Participation Patterns and Associated Factors in Japanese Children With Autism

BACKGROUND

Children's participation is an important outcome for children, families, and rehabilitation.

OBJECTIVES

We compared participation patterns (home and community) of 6- to 12-year-old Japanese children with autism and children with typical development (TD) and explored the associations of participation with familial, environmental, and child-related factors.

METHOD

Twenty-five mothers of children with autism and 21 mothers of TD children completed a survey covering their child's participation and environment, family empowerment, autism symptoms, sensory processing, behavior, and demographic characteristics.

RESULTS

Children with autism showed restricted home and community participation. Home involvement was associated with family empowerment and the children's age, whereas home frequency was linked to environmental supportiveness and household income.

CONCLUSION

Japanese children with autism need appropriate support to address decreased participation. Occupational therapists may focus on family empowerment and the child's environment to facilitate the home participation of children with autism.

Changes in Challenging Behaviors Accompanying Transition to a New Facility in Individuals with Intellectual Disabilities

Challenging behavior (CB), the most common example being extreme self-injurious or aggressive/destructive behavior, is often observed as a major behavior issue in individuals with severe intellectual disabilities. This study investigated how CB changed among residents of a facility for people with disabilities before and after it was restructured from a traditional format single room shared by two to three individuals with approximately 20 residents lived together to a format featuring private areas with two rooms per resident and a unitcare system. Twenty-one residents of Care Home A, which was rebuilt in the new care format, were selected. Care staff completed a questionnaire one month before, one month after, and six months after residents moved to the new facility. Scores were compared among each time point. The results revealed significant reductions in residents' aggressive, stereotyped, and targeted behaviors, such as hitting their own head and fecal smearing. The major features of the restructured facility were a living space consisting of two private rooms per resident and a shift to unit care for the entire ward. These new features enabled residents to reduce destructive stimuli and made it easier to understand what to do in each private room.

Factors influencing postpartum depression among Japanese parents: A prospective longitudinal study

AIM

Postpartum depression (PPD) may have negative effects on the parents and lead to impaired cognitive, socioemotional, and behavioral development in their children. The purpose of this study was to examine factors associated with PPD in parents during the first year after delivery.

METHODS

This study used a self-administered questionnaire. Questionnaires were mailed at 5 days, 3 months, 6 months, and 1 year after delivery, respectively. The particpants were 107 pairs of mothers and fathers. PPD was assessed using the Edinburgh Postnatal Depression Scale (EPDS). Data on sense of coherence (SOC), Quality Marriage Index, Social Support Scale, Mother-to-Infant Bonding Scale, and sociodemographic variables were collected. Multiple regression analysis was performed to examine the strength of the association between several variables and the EPDS at each survey period for fathers and mothers, respectively.

RESULTS

The prevalence of PPD in the first-year postpartum ranged from 12.1%-23.4% to 7.5%-8.4% for fathers and mothers, respectively. SOC had the strongest impact on EPDS scores for both fathers and mothers at all four survey periods.

CONCLUSIONS

Our findings suggest that stress coping skills are an important factor affecting PPD throughout the first-year postpartum for both fathers and mothers.

Associations between Optimism and Attentional Biases as Measured by Threat-Avoidance and Positive-Search Tasks

Evidence suggests that optimism has a positive impact on health status. Attentional bias modification (ABM) may be beneficial for enhancing optimism, but its effective application requires a detailed investigation of the association between attentional bias and optimism. This study aimed to determine the association between attentional bias and optimism based on different task types. Eighty-four participants completed the attentional bias measures using the dot-probe task (DPT), emotional visual search task (EVST) paradigms, and psychological assessments. Optimism was assessed using the Life Orientation Test-Revised with subscales for optimism and pessimism. Pearson's correlation coefficient and multivariate linear regression analysis were applied to investigate the association between optimism and attentional bias. Neither the attentional bias derived from DPT nor EVST was significantly correlated with optimism total score or subscales. Regression analysis also showed no association between attentional bias and optimism (DPT, β = 0.12; EVST, β = 0.09), optimism subscales (DPT, β = 0.09; EVST, β = 0.17), or pessimism subscales (DPT, β = -0.10; EVST, β = 0.02). Our findings showed no evidence that attentional biases derived from either the DPT or EVST measures are associated with optimism or pessimism. Further studies are needed to effectively adapt the ABM to enhance optimism.

