THE WORLDWIDE BURDEN OF INFANT MENTAL AND EMOTIONAL DISORDER: REPORT OF THE TASK FORCE OF THE WORLD ASSOCIATION FOR INFANT MENTAL HEALTH.

Children worldwide experience mental and emotional disorders. Mental disorders occurring among young children, especially infants (birth -3 years), often go unrecognized. Prevalence rates are difficult to determine because of lack of awareness and difficulty assessing and diagnosing young children. Existing data, however, suggest that rates of disorders in young children are comparable to those of older children and adolescents (von Klitzing, Dohnert, Kroll, & Grube, ). The lack of widespread recognition of disorders of infancy is particularly concerning due to the unique positioning of infancy as foundational in the developmental process. Both the brain and behavior are in vulnerable states of development across the first 3 years of life, with potential for enduring deviations to occur in response to early trauma and deprivation. Intervention approaches for young children require sensitivity to their developmental needs within their families. The primacy of infancy as a time of unique foundational risks for disorder, the impact of trauma and violence on young children's development, the impact of family disruption on children's attachment, and existing literature on prevalence rates of early disorders are discussed. Finally, global priorities for addressing these disorders of infancy are highlighted to support prevention and intervention actions that may alleviate suffering among our youngest world citizens.

[A Comprehensive Care System for Children with Anorexia Nervosa in Pediatric Practice].

Against the backdrop of rapid industrialization and westernization after the World War II, there has been an ever increasing number of children with anorexia nervosa (AN) in pediatric practice, making it one of the most common diseases in children. With a severe lack of AN specialists in Japan, pediatricians need to face the daunting task of treating AN on their own. Malnutrition overlooked during periods of growth and development yields a risk of death, growth disturbance and an intractable conditions with secondary disorders of brain atrophy, osteoporosis, infertility, maltreatment and childrearing failures, mental disorders and others, which can last for life. Prevention is the best and a must for AN, and an early detection and treatment need to be in place to mitigate its progress and aggravation. It is crucial that an effective care is provided in early, treatable stage to assist the patient back to a healthy developmental trajectory. In 1993, the Department of Pediatrics, School of Medicine, Keio University (hereafter PKU) appointed a child psychiatrist as its fulltime staff and has included inpatient treatment of AN as a compulsory item of its postgraduate training program. Over the past twenty years, PKU has developed a comprehensive treatment system of AN (Scientific Report of Ministry of Welfare and Labor 2006). In the primary care of AN, a screening tool using simple physical measurement of weight on growth chart combined with pulse proves effective. When a weight on growth chart reveals an unhealthy weight loss and is combined with bradycardia, it detects AN at sensitivity of 83% and specificity of 93%. In the secondary care of AN, 40 pediatric institutions affiliated with PKU implemented early treatment of AN with the support of the Mental Health Division of PKU. In the tertiary care for severely emaciated AN patients, an around-the-clock intensive treatment program, called Anorexia Nervosa Intensive Care Unit (ANICU) was instituted. The gist of ANICU is to enhance the patient's awareness of the danger of catabolism and her incentive to overcome AN through active commitment to the treatment. This treatment program harbors principles of integrity, structure and persistence; starting with a complete bed rest and regular small-step provision of nutrition and steady enhancement of daily activities, it steadily and systematically converts the body's metabolism from catabolism to anabolism. In this treatment program, more than one hundred patients' lives were saved without a single fatal case. Trainees in PKU were provided with firsthand experience of providing comprehensive care, including taking on a role of feeding the AN patients three times a day. Around three hundred trainees were trained at PKU over the past twenty years, many of whom now treat AN in their affiliated hospitals. This collaborative care, comprised of a pediatric team, family and school, supported by a specialist, will become the most reliable way of treating AN in the coming days. We hope to decrease the sufferings of children with AN through spreading this comprehensive care system for children with AN in Japan.

Improvement of asymmetric stomatognathic functions, unilateral crossbite, and facial esthetics in a patient with skeletal Class III malocclusion and mandibular asymmetry, treated with orthognathic surgery.

