with that throughout 2020 and 2021. Approximately 1.5 % of all emergency transportation cases were related to acute alcohol intoxication. The number of emergency transportation cases due to acute alcohol intoxication declined by 0.5 % in 2020 and 0.7 % in 2021 compared with that in 2019. Moreover, compared with that in 2019, the number of cases of emergency transportation due to acute alcohol intoxication significantly decreased in 2020 (incidence rate ratio: 0.78; 95 % confidence interval: 0.67-0.91) and 2021 (incidence rate ratio: 0.73; 95 % confidence interval: 0.63-0.86). Lifestyle changes due to the COVID-19 pandemic affected the number of emergency transports due to acute alcohol intoxication in 2020 and 2021 (during the COVID-19 pandemic) compared to that in 2019 (before the pandemic).

Asian Intensive Reader of Pneumoconiosis program: examination for certification during 2008-2020.

This study examined physicians' participation and performance in the examinations administered by the Asian Intensive Reader of Pneumoconiosis (AIR Pneumo) program from 2008 to 2020 and compared radiograph readings of physicians who passed with those who failed the examinations. Demography of the participants, participation trends, pass/fail rates, and proficiency scores were summarized; differences in reading the radiographs for pneumoconiosis of physicians who passed the examinations and those who failed were evaluated.By December 2020, 555 physicians from 20 countries had taken certification examinations; the number of participants increased in recent years. Reported background specialty training and work experience varied widely. Passing rate and mean proficiency score for participants who passed were 83.4% and 77.6 ± 9.4 in certification, and 76.8% and 88.1 ± 4.5 in recertification examinations. Compared with physicians who passed the examinations, physicians who failed tended to classify test radiographs as positive for pneumoconiosis and read a higher profusion; they likely missed large opacities and pleural plaques and had a lower accuracy in recognizing the shape of small opacities. Findings suggest that physicians who failed the examination tend to over-diagnose radiographs as positive for pneumoconiosis with higher profusion and have difficulty in correctly identifying small opacity shape.

Association between maternal cholesterol level during pregnancy and placental weight and birthweight ratio: data from the Japan Environment and Children's Study.

BACKGROUND: Placental weight to birthweight ratio (PW/BW ratio), or its inverse, is used as an indicator of placental efficiency. Past studies have shown an association between an abnormal PW/BW ratio and adverse intrauterine environment, however, no previous studies have examined the effect of abnormal lipid levels during pregnancy on PW/BW ratio. We aimed to evaluate the association between maternal cholesterol levels during pregnancy and placental weight to birthweight ratio (PW/BW ratio). METHODS: This study was a secondary analysis using the data from the Japan Environment and Children's Study (JECS). 81 781 singletons and their mothers were included in the analysis. Maternal serum total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C) levels during pregnancy were obtained from participants. Associations between maternal lipid levels and placental weight and PW/BW ratio were assessed by regression analysis using restricted cubic splines. RESULTS: Dose-response relationships were observed between maternal lipid level during pregnancy and placental weight and PW/BW ratio. High TC and LDL-C levels were associated with heavy placental weight and high PW/BW ratio, i.e., inappropriately heavy placenta for birthweight. Low HDL-C level was also associated with inappropriately heavy placenta. Low TC and LDL-C levels were associated with low placental weight and low PW/BW ratio, i.e., inappropriately light placenta for birthweight. High HDL-C was not associated with PW/BW ratio. These findings were independent of pre-pregnancy body mass index and gestational weight gain. CONCLUSIONS: Abnormal lipid levels such as elevated TC and LDL-C, and low HDL-C level, during pregnancy were associated with inappropriately heavy placental weight.

Laparoscopic treatment for multiple huge diospyrobezoars in the stomach.

We report a case of a patient with multiple diospyrobezoars, a phytobezoar attributed to persimmons (Diospyros kaki) consumption, in the stomach, who was treated with laparoscopic complete surgical excision. A 76-year-old man with gastric phytobezoars presented to our hospital. Abdominal contrast-enhanced computed tomography revealed three well-defined, oval, nonhomogeneous masses with a mottled appearance in the stomach. Esophagogastroduodenoscopy revealed three large brown solid phytobezoars and gastric ulcers at the gastric angle. The clinical diagnosis was diospyrobezoar, and, due to the huge masses, the patient eventually underwent laparoscopic treatment when the medical and endoscopic approaches were unsuccessful. After gastrotomy in the anterior wall of the stomach, the phytobezoar was mobile inside the stomach, which was opened beside the gastric incision. The three phytobezoars were removed through the wound protector using sponge-holding forceps; the hole in the gastrotomy was closed in the mucosal and seromuscular layers with an intracorporeal suture technique. The weight and size of the phytobezoars were 140 g and 115 × 55 × 50 mm, 70 g and 55 × 45 × 35 mm, and 60 g and 50 × 40 × 35 mm, respectively. The patient was discharged on the 8th postoperative day without any complications. Laparoscopic surgery to extract bezoar is the treatment of choice for this rare entity, because it is a safe and effective approach.