Diagnostic model for preschool workers' unwillingness to continue working: Developed using machine-learning techniques

The turnover of kindergarten teachers has drastically increased in the past 10 years. Reducing the turnover rates among preschool workers has become an important issue worldwide. Parents have avoided enrolling children in preschools due to insufficient care, which affects their ability to work. Therefore, this study developed a diagnostic model to understand preschool workers' unwillingness to continue working. A total of 1002 full-time preschool workers were divided into 2 groups. Predictors were drawn from general questionnaires, including those for mental health. We compared 3 algorithms: the least absolute shrinkage and selection operator, eXtreme Gradient Boosting, and logistic regression. Additionally, the SHapley Additive exPlanation was used to visualize the relationship between years of work experience and intention to continue working. The logistic regression model was adopted as the diagnostic model, and the predictors were "not living with children," "human relation problems with boss," "high risk of mental distress," and "work experience." The developed risk score and the optimal cutoff value were 14 points. By using the diagnostic model to determine workers' unwillingness to continue working, supervisors can intervene with workers who are experiencing difficulties at work and can help resolve their problems.

Burnout among kindergarten teachers and associated factors

Burnout among kindergarten teachers is a subject of great concern. Although burnout is reported to be significantly associated with turnover intention and work engagement, few studies have examined factors associated with burnout among these teachers. Therefore, in the present study, we performed a cross-sectional survey of burnout and associated factors among kindergarten teachers. We distributed 3363 questionnaires to all 205 authorized kindergartens and childcare institutions in Nagasaki Prefecture and received 1086 responses (response rate: 32.3%). The participants were limited to full-time female class teachers. After excluding survey forms with incomplete content, we ultimately examined valid responses from 442 participants. The survey examined burnout (Maslach Burnout Inventory, MBI), teacher stress (Nursery Teacher's Stress Scale, NTSS), coping behaviors (Brief Scales for Coping Profile, BSCP), and social support (Social Support Scale, SSS). A multiple regression analysis revealed that all 3 MBI subscales were positively associated with "understanding of how to handle children" on the NTSS and negatively associated with "superiors" on the SSS. "Emotional exhaustion" was significantly associated with "interpersonal relations at work" and "lack of time" on the NTSS, and "avoidance and suppression" on the BSCP. "Depersonalization" was significantly associated with age, "disconnect in working conditions" on the NTSS, and "proactive problem solving" and "venting emotions to others" on the BSCP. "Diminished professional accomplishment" was significantly associated with age, "lack of time" on the NTSS, and "proactive problem solving" and "change in perspective" on the BSCP. These results suggest that support from superiors that enables teachers to better understand children and handle them appropriately is necessary to prevent burnout.

Relationship between Sensitivity Tendency and Psychological Stress Reactivity in Healthy Students

This study examined the relationship between sensory processing sensitivity and psychological stress reactivity in 69 healthy Japanese university students. The Japanese version of the Highly Sensitive Person Scale and the Japanese version of the Adolescent/Adult Sensory Profile were used for subjective assessment. The Galvanic skin response was measured as an objective measure of stress responses while the participants were completing the Stroop task. The Wilcoxon signed-rank test, the Spearman rank correlation coefficient, and the Mann−Whitney U test were conducted for data analysis. The results demonstrated that there was no significant correlation between the Japanese version of the Highly Sensitive Person Scale and Galvanic skin response. However, there was a marginal trend toward significance between low registration in the Japanese version of the Adolescent/Adult Sensory Profile and Galvanic skin response (rs = 0.231, p < 0.10; rs = 0.219, p < 0.10), suggesting that self-rated sensitivity was not necessarily associated with objective measures. These results indicate that sensory processing sensitivity analyses require the consideration of the traits and characteristics of the participants and multifaceted evaluations using a sensitivity assessment scale other than the Japanese version of the Highly Sensitive Person Scale.

