Tokyo Metropolitan Institute of Public Health

Eating vegetables first at meals may be associated with mental capital, such as resilience and self-esteem; however, the association has not been well-studied. We examined how trajectories in eating vegetables first from Grade 1 to 6 were associated with resilience and self-esteem at Grade 6 among children in Adachi City, Tokyo, Japan. We used data from the Adachi Child Health Impact of Living Difficulty (A-CHILD) study (N = 2654). Resilience and self-esteem were measured using the Children's Resilient Coping Scale reported by parents and the Children's Perceived Competence Scale reported by children, respectively. Group-based trajectory analysis was performed to identify subgroups of eating vegetables first. Four distinct trajectories were identified: "Not eating vegetables first" (N = 1481, 55.8%), "Increase eating vegetables first" (N = 841, 31.7%), "Reduce eating vegetables first" (N = 157, 5.9%) and "Constant eating vegetables first" (N = 175, 6.6%). After adjusting for potential confounders, children in "Constant eating vegetables first" scored higher resilience (d = 0.20, 95% Confidence Interval, CI: 0.004, 0.39) and higher self-esteem (d = 0.27, 95% CI: 0.06, 0.47) than children in "Not eating vegetables first". Eating vegetables first at meals is associated with mental capital among elementary school children. Four trajectory groups can be identified based on the probability of eating vegetables first. Children who "Constant eating vegetables first" from Grade 1 to Grade 6 had higher mental capital scores (resilience and self-esteem) in Grade 6 than children who did "Not eating vegetables first". Eating vegetables first at meals is associated with mental capital among elementary school children. Further research is recommended to explore the mechanism of how eating vegetables first affects child mental capital.

Few published studies are reported for reproductive and neurobehavioral toxicity of combined exposure to neonicotinoid insecticides and synergists in mammals. This study aimed to evaluate the reproductive and neurobehavioral effects of combined dinotefuran (DIN) and piperonyl butoxide (PBO) in an F1-generation toxicity study in mice. DIN and PBO were given in the diet to provide levels of 0% (control), PBO 0.03%, DIN 0.012% + PBO 0.03%, and DIN 0.024% + PBO 0.03% from 5 weeks of age of the F0 generation to 11 weeks of age of the F1 generation in mice. Selected reproductive and neurobehavioral parameters were measured in the F1 generation. For exploratory behavior in the F0 generation, the number of horizontal activities increased with a statistically significant dose-related response in adult males. For exploratory behavior in the F1 generation, the total distance, movement time, average speed, and average time of movement increased with statistically significant dose-related responses in adult males. In the spontaneous behavior of males in the F1 generation, the parallel lines during the control and treatment groups indicated significant distances in the total distance, average speed, and average time of movement. The dose levels of DIN with PBO in the present study affected exploratory and spontaneous behavior at lower dose levels than those observed in previous studies with the single administration of DIN and PBO. Therefore, the dose level of PBO (0.03%, approximately 44-116 mg/kg body weight/day) is estimated to have a synergistic effect on DIN exposure.

ABSTRACTBackgroundSchool refusal has negative consequences throughout life. While parental education and child poverty are closely linked to school refusal, the mechanism by which parental low education influences school refusal in offspring remains unclear. This cross‐sectional study examined the association between parental low education and several dimensions of child poverty (low income and deprivation) with school refusal among first grade (6–7 years old) elementary school students in Japan.MethodsData were obtained from the Adachi Child Health Impact of Living Difficulty (A‐CHILD) study conducted in 2015, 2017, 2019 and 2021 in Adachi City, Tokyo, Japan (N = 13 258). Parental education was classified as none, one or both parents graduated from some college or more. Inability to afford essential items or service payments was used to measure deprivation. A multivariate logistic regression model was used for the analysis, adjusting for other sociodemographic characteristics.ResultsThe prevalence of school refusal was 3.1% (N = 416). We found a positive association between parental low education and school refusal after adjusting for covariates (OR = 1.40, 95% CI: 1.08, 1.82). The association was attenuated by further adjustment by low income and deprivation, which showed a higher risk of school refusal (OR = 1.45, 95% CI: 0.98, 2.13 and OR = 1.62, 95% CI: 1.25, 2.10, respectively). Low income and deprivation explained 9.2% and 39.4% of the association between parental low education and school refusal of the offspring, respectively.ConclusionsLower educational attainment of parents was a risk of school refusal from an early stage of mandatory education in Japan, which can be explained partially by low income and deprivation. Policymakers should be aware that school refusal from an early age is common in families with low socio‐economic status and should proactively reach out to these parents.