Artificial Intelligence in Quantitative Chest Imaging Analysis for Occupational Lung Disease.

Occupational lung disease manifests complex radiologic findings which have long been a challenge for computer-assisted diagnosis (CAD). This journey started in the 1970s when texture analysis was developed and applied to diffuse lung disease. Pneumoconiosis appears on radiography as a combination of small opacities, large opacities, and pleural shadows. The International Labor Organization International Classification of Radiograph of Pneumoconioses has been the main tool used to describe pneumoconioses and is an ideal system that can be adapted for CAD using artificial intelligence (AI). AI includes machine learning which utilizes deep learning or an artificial neural network. This in turn includes a convolutional neural network. The tasks of CAD are systematically described as classification, detection, and segmentation of the target lesions. Alex-net, VGG16, and U-Net are among the most common algorithms used in the development of systems for the diagnosis of diffuse lung disease, including occupational lung disease. We describe the long journey in the pursuit of CAD of pneumoconioses including our recent proposal of a new expert system.

Filter blot method: A simple method for measuring 3-nitrotyrosine in proteins of atmospheric particulate matter.

Air pollutants, such as nitrogen dioxide (NO2), ozone (O3), and particulate matter (PM), have been epidemiologically reported to contribute to the onset and exacerbation of asthma. We have previously shown that several proteins in atmospheric PM are allergenic in mouse asthma models and that these proteins are nitrated by atmospheric NO2 and O3 in chemical reactions. Based on these results, the amount of 3-nitrotyrosine (3-NT) in atmospheric PM could be an air pollution marker integrating NO2, O3, and PM. We established a method to measure 3-NT by high-performance liquid chromatography electrochemical detection (HPLC-ECD). Although this method is accurate, it requires a filter treatment process, which is time-consuming and costly for an environmental monitoring tool, in which many samples are measured simultaneously. Therefore, in this study, we investigated a simple immunoblotting method in which atmospheric PM proteins were directly transferred to a polyvinylidene fluoride (PVDF) membrane and measured using an anti-3-NT antibody (the filter blot method). The 3-NT value obtained from this method was significantly correlated (r = 0.809, p < 0.001) with that of the HPLC-ECD method, with a detection power of 0.1 µg/mL for tyrosine nitrated bovine serum albumin equivalents. Multiple regression analysis using the filter blot method showed that the amount of 3-NT in atmospheric PM was significantly associated with the published environmental measurements of O3 and PM in the region. Therefore, the filter blot method may be useful for the environmental monitoring of 3-NT in atmospheric PM.

Imaging diagnosis of pneumoconiosis with predominant nodular pattern: HRCT and pathologic findings.

The radiological patterns of known pneumoconiosis have been changing in recent years. The basic pathology in pneumoconiosis is the presence of dust macules, mixed dust fibrosis, nodules, diffuse interstitial fibrosis, and progressive massive fibrosis. These pathologic changes can coexist in dust-exposed workers. High resolution CT reflects pathological findings in pneumoconiosis and is useful for the diagnosis. Pneumoconiosis such as silicosis, coal workers' pneumoconiosis, graphite pneumoconiosis, and welder's pneumoconiosis, has predominant nodular HRCT pattern. Diffuse interstitial pulmonary fibrosis is sometimes found in the lungs of this pneumoconiosis. In the early stages of metal lung, such as aluminosis and hard metal lung, centrilobular nodules are predominant findings, and in the advanced stages, reticular opacities are predominant findings. The clinician must understand the spectrum of expected imaging patterns related to known dust exposures and novel exposures. In this article, HRCT and pathologic findings of pneumoconiosis with predominant nodular opacities are shown.

Influence of chest/head circumference ratio at birth on obstetric and neonatal outcomes: The Japan environment and children's study.