Factors associated with kindergarten teachers' willingness to continue working

The turnover rate among kindergarten teachers in advanced countries is extremely high. As such, there is an urgent need to determine the reasons for this turnover and to identify ways to prevent it. The current study investigates the individual and environmental factors that impact kindergarten teachers' willingness to continue working.A total of 600 kindergarten teachers in Japan participated in this study. Participants responded to questionnaires regarding their willingness to continue working, mental health, work engagement, and the availability of social support. Multiple logistic regression analysis was used to analyze participants' data, with willingness to continue working for 5 or more years as the dependent variable. Additionally, Spearman rank correlation was used to examine the correlations between factors associated with willingness to continue working.Factors such as older age, living with a spouse, caring for younger children (up to 2 years old) at work, good mental health, and higher work engagement were significantly associated with teachers' higher willingness to continue working. Factors such as marriage, health and family problems, overtime work, issues with workplace childcare, and education policy, working time/day problems, human relations, and difficulties taking care of children were correlated with teachers' lack of willingness to continue working.The findings of this cross-sectional study suggest that welfare benefits and individual support systems could be key elements to encourage kindergarten teachers to continue working and could lead to their improved job satisfaction and mental health. Balanced work conditions and workers' high agreement with their workplace's overall childcare or educational policies may lead to lower turnover. Some programs - such as relationship counselling - could have a positive impact on teachers' mental health and job satisfaction.

The mental health status of children who have been evacuated or migrated from rural areas in Fukushima prefecture after the Fukushima daiichi nuclear power station accident:results from the Fukushima health management survey

INTRODUCTION

We evaluated the mental health status of children residing in Kawauchi village (Kawauchi), Fukushima Prefecture, after the 2011 accident at the Fukushima Daiichi Nuclear Power Station, based on the children's experience of the nuclear disaster.

METHODS

We conducted this cross-sectional study within the framework of the Fukushima Health Management Survey (FHMS);FHMS data on age, sex, exercise habits, sleeping times, experience of the nuclear disaster, and the "Strengths and Difficulties Questionnaire (SDQ)" scores for 156 children from Kawauchi in 2012 were collected. Groups with and without experience of the nuclear disaster - "nuclear disaster (+)" and "nuclear disaster (-)" - were also compared.

RESULTS

Our effective response was 93 (59.6%);the mean SDQ score was 11.4±6.8 among elementary school-aged participants and 12.4±6.8 among junior high school-aged ones. We statistically compared the Total Difficulties Scores (TDS) and sub-item scores of the SDQ between "elementary school" and "junior high school" or "nuclear disaster" (+) and (-). There was no significant difference between these items.

CONCLUSIONS

We found indications of poor mental health among elementary and junior high school-aged children in the disaster area immediately following the accident, but no differences based on their experience of the nuclear disaster. These results indicate the possibility of triggering stress, separate to that from experiences related to the nuclear disaster, in children who lived in affected rural areas and were evacuated just after the nuclear disaster.

Mental health literacy regarding eating disorders in female Japanese university students

Mental health literacy (MHL) refers to one's knowledge and beliefs about mental disorders. MHL is necessary for the prevention and early detection of eating disorders, but little research exists on the MHL of Japanese people. This paper aims to reveal the degree of MHL about eating disorders in the Japanese individuals most susceptible to them (namely, female university students). Female Japanese university students were surveyed with a self-report questionnaire, using the Japanese versions of anorexia nervosa and bulimia nervosa vignettes. Most participants responded that the main problem described in each vignette were "eating disorders" and tended to suggest medical care for the treatment. However, many still believed these issues to be simple problems of eating behavior. Overall, the participants demonstrated inadequate MHL about eating disorders. Initiatives to improve this population's knowledge and understanding of eating disorders are necessary.

Visual attention affects late somatosensory processing in autism spectrum disorder

PURPOSE

Somatosensory processing problems are often reported in individuals with autism spectrum disorder (ASD), along with an abnormal multimodal integration of visual, tactile or proprioceptive information. However, the effects of visual stimulation and attention on somatosensory processing in ASD remain unknown. This study explores the effects of visual attention on somatosensory processing in ASD.

MATERIALS AND METHODS

The neural activity in somatosensory areas and associated regions was investigated by measuring somatosensory evoked potentials (SEPs) elicited by median nerve stimulation, in three different conditions (closed eyes, open eyes and focused attention to a visual task). Nine individuals with ASD and nine typically developing (TD) individuals participated in the study.