BackgroundClinical evidence on how social network diversity (SND) influences the risk of infection and disease severity during the coronavirus disease 2019 (COVID-19) pandemic remains limited. We aim to investigate the associations between SND and the risk of COVID-19 infection and disease severity using a large-scale longitudinal cohort study.MethodsWe analyzed data from participants in a longitudinal study, the Japan COVID-19 and Society Internet Survey (JACSIS) between 2020 and 2023. The SND score was calculated as the sum of seven distinct types of social networks. COVID-19 infection was assessed as ever infection, and severity was defined as oxygen-requiring admission, using a self-reported questionnaire. Poisson regression with robust standard errors estimated risk ratios (RRs) and 95% confidence intervals (CIs), adjusting for sociodemographic and clinical characteristics.ResultsOf 13,713 participants (mean age 53.2 ± 15.7 years, 46.4% women), 3,251 (23.7%) developed COVID-19, and among infected individuals, 277 (8.5%) required oxygen therapy. Higher SND scores were associated with COVID-19 infection with linear trend (SND score 7 vs. 0: adjusted RR 2.49; 95% CI 2.11–2.95). In contrast, the association between SND score and disease severity followed a U-shaped pattern, with 4–5 SND showing the lowest risk of oxygen-requiring admission (adjusted RR 0.15; 95% CI 0.11–0.30) compared to those with 0 SND.ConclusionWhile higher SND was associated with increased COVID-19 infection risk, moderate social network diversity appeared protective against severe disease outcomes. These findings suggest a complex trade-off between exposure risk and potential health benefits of social networks during infectious disease outbreaks.

Disturbance of hearing or olfaction is known to be associated with cognitive impairment. Multisensory impairment-simultaneous dysfunction in multiple senses-is common among older adults. This study examined the relationship between cognitive impairment and the co-occurrence of olfactory and auditory dysfunctions in older adults. Data were obtained from a population-based survey. Of 1346 randomly selected residents, 527 participated; after excluding 22 with incomplete data, 505 residents aged 65-84 years were enrolled. Cognitive function was assessed using the Japanese Quick Mild Cognitive Impairment Screen (Qmci-J). Olfactory and auditory function, assessed using the Open Essence test and pure-tone audiometry, respectively, were classified as normal, moderate, or severe, yielding nine combined groups. Associations with cognitive impairment (Qmci-J ≤ 60) were examined using modified Poisson regression to estimate the prevalence ratio (PR), adjusting for demographic, health-related, and socioeconomic covariates. Among 505 participants, 225 (44.6%) had cognitive impairment. Severe dysfunction in either olfaction or audition, combined with at least moderate dysfunction in the other, was significantly associated with cognitive impairment. The highest PR was observed in participants with severe dysfunction in both senses (PR = 1.90, 95% CI: 1.16-3.10). These associations remained significant even after adjustment for all covariates. Although no significant additive or multiplicative interaction was observed, the co-occurrence of severe olfactory and auditory dysfunctions showed the highest PR, consistent with an additive effect. Olfactory and auditory dysfunctions are additively associated with cognitive impairment, highlighting the importance of considering multisensory impairment in older adults. The technical efficacy of this study is high. The study design, data collection procedures, and statistical analyses are clearly described and reproducible. In addition, all key assessments used in this study, including the Quick Mild Cognitive Impairment Screen (Qmci), the Open Essence Test, and pure-tone audiometry, are standardized, validated, and widely accepted measures, as detailed in the manuscript.