OBJECTIVES: Some newborns that are not small-for-gestational-age (non-SGA, birthweight ≥10th percentile for a given gestational age) may have pathologic growth restrictions. This study examined the association of adverse obstetric and neonatal outcomes with chest/head circumference ratio at birth in non-SGA and SGA newborns. METHODS: This study was a cross-sectional evaluation of data from a nationwide prospective birth cohort study, the Japan Environment and Children's Study. We analyzed 93 690 non-anomalous singletons born at 34-41 gestational weeks. We defined low, normal, and high chest/head circumference ratio as <10th percentile, 10th-90th percentile, and >90th percentile, respectively, according to the internally constructed chest/head circumference percentile chart. Modified Poisson regression was used to estimate adjusted prevalence ratios (aPR) for the outcomes studied. RESULTS: Compared with non-SGA newborns with a normal ratio, those with a low ratio had an increased occurrence of low birthweight (1.75, 1.58-1.94 [aPR, 95% confidence interval]), cesarean delivery (1.34, 1.29-1.38), Apgar score <7 at 5 min (1.57, 1.14-2.17), respiratory complications (1.20, 1.04-1.39), and prolonged hospitalization (1.36, 1.30-1.42). In contrast, the high-ratio group had a lower rate of low birthweight (0.71, 0.59-0.86), cesarean delivery (0.82, 0.77-0.87), and prolonged hospitalization (0.83, 0.78-0.89). In SGA newborns, a low ratio was associated with increased aPRs for low birthweight, cesarean delivery, hypoglycemia, and prolonged hospitalization, whereas a high ratio showed no such association. CONCLUSIONS: Findings indicate that the chest/head circumference ratio at birth influence obstetric and neonatal outcomes regardless of the birthweight status.

[Allergy and immunotoxicology in preventive and clinical medicine from theory to practice: Occupational allergy and isocyanate-induced asthma].

Genetic and environmental factors and their interactions cause diseases and deteriorate health (Genetic and Environmental Interaction). Exposure to environmental factors plays a major role in the deterioration of health in the workplace.Occupational asthma (OA) is a common disorder in the workplace. Approaches to OA are well described and discussed in "Japanese Guideline for Diagnosis and Management of Occupational Allergic Diseases" by the Japanese Society of Occupational and Environmental Allergy. According to the guideline, OA and work-aggravated asthma comprise work-related asthma, and OA can be further divided into two disease entities: sensitizer-induced OA and irritant-induced OA. The guidelines also describe diagnostic and therapeutic strategies for OA. Since a definitive diagnosis of OA requires a comprehensive decision based on a detailed interview on clinical symptoms related to employment status and clinical tests, including inhalation tests of suspected substances as needed, the possibility of OA should be considered as the first step toward diagnosis of the patient. Otherwise, OA may not be diagnosed. Therapeutic strategies include exposure avoidance, environmental arrangements in the workplace, utilization of social resources for workers, and conventional pharmacotherapy for asthma.Artificially synthesized small compounds are used in various industries and can cause allergies. For example, isocyanates are small compounds in the -NCO group, which have been toxicologically studied. It was later shown that isocyanate could cause various nontoxic adverse health effects, including allergic reactions. Since small agents with low molecular weights bind to proteins, detecting their specific immunoglobulin E (IgE) antibodies targeting small compounds is generally difficult. In contrast, isocyanate-specific IgE antibodies are detectable in individuals with isocyanate allergies.Suspecting OA is essential in cases exposed to newly synthesized compounds, or to those that are already known but applied to new uses, which can be better understood and predicted by studying the health effects of isocyanates.Academic interest in various issues related to allergies, immunology, and toxicology in the workplace includes clinical medicine, epidemiology, and epigenetics related to environmental exposure. Further advanced research in these areas is necessary and promising.

Perceptual and objective physical quality of chest images: a comparison between digital radiographic chest images processed for cancer screening and pneumoconiosis screening in Japan.

This study (1) evaluated the perceptual and objective physical quality of digital radiographic chest images processed for different purposes (routine hospital use, lung cancer screening, and pneumoconiosis screening), and (2) quantified objectively the quality of chest images visually graded by the Japan National Federation of Industrial Health Organization (ZENEIREN). Four observers rated the images using a visual grading score (VGS) according to ZENEIREN's quality criteria. Signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were measured. Between groups, differences were assessed using ANOVA (followed by Bonferroni multiple comparisons) or unpaired t-test. The Pearson's correlation coefficients were calculated for the correlation between perceptual quality and objective physical image quality. The image quality perceived by the observers and the SNR measurements were highest for the images generated using parameters recommended for lung cancer screening. The images processed for pneumoconiosis screening were rated poorest by the observers and showed the lowest objective physical quality measurements. The chest images rated high quality by ZENEIREN generally showed a higher objective physical image quality. The SNR correlated well with VGS, but CNR did not. Highly significant differences between the processing parameters indicate that image processing strongly influences the perceptual quality of digital radiographic chest images.

Current state of knowledge and information sharing among home healthcare professionals involved in heart failure management.