RESULTS

There were significant interactions between groups (ASD, TD) and conditions (closed eye, open eye, visual task requiring focused attention) for P100-N140 SEP amplitudes evaluated by 2-way analysis of variance. Post hoc analyses revealed that the P100-N140 amplitude with closed eyes recorded larger SEPs in the ASD group than in the TD group at C3' of the international 10-20 system. In the ASD group, the P100-N140 amplitude elicited smaller responses during visual tasks than with closed or open eyes. There were no significant differences in N20-P25 SEP components.

CONCLUSIONS

These findings suggest that visual attention affects the later stages of somatosensory processing in individuals with ASD.

Cerebral haemodynamics during motor imagery of self-feeding with chopsticks: differences between dominant and non-dominant hand

Purpose: Motor imagery is defined as a dynamic state during which a subject mentally simulates a given action without overt movements. Our aim was to use near-infrared spectroscopy to investigate differences in cerebral haemodynamics during motor imagery of self-feeding with chopsticks using the dominant or non-dominant hand.Materials and methods: Twenty healthy right-handed people participated in this study. The motor imagery task involved eating sliced cucumber pickles using chopsticks with the dominant (right) or non-dominant (left) hand. Activation of regions of interest (pre-supplementary motor area, supplementary motor area, pre-motor area, pre-frontal cortex, and sensorimotor cortex was assessed.Results: Motor imagery vividness of the dominant hand tended to be significantly higher than that of the non-dominant hand. The time of peak oxygenated haemoglobin was significantly earlier in the right pre-frontal cortex than in the supplementary motor area and left pre-motor area. Haemodynamic correlations were detected in more regions of interest during dominant-hand motor imagery than during non-dominant-hand motor imagery.Conclusions: Haemodynamics might be affected by differences in motor imagery vividness caused by variations in motor manipulation.

Neonatal behavior and social behavior and sensory issues in 18-month toddlers

BACKGROUND

There has long existed a need for early detection and early intervention for children with autism spectrum disorder. Accordingly, the aim of this study was to demonstrate, in a prospective manner, the relationship between behavioral features during the neonatal period and social behavior and sensory issues at 18 months.

METHODS

Participants were 105 full-term infants considered "healthy" by an obstetrician. The behavioral features of the infants were evaluated using the Neonatal Behavioral Assessment Scale (NBAS) between 2 and 7 days after birth. Follow-up assessments were conducted 18 months later using a Japanese version of the Modified Checklist for Autism in Toddlers (M-CHAT-JV) and the Infant / Toddler Sensory Profile (ITSP).

RESULTS

Sixteen (15.2%) of the 105 infants were M-CHAT-JV-positive. There were significant differences between the M-CHAT-JV-positive and M-CHAT-JV-negative groups in two of the NBAS clusters: orientation and motor. We observed a significant negative correlation between the NBAS orientation cluster and the ITSP "low registration" and "auditory processing" sections, as well as between the NBAS motor cluster and the ITSP "sensation avoiding" and "tactile processing" sections. Logistic regression analysis showed that the NBAS orientation cluster and ITSP low registration were significantly associated with the M-CHAT-JV at 18 months.

CONCLUSIONS

The results suggest a relationship between the NBAS orientation cluster in full-term neonates and their social behavior and sensory features at 18 months.

Relationship between parenting stress and children's behavioral characteristics in Japan

BACKGROUND

The evaluation of a child tends to differ between the mother and father regardless of whether the child has a disability or not, although parents have key information about the behavioral characteristics of the child. The number of reports in Japan, however, is limited. We, therefore, investigated the relationship between the parenting stress experienced by parents of non-clinical preschool children and the children's behavioral characteristics.

METHOD

The subjects were 83 pairs of mothers and fathers with non-clinical children in kindergarten and nursery school (average age, 59.1 ± 13.0 months; 36 boys, 47 girls). The study was conducted using the Parenting Stress Index-Short Form (PSI-SF) and the Strengths and Difficulties Questionnaire (SDQ).

RESULTS

There was no difference in the PSI-SF scores between mothers and fathers, but hyperactivity/inattention, peer relationship problems, and the total score of the SDQ were significantly higher in fathers. On multiple regression analysis, parenting stress experienced by fathers was significantly related to hyperactivity/inattention, while parenting stress experienced by mothers was significantly related to peer relationship problems and emotional symptoms.

CONCLUSION

Children's behavioral characteristics related to parenting stress differ between mothers and fathers.