Patients with a dentofacial skeletal deformity have not only esthetic and morphologic problems related to facial proportions and dentition, but also problems of stomatognathic functions. Therefore, in addition to morphologic analysis, functional analysis is important for the diagnosis and evaluation of treatment in these patients. However, no reports have described longitudinal simultaneous evaluations of stomatognathic functions, and the comprehensive effects of surgical orthodontics on the stomatognathic functions are unclear. A patient was diagnosed as having a skeletal Class III jaw-base relationship, mandibular asymmetry, unilateral crossbite, asymmetric stomatognathic functions, and a temporomandibular disorder. She was treated with a combination of surgery and orthodontic therapy. As a result, facial proportions and occlusion improved; in particular, asymmetric stomatognathic functions, including masticatory muscle activity, condylar movement, and occlusal force, became symmetric between the left and right sides. Moreover, after 2 years of retention, the activity of the masticatory muscles and the values of occlusal force and occlusal contact area exceeded those at pretreatment. These results suggest that improvement of asymmetric stomatognathic functions can be achieved by correction of dentofacial morphology by surgical orthodontic treatment in patients with mandibular asymmetry.

Evaluation of optimal length and insertion torque for miniscrews.

INTRODUCTION: The purpose of this article was to test the theory that short miniscrews will decrease the possibility of damaging the root, but the failure rate will increase. METHODS: One hundred eighty-six miniscrews (diameter, 1.3 × 5 mm, n = 63; 6 mm, n = 62; 7 mm, n = 61) were placed in 105 consecutive patients. Multislice computed tomography and cone-beam computed tomography scans were taken before and after miniscrew placement. Insertion torque was measured at miniscrew placement. RESULTS: The success rate of the miniscrews in the maxilla (93.4%) was higher than that in the mandible (70.3%). A significantly lower success rate with 5-mm miniscrews was observed compared with 6-mm and 7-mm miniscrews in the mandible. Miniscrews placed in less than approximately 3.8 mm of bone and those within 1.4 mm of the root had significantly higher failure rates. Miniscrews placed with insertion torque greater than 10 Ncm had a tendency for a lower success rate. CONCLUSIONS: The optimum lengths of miniscrews of a diameter of 1.3 mm are 5 mm in the maxilla and 6 mm in the mandible. They should be placed at a distance from the root with insertion torque less than 10 Ncm for safe orthodontic anchorage without failure.

Convalescent resting tachycardia predicts unfavorable outcome of anorexia nervosa.

BACKGROUND: In patients with anorexia nervosa (AN) who have tachycardia during the clinical course, difficulty in treatment has been observed. The purpose of the present study was to evaluate the association between heart rate (HR) in the weight loss and weight recovery periods, and outcome. METHODS: The subjects consisted of 40 girls with AN (age at onset, 8-16 years). The outcome 1-5 years after the initiation of treatment was regarded as favorable for both bodyweight within 15% of the standard weight and regular menstruation during the last 6 months, and unfavorable for bodyweight <85% of the standard weight and absent or nearly always absent menstruation. HR during the weight loss period was obtained at the outpatient clinic on the first visit. For HR during the weight recovery period, we used the resting and peak HR obtained in exercise tolerance test, which was performed when the bodyweight successfully increased along with improvement in physical complications. The association between each HR and outcome was evaluated. RESULTS: Favorable outcomes were observed in 19 of the 40 patients after the 1 year follow up but in 32 after the 5 year follow up. Resting HR during the weight recovery period was higher throughout the 5 years in the unfavorable than in the favorable outcome group, with significant differences after the 2, 4, and 5 year follow ups. CONCLUSION: In AN, resting tachycardia during the convalescent period is associated with unfavorable outcome.

Akachan ni Kanpai! Celebrating the baby: Baby, family, culture.

"Akachan ni Kanpai! Celebrating the Baby: Baby, Family, Culture" was the theme of the 11th World Congress of the World Association for Infant Mental Health (August 2008). It denotes every baby's right to be blessed from the beginning of life, whether the baby is healthy, ill, disabled, or born into unwelcoming social contexts. Across the world, modern families of the 21st century face increasingly stressful lives. Japan, with a rapid postwar social change, has yielded increasing cases of postnatal depression and abuse, alerting her to reevaluate amae, a cultural affinity for interdependency. Amae, as studied by Takeo Doi, originates in the mother--infant relationship and is carried through into adulthood characterizing Japanese mentality. The Japanese values for things simple, small, slow, and silent are typical in the art of haiku and Noh, but also render significant in infant mental health. Infants born under impossible conditions, such as those born extremely small and with congenital anomalies, survive through simple, sincere, sensitive care imbued with respect to their subtle signs. Their narratives of slow and steady progress from despair to a loving family context urge us to say "Akachan ni Kanpai" to countless infants worldwide whose voices are yet to be heard.