BACKGROUND: The current state of knowledge related to disease management of heart failure (HF) and information coordination practices provided by non-physician healthcare professionals such as nurses and therapists working at home-visit nursing stations in Japan are not well known. METHODS: A questionnaire survey of healthcare professionals working at home-visit nursing stations was conducted in Kochi Prefecture. Data collected from 151 nurses and therapists were analyzed. RESULTS: Regarding the basic characteristics of the respondents, the majority were in their 30s and 40s, and approximately 75 % were nurses. In terms of HF knowledge, 53.7 % of respondents said that they "knew" about the New York Heart Association classification. A total of 40.0 % of respondents said that they were "aware of the existence of the HF handbook", and only 29.3 % of respondents said that they "knew" the classification of HF stages. When they were asked about their level of satisfaction related to all medical information provided by the hospital and hospital wards, no one was "very satisfied", and the most common response (66.2 %) was "not very satisfied". In the essential medical information that respondents wanted to obtain from hospitals and hospitals wards for managing HF patients at home, "medication at discharge", "current medical history", "fluid intake and restrictions", "symptoms, signs, and response to exacerbation", and "ideal body weight" were the top five contents. CONCLUSION: In the cross-sectional study targeted healthcare professionals working at home-visit nursing stations in Kochi Prefecture, the current state of knowledge related to HF and information coordination practices among healthcare professionals were not fully satisfactory in HF management. It is necessary to increase educational opportunities regarding HF for them and further promote information sharing.

Impact of school closures on pediatric ambulance transport in Japan.

BACKGROUND: After the coronavirus disease (COVID-19) pandemic, nationwide school closures were implemented in many countries. This study aimed to determine the impact of the school closures on pediatric ambulance transport, comparing the situation before and after the COVID-19 pandemic. METHODS: This retrospective observational study was conducted using data from the Kochi-Iryo.net database. In Kochi prefecture, schools were closed from March 6 to May 24, 2020. Pediatric emergency transport during the school closure period in 2020 was compared with that in the same period in 2019 (before the COVID-19 pandemic) and in 2021 (when schools were not closed). Statistical analysis comprised χ2 tests with Bonferroni adjustments for multiple testing. To adjust for patient backgrounds, we also performed multiple logistic regression analyses for numbers of pediatric ambulance transports. RESULTS: The rate of pediatric ambulance transports was significantly lower (p = 0.008) in 2020 (276; 3.97%) than in 2019 (391; 4.87%), but there was no significant difference (p = 0.360) between 2019 (391; 4.87%) and 2021 (352; 4.56%). Multivariable analysis revealed similar trends (2019 vs. 2020: OR 0.86, 95% CI 0.73-1.00; 2019 vs. 2021: OR 0.96, 95% CI 0.82-1.11). Regarding the characteristics of pediatric ambulance transport journeys, there were no significant differences in 2019, 2020, and 2021 in terms of sex, severity, locations of ambulance stations, and disease classification. CONCLUSIONS: There was a decrease in pediatric ambulance transportation due to the public health interventions for COVID-19, including school closures. However, this decrease was not solely due to school closures.

Knowledge, attitude, perception, and factors associated with the risk perception of COVID-19 among nursing college students in Japanese universities: A cross-sectional study.

Background and Aim: The spread of coronavirus disease 2019 (COVID-19) in the world has brought different attitudes and perceptions among social strata. Nursing students being future first-line healthcare workers are more at risk of being infected and exposed to various stressors from shared information. The objectives of this study were to evaluate the knowledge, attitude, and perception of COVID-19 among nursing students and to estimate predictors of their risk perception. Methods: We conducted an online survey among undergraduate nursing students at three selected Japanese Universities. Data on knowledge, attitude, and perception toward COVID-19 were collected using a structured questionnaire. We performed multiple logistic regression analyses to identify factors associated with the risk perception toward COVID-19 infection. Results: Of the 414 nursing students who participated in the study, 368 (90.4%) reported that the media including radio, television, internet, and/or social media were the main source of knowledge. Fever (96.1%) and dry cough (89.6%) were reported as the main symptoms. Regarding the attitude toward the treatment and preventive measures, almost 92.8% of participants recommended the use of vaccines. Being female appeared to be three times associated with the fear of getting infected (adjusted odds ratio [aOR]:3.03; 95% confidence interval [CI]: 1.21-7.58). Students who took part in extracurricular activities reported that they feared being infected with COVID-19 (aOR:2.62; 95% CI:1.33-5.16). Other factors did not show an association. Conclusion: Knowledge and attitude of nursing students toward COVID-19 were accurate for the majority of them, with the main source of information being the media. Practicing extracurricular activities and being female were associated with the fear of the disease. Efficient and controlled communication is needed during widespread disease outbreaks.