Factors associated with preschool workers' willingness to continue working

In industrialized countries, the turnover rate of preschool workers is extremely high and now represents a social problem. Consequently, it has become important to promote stable early care and educational environments for this population. Several factors related to working environments are known to affect turnover intention; however, the specific factors related to turnover intention among preschool workers have not yet been identified. Considering this, the objective of the present study was to determine factors associated with preschool workers' willingness to continue working.The participants of this study were 1137 preschool workers based in Nagasaki Prefecture, Japan. Multivariate logistic regression analysis was used to analyze the participants' data, with willingness to continue working for 5 years or more set as the dependent variable.Analysis of the results for all subjects clearly showed that male sex, older age, good mental health, high number of social supports, and good work engagement have a positive effect on willingness to continue working. Further, stratifying the participants in terms of age revealed that for preschool workers under 39 years, male sex, good mental health, high number of social supports, and good work engagement act positively in regard to willingness to continue working. Meanwhile, for those over 40 years, it was found that permanent employment and good work engagement act positively in this regard. Thus, work engagement was the only common factor between preschool workers under 39 and over 40.The findings of this cross-sectional study demonstrate that the factors associated with willingness to continue working among preschool workers differ between younger and older professionals. These findings underline the importance of considering age categories when attempting to maximize such professionals' willingness to continue working.

Relationship between Motor Coordination, Cognitive Abilities, and Academic Achievement in Japanese Children with Neurodevelopmental Disorders

Background/Objective

Motor coordination impairment is common in children with neurodevelopmental disorders such as autism spectrum disorder (ASD) and attention deficit/hyperactivity disorder (AD/HD). The purpose of this study was to investigate the relationship between motor coordination, cognitive ability, and academic achievement in Japanese children with neurodevelopmental disorders.

Methods

Thirty-four school-age (6–12 years old) children with neurodevelopmental disorders and 34 age-matched typically developing (TD) children were recruited in this study. Correlations between the scores of the Movement Assessment Battery for Children-2 (M-ABC2) and the Kaufman Assessment Battery for Children — Second Edition (K-ABCII) that assesses cognitive abilities, and academic achievement were analyzed.

Results

The children with neurodevelopmental disorders obtained a lower total score and all component scores on M-ABC2 compared to the TD children. In children with neurodevelopmental disorders, M-ABC2 Manual Dexterity score was significantly correlated with K-ABCII Simultaneous Processing (r = .345, p = .046), Knowledge (r = .422, p = .013), Reading (r = .342, p = .048), Writing (r = .414, p = .017), and Arithmetic (r = .443, p = .009) scores. In addition, M-ABC2 Balance score was significantly correlated with K-ABCII Learning (r = .341, p = .048), Writing (r = .493, p = .004), and Arithmetic (r = .386, p = .024) scores.

Conclusion

These findings stress that it is essential to accurately identify motor coordination impairments and the interventions that would consider motor coordination problems related to cognitive abilities and academic achievement in Japanese children with neurodevelopmental disorders.

Effectiveness of Earmuffs and Noise-cancelling Headphones for Coping with Hyper-reactivity to Auditory Stimuli in Children with Autism Spectrum Disorder: A Preliminary Study

Objective/Background

The purpose of this pilot study was to examine the effectiveness of standard earmuffs and noise-cancelling (NC) headphones in controlling behavioural problems related to hyper-reactivity to auditory stimuli in children with autism spectrum disorder (ASD).

Methods

Twenty-one children with ASD aged 4-16 years (16 boys and 5 girls), after a 2-week nonwearing baseline period, were asked to use standard earmuffs and NC headphones for 2 weeks, in a random order. Parents or teachers rated participants' behaviours that were related to their reaction to auditory stimuli.

Results

Four participants refused to wear either the earmuffs or the NC headphones. It was found that the T-score on the Goal Attainment Scaling was significantly higher during the earmuff period than that in the baseline period (Z = 2.726, p = .006). The behaviours of 5 children with ASD improved during the NC headphone period as compared with those in the baseline period; there were no differences in the T-scores on the Goal Attainment Scaling between the NC headphone period and the baseline period (Z = 1.689, p = .091) and between the earmuff and NC headphone periods (Z = -0.451, p = .678).

Conclusion

This study demonstrated the effectiveness of standard earmuffs and NC headphones in helping children with ASD to cope with problem behaviours related to hyperreactivity to auditory stimuli, therefore, children with ASD could use earmuffs to help to deal with unpleasant sensory auditory stimuli.