[Interrelationship among factors associated with drinking behaviors in dental students].

We analyzed the Kurihama Alcoholism Screening Test (KAST), the Adolescent Alcohol Involvement Scale (AAIS), the Fagerstroem Tolerance Questionnaire (FTQ), the Tokyo University ALDH2-Phenotype Screening Test (TAST), results of ethanol patch tests, the presence or absence of a smoking habit, and gender by "Hayashi's quantification theory, type II" in 415 senior students (232 males and 183 females) of a dental college between 2000 and 2003, and evaluated their relationships. When drinking education is given to dental students, both the prevention of acute alcohol intoxication by chugging and the prevention of alcohol dependence in students with drinking behavior suggesting this tendency are necessary. For acute alcohol intoxication, attention can be aroused in students with positive ethanol patch tests. However, there is no definite instruction method for the prevention of alcohol dependence. Therefore, we analyzed the relationships among drinking, smoking, and constitution based on data obtained during the 4 years when the above 3 types of surveys were performed. Plotting of the results of analysis showed that the students can be classified by the ethanol patch test and TAST into those with "alcohol-sensitive" constitution and those with "alcohol-tolerant" constitution. Most problem drinkers were "alcohol-tolerant". KAST showed plotting along the constitution axis from "normal drinking group" to "problem drinking borderline group" but a change in the angle to an L shape at the transfer point from "problem drinking borderline group" to "problem drinking group", showing more serious states along the smoking axis. These results suggest that drinking behavior is first regulated by alcohol- sensitive or alcohol-tolerate constitution, and alcohol-tolerate students with a smoking habit have alcohol dependence tendency, and tend to show serious problem drinking. Improvement in the drinking habit is necessary in alcohol-tolerate students with a smoking habit so that they will not develop alcohol dependence.

[Relationship between ethanol patch test and problem drinkers among dental students].

In 2000 and 2001, we carried out a drinking habit survey and the Ethanol Patch Test on 232 fourth-year dental students (128 males, 104 females). The results were statistically analyzed. For the survey, the students were asked to fill out, anonymously, the forms of the Tokyo-University ALDH2-Phenotype Screening Test (TAST), the Kurihama Alcoholism Screening Test (KAST), and the Adolescent Alcohol Involvement Scale (AAIS). The results of the subsequent Ethanol Patch test were evaluated by the students themselves. The Patch test demonstrated that 44.5% of males and 49.0% of females were positive to the test or ALDH2 deficient, the rest having the marker substance. According to the TAST results, ALDH2-deficient or TAST-positive (alcohol-intolerant) subjects accounted for 48.4% of males and 51.9% of females, the rest being ALDH2-present or TAST-negative students. Among the Patch test-positive group, the ratio of problem drinkers according to the KAST was 8.8% in males and 2.0% in females. The corresponding figures for the test-negatives group were; 22.5% in males; 7.5% in females, being higher than those for the test-positive group. Among the test-positive group, the ratio of problem drinkers scoring at least 42 points on the AAIS stood at 19.3% in males, 7.8% in females and among the test-negative group, the corresponding figures were; 21.1% in males; 13.2% in females, the difference from those for the other group being relatively small. The results of the Ethanol Patch test were related to those of the TAST and KAST, but not to the AAIS. The correlation between the Patch test and KAST indicates that the test-negatives are prone to become alcohol-dependant. Though the results of the Patch test and those of the AAIS were not related, the findings show that some alcohol-intolerant university students are drinking excessively.

[Mother-infant mental health from viewpoint of relationship disturbance].