Objectives:The bidirectional increase of visitors between Vietnam and Japan has raised concerns about the spread of CRF01_AE; however, the epidemiological characteristics of CRF01_AE in Vietnam and its relationship with Japan remain unclear. We compared the CRF01_AE gene sequences from Vietnam and Japan to understand their epidemiolocal relationships.Design:A molecular-epidemiological observational study.Methods:We analyzed 753 protease--reverse transcriptase sequences from CRF01_AE-infected individuals in northern Vietnam and 500 CRF01_AE sequences from the Japanese Drug Resistance HIV-1 Surveillance Network's cluster database. We inferred the chronological phylogeny of these sequences with HIV-1 subtype references and identified statistically significant Vietnam-related clusters (VRCs). Individuals’ sex, infection risk, age, collection year, collection site, and nationality were analyzed in relation to clustering and bilateral epidemiological relationships.Results:A total of 33 VRCs and 41 Vietnam-related pairs were identified. Of these, eight were linked to known Japanese domestic transmission clusters (dTCs). Two VRCs included Vietnamese individuals diagnosed in Japan. One Japanese dTC linked to Vietnam included numerous Philippine nationals who were diagnosed in Japan. Regression analysis revealed that VRCs with a higher proportion of young people had a higher number of MSM (adjR2 = 0.422, P < 0.001). Although VRCs involved different risk groups in northern Vietnam, a strong association was observed between bilateral epidemic links and MSM (adjOR = 8.718, P < 0.001).Conclusion:CRF01_AE in northern Vietnam has spread through many different at-risk populations. Some MSM groups were associated with the epidemiological relationship between northern Vietnam and Japan.

IntroductionDiagnostic errors significantly contribute to adverse events, patient harm and malpractice claims. While most research focuses on physicians, allied health professionals (AHPs) also play a critical role in diagnostic processes. Existing studies, primarily based on medical-record reviews, often overlook communication gaps and team dynamics affecting diagnostic accuracy. This study aims to (1) describe the overall characteristics and patterns of diagnostic errors reported in the national adverse-event database and (2) compare the clinical features, diagnostic processes and contributing factors between cases involving physicians and those involving AHPs.MethodsWe examined diagnostic-error reports from 1631 hospitals in the Japan Council for Quality Healthcare database (2010–2023). Cases were identified using predefined keywords, and two independent physicians assessed them using the Revised Safer Dx Instrument and Diagnostic Error Evaluation and Research (DEER) taxonomy. Contributing factors were analysed, and statistical methods explored error patterns and stakeholder comparisons.ResultsAmong 147 654 event reports, 445 cases involved diagnostic errors. The most common errors occurred in diagnostic testing, assessment and follow-up, particularly misinterpretation of pathological or radiological reports on new injuries during hospitalisation. Physicians were the primary responsible providers (79.3%), while nurses were involved in 19.3% of cases. DEER taxonomy analysis revealed that nurses were more associated with errors in presentation, history-taking and physical examination (p<0.001). Additionally, patient-related factors, observation, reporting and training played a significantly greater role in errors involving nurses than physicians (p<0.001).DiscussionBy leveraging expert-assessed unstructured data, this study provides a broader perspective on diagnostic safety. Findings highlight the critical role of AHPs in diagnostic errors. Our study underscores the need for targeted, profession-specific interventions embedded within broader interprofessional initiatives to effectively reduce diagnostic errors and enhance patient safety.

Although salted seafood is a known carcinogen for intestinal tract cancer, its effects on biliary tract cancer remain unclear. We examined salted seafood consumption's associations with biliary tract cancer on islands in Tokyo, where large salted seafood amounts are consumed. Due to the island region's small population, we applied age standardization using an indirect method based on Tokyo's population as the standard population. The standardized incidence ratio was calculated using Tokyo Metropolitan Cancer Registry data from 2013 to 2018. The salted seafood amount consumed was obtained from a nutritional survey conducted on the islands. Spearman's correlation coefficient was calculated between the salted seafood amount consumed and biliary tract cancer's incidence among the islands. Six islands were included in this study (Oshima, Niijima, Kouzushima, Miyakejima, Hachijojima, and Ogasawara). The standardized incidence ratio was high in the islands (1.24). Of the six islands, Niijima (1.56) and Hachijojima (1.60) had high standardized incidence ratios, whereas Miyakejima (0.62) and Ogasawara (0.61) had low standardized incidence ratios. We found a positive correlation between the salted seafood amount consumed and biliary tract cancer's standardized incidence ratio (r=0.797, p=0.058). Our ecological study suggests that salted seafood consumption may be a risk factor for biliary tract cancer. Further research, including animal studies and case-control studies conducted on the islands of Tokyo, is needed to clarify the association between salted seafood consumption and the incidence of biliary tract cancer.