Measurement and comparison of individual external doses of high-school students living in Japan, France, Poland and Belarus-the 'D-shuttle' project

Twelve high schools in Japan (of which six are in Fukushima Prefecture), four in France, eight in Poland and two in Belarus cooperated in the measurement and comparison of individual external doses in 2014. In total 216 high-school students and teachers participated in the study. Each participant wore an electronic personal dosimeter 'D-shuttle' for two weeks, and kept a journal of his/her whereabouts and activities. The distributions of annual external doses estimated for each region overlap with each other, demonstrating that the personal external individual doses in locations where residence is currently allowed in Fukushima Prefecture and in Belarus are well within the range of estimated annual doses due to the terrestrial background radiation level of other regions/countries.

Relationship between Sympathetic Skin Responses and Auditory Hypersensitivity to Different Auditory Stimuli

[Purpose] Auditory hypersensitivity has been widely reported in patients with autism spectrum disorders. However, the neurological background of auditory hypersensitivity is currently not clear. The present study examined the relationship between sympathetic nervous system responses and auditory hypersensitivity induced by different types of auditory stimuli. [Methods] We exposed 20 healthy young adults to six different types of auditory stimuli. The amounts of palmar sweating resulting from the auditory stimuli were compared between groups with (hypersensitive) and without (non-hypersensitive) auditory hypersensitivity. [Results] Although no group × type of stimulus × first stimulus interaction was observed for the extent of reaction, significant type of stimulus × first stimulus interaction was noted for the extent of reaction. For an 80 dB-6,000 Hz stimulus, the trends for palmar sweating differed between the groups. For the first stimulus, the variance became larger in the hypersensitive group than in the non-hypersensitive group. [Conclusion] Subjects who regularly felt excessive reactions to auditory stimuli tended to have excessive sympathetic responses to repeated loud noises compared with subjects who did not feel excessive reactions. People with auditory hypersensitivity may be classified into several subtypes depending on their reaction patterns to auditory stimuli.

Study by Use of 1H NMR Spectroscopy of the Adsorption and Decomposition of Glycine, Leucine, and Derivatives in TiO2 Photocatalysis

The photocatalytic decomposition and adsorption of glycine (Gly), Gly-Gly, and Gly-Gly-Gly, and leucine (Leu), Leu-Gly, Gly-Leu, and Leu-Gly-Gly, in TiO₂ (100% anatase crystal form) aqueous suspension were investigated by ¹H NMR spectroscopy. The side chain of Leu, the carboxylic group, and the peptide bond were recognized as the adsorptive sites of the peptides on the surface of TiO₂. For Gly-Leu and Leu-Gly-Gly, the photocatalytic decomposition that took place under UV irradiation resulted from the preferable adsorption of the hydrophobic side chain of Leu on the TiO₂ surface, while for Gly-Gly and Gly-Gly-Gly, the photodecomposition proceeded by weak adsorption of the peptide bonds on the surface of TiO₂.

Successful treatment using high-dose intravenous immunoglobulin in a patient with rapidly progressive interstitial pneumonia associated with dermatomyositis

Abstract A 36-year-old male patient with dermatomyo-sitis (DM) associated with rapidly progressive interstitial pneumonia (IP) was successfully treated by high-dose intravenous immunoglobulin (IVIG). He suffered from myopathy, skin lesions, and IP. In spite of the treatment with a high-dose corticosteroid, IP progressed rapidly. Then high-dose intravenous immunoglobulin (20 g/day, 4 days) was administered. The skin lesions, myopathy, and pulmonary lesions improved. High-dose IVIG was considered to be a relatively safe and effective treatment for progressive IP associated with DM.

Usefulness of near-infrared spectroscopy to detect brain dysfunction in children with autism spectrum disorder when inferring the mental state of others

AIMS

The purpose of this study was to examine the usefulness of near-infrared spectroscopy (NIRS) for identifying abnormalities in prefrontal brain activity in children with autism spectrum disorders (ASD) as they inferred the mental states of others.

METHODS

The subjects were 16 children with ASD aged between 8 and 14 years and 16 age-matched healthy control children. Oxygenated hemoglobin concentration was measured in the subject's prefrontal brain region on NIRS during tasks expressing a person's mental state (MS task) and expressing an object's characteristics (OC task).