Infants can adapt themselves and their relationship with their caregivers in a way incomparable to any other stage in life. Infants are innately motivated to communicate with people and to actively take part in human social interaction. The question is how to provide an environment that facilitates such potentials for each particular infant and its family. Japan strove to improve the physical aspect of maternal and infant care after the second World War and yielded a nation-wide perinatal and infant screening system that produced a world minimum infant mortality rate and more than 80% compliance rate of infant checkups. Instead, infant abuse and infants with development disorders and psychosomatic symptoms has alerted the professionals to improve their approach. In addition, the increasing incidence of child abuse, juvenile crimes, eating disorders and other emotional and behavioral problems of children and adolescents has alerted the government and public to reconsider the importance of early intimate relationship. Creating a secure base for families to enjoy nurturing companionship with their infants is now common goal of infant mental health in Japan. As professionals we try to introduce a more dynamic, natural, non-judgmental empathic approach to support troubled infant care-giving systems. Whichever problem an infant may suffer, whether a problem of body or mind, its mother is bound to suffer and much more so in Japan with its old values for divine motherhood, stigmas associated with abnormality and new demands for perfect mothering. It should be acknowledged more and more that a well-meant effort on the side of infant workers cannot yield beneficial outcomes for mothers and infants unless we take into full account the importance of the complex intertwining of diverse factors, including the infant's predisposition, the mother's upbringing and past trauma and quality of the attachment system supporting the mother and family interaction. It is here that an urgent need to introduce infant mental health exists. Health professionals exchange, having shown their clinical attitudes and knowledge to their trainees, mutual nurturing companionship among workers, infants and families, which is the spirit of infant mental health. The dawn of infant mental health is steadily breaking in Japan.

Characteristics of PCR fragments amplified using five microsatellite markers for identifying the Nagoya breed.

The Nagoya breed is a native chicken of Aichi Prefecture, Japan, a dual-purpose breed for eggs and meat. A method for distinguishing the Nagoya breed from Aichi Prefecture from other chickens using five microsatellite markers (ABR0015, ABR0257, ABR0417, ABR0495 and ADL0262) has already been utilized in order to check the authenticity of Nagoya breed-labeled chicken on the market. The present study was conducted to investigate nucleotide sequences and sizes of PCR fragments containing the five microsatellite regions for the Nagoya breed and to confirm that the genomic identification could continue to be applied in the future. The DNA sequencing of fragments containing the five markers showed that ABR0015, ABR0417 and ABR0495 had a single haplotype, ABR0257 had three haplotypes, and ADL0262 had two haplotypes, although all the markers exhibited one fixed fragment size each upon sequencing of the fragments and fragment analysis. The results of the fragment analysis of each marker using DNA samples of 28 Nagoya breed males (G0 generation) reared in 2000-2001 and 20 of their offspring males (G8) reared in 2008-2009 showed one fixed fragment size in both populations. Therefore, we confirmed that the five microsatellite markers are useful tools for accurately distinguishing the Nagoya breed from other chickens.

The circadian variation of cortisol secretion in patients with anorexia nervosa in childhood and adolescence after recovery of body weight by treatment using gas chromatography/mass spectrometry in selected ion monitoring.

Anorexia nervosa (AN) is a chronic psychiatric disorder which is characterized by patient-induced weight loss. Complications in many organ systems can be seen in AN such as cardiovascular, gastrointestinal, and endocrine system including hypothalamic-pituitary-adrenal axis, even after recovery of body weight by treatment. Urinary steroid profile analysis using gas chromatography/mass spectrometry (GC/MS) in selected ion monitoring (SIM) has been reported to be useful for the diagnosis of abnormal steroidogenesis in newborn infants, childhood, and adults. The aim of this study was to analyze the circadian variation of cortisol secretion in patients with anorexia nervosa (AN) in childhood and adolescence after recovery of body weight by treatment using GC/MS in SIM. The subjects were 7 healthy young adults (20-23 yr of age, BMI 19.7-24.8 kg/m(2)) and 5 AN patients in childhood and adolescence (13-19 yr of age), who had recovered body weight by treatment (BMI 15.4-19.3 kg/m(2); 3(rd)-25(th) to 50(th) percentile). Urine samples were collected for 26 hours (from 21:00 to 23:00 next day) at each urination. In each sample, the cortisol metabolites were measured by GC/MS in SIM. The sum of all cortisol metabolites was calculated as mg/g creatinine. In all 5 AN patients in childhood and adolescence, the circadian variation of the sum of cortisol metabolites was observed and was similar to that in healthy young adults. Although our data are preliminary, in patients with AN in childhood and adolescence, who have recovered body weight by treatment, the circadian variation of cortisol secretion may be conserved.

Research on promotion of management of children with psychosomatic and psychosocial disorders in Japan.

BACKGROUND: The number of children with psychosomatic and psychosocial disorders has been increasing in Japan. There are, however, few trained pediatricians who have adequate knowledge of the treatment needed. The Research Group on the Promotion of Management of Children with Psychosomatic and Psychosocial Disorders carried out the present study to (i) disseminate knowledge about psychosomatic and psychosocial disorders of children; and (ii) establish a community-based network model to ensure effective communication among relevant institutions. METHODS: To disseminate knowledge of the psychosocial and psychosomatic disorders, the Research Group compiled the Handbook for Psychosomatic Disorders of Children and distributed it to pediatricians throughout Japan. A follow-up questionnaire survey was then carried out. Also, in order to examine the current status of the communication network between pediatricians and the related institutions, the Research Group conducted a questionnaire survey on general pediatricians. RESULTS: Sixty-five percent of the respondents indicated that they were actually using the Handbook. The topics in the Handbook that were most frequently referred to by the respondents were attention deficit hyperactivity disorders, school refusal, eating disorders, and orthostatic dysregulation. Thirty-seven percent of the participants indicated changes in their behavior towards psychosomatic and psychosocial problems. The results of the survey on communication networks found that the pediatricians generally collaborated with different institutions depending on the nature of the problems, such as school refusal and bullying, developmental disorders, child abuse and maltreatment, and others. CONCLUSION: Promotion of the Handbook would greatly contribute to improving the management of children with psychosomatic and psychosocial disorders, together with the construction of the basic network model for management of these children.

Psychosomatic disorders in children: an emerging challenge to health care in Japan.

BACKGROUND: Japan has been witnessing a considerable rise in the number of children presenting with psychosomatic disorders. Thus, there is a mounting demand for pediatricians to be trained in the caring of children with psychosomatic disorders. METHOD: A questionnaire based-survey was conducted to investigate the average number of working hours for the first year (Postgraduate Year 1 (PGY1)) pediatric residents at Keio University Hospital. The same survey was conducted retrospectively with doctors with at least 10 years of experience in child health care. Another survey was conducted at our 27 affiliated hospitals with respect to the number of outpatients and patients presenting with psychosomatic disorders. RESULTS: The survey showed that, in the ward for preschool and school-age children, PGY1 residents spent on average 78.9 h per week. Time required for care of psychosomatic disorders was more than 30% of the total amount of time allotted for information acquisition, interviews and consultations, as well as conferences and discussions. There was virtually no time spent on the care for psychosomatic disorders in our pediatric residency program 10 years ago. It is an implication of the survey that the apparent number of patients with psychosomatic problems is not dependent on the size or location of the hospital. CONCLUSION: General pediatricians will be spending more time than ever before in the caring of children with psychosomatic disorders. Moreover, pediatricians trained for child health care for psychosomatic disorders are short of supply or non-existent, even in the major affiliated hospitals.

Human alkaline phosphatase expression and secretion into chicken eggs after in vivo gene electroporation in the oviduct of laying hens.

In vivo gene electroporation was used to examine whether or not a recombinant protein is synthesized in the chicken oviduct and subsequently secreted into eggs. A plasmid DNA containing a secretion form of the human alkaline phosphatase gene was injected into mucosa of the chicken magnum. Immediately, in vivo gene electroporation was conducted. The human alkaline phosphatase activity in the oviduct mucosa increased and reached its peak at 2 days posttransfection, followed by a sharp decrease to a negligible level at 4 days posttransfection. In the egg white, the alkaline phosphatase activity showed a similar change to that in the magnum mucosa except for a delay of 4 days. The present results imply that in vivo gene electroporation method in the oviduct may serve as a rapid production system of recombinant proteins into chicken eggs.