RESULTS

There was a significant main effect of group (ASD vs control), with the control group having more activity than the ASD group. But there was no significant main effect of task (MS task vs OC task) or hemisphere (right vs left). Significant interactions of task and group were found, with the control group showing more activity than the ASD group during the MS task relative to the OC task.

CONCLUSIONS

NIRS showed that there was lower activity in the prefrontal brain area when children with ASD performed MS tasks. Therefore, clinicians might be able to use NIRS and these tasks for conveniently detecting brain dysfunction in children with ASD related to inferring mental states, in the clinical setting.

Study of understanding the internalized stigma of schizophrenia in psychiatric nurses in Japan

AIM

 'Internalized stigma' is a construct that reflects the degree to which a person accepts beliefs endorsed by society about mental illness. Among people with schizophrenia spectrum disorders, internalized stigma has been found to moderate the associations between insight and social function, hope, and self-esteem. Among families of patients with schizophrenia, internalized stigma may not only hinder help-seeking but also result in the families attempting to provide care themselves, without assistance from mental health services. Little is known about internalized stigma among service providers, especially psychiatric nurses in Japan. Therefore, we investigated the correlation between internalized stigma and 'beliefs about the most appropriate form of hospitalization' among psychiatric nurses.

METHODS

The subjects were 215 psychiatric nurses employed in psychiatric hospitals who completed the personal stigma scale, perceived stigma scales, and Difficulty of Community Living Scale (DCLS) with respect to a chronic schizophrenia case vignette.

RESULTS

Internalized stigma was positively correlated with greater 'beliefs about the most appropriate form of hospitalization' among psychiatric nurses. We also showed that stronger 'beliefs about the social disadvantages of schizophrenia patients in the community' was positively correlated with stronger 'beliefs about the most appropriate form of hospitalization'.

CONCLUSION

The present findings suggest that the psychiatric nurses employed at Japanese psychiatric hospitals have a pessimistic view of the community living of people with schizophrenia and their families. And these psychiatric nurses' beliefs were related to their understanding of the deeply dependent relationship between patients and families, and was related to the Confucian ideal.

Caregiver burden and coping strategies for patients with schizophrenia: comparison between Japan and Korea

AIM

With the current shift to community-centered mental health services, considerable research on the family burden of caring for patients with schizophrenia has been conducted in developed countries. However, there has been no investigation of families with Japanese or Korean sociocultural backgrounds. Therefore, the present study compared the caregiver burden and coping strategies of families of patients with schizophrenia in Japan and Korea in order to elucidate similarities and differences in the sociocultural factors that affect the care experience of families in Northeast Asia.

METHODS

A total of 99 Japanese (Nagasaki) and 92 Korean (Seoul, Daegu) family members of patients with schizophrenia were surveyed in regards to caregiver burden, coping strategies, and nursing awareness of the caregiver role regarding the patient with schizophrenia.

RESULTS

Analysis revealed the following: (i) although no difference in caregiver burden and coping strategy was observed between the countries, the nursing awareness of families' caregiver role was significantly higher in Japan than in Korea; (ii) caregiver burden was significantly associated with the patient's social functioning and care needs in both countries; and (iii) caregiver burden was significantly associated with reduction of social interests, coercion, avoidance, resignation, and nursing awareness of caregiver role in both countries.

CONCLUSION

Although the nursing awareness of families' roles in caring for patients with schizophrenia differed between Japan and Korea, similar trends were observed for the causes of caregiver burden. These findings suggest that in order to provide effective support for reducing caregiver burden, the necessity of such support must be emphasized in both countries.

Excluded-volume effect on quasi-elastic light scattering by flexible macromolecules

First-order perturbation expressions are developed for the first cumulant (initial time derivative) of the dynamic structure factor observable by photon-correlation measurements of the light scattered by flexible chain molecules in solution. A dimensionless coefficient C, which measures the initial departure of the first cumulant from proportionality to the square of the scattering vector, is found to be only slightly altered by excluded-volume effects.

Burden and coping strategies in mothers of patients with schizophrenia in Japan

AIM

The present study was conducted to identify factors contributing to burden of care in 57 mothers caring for patients with schizophrenia.

METHODS

Members of the Federation of Families of People with Mental Illness in Nagasaki Prefecture were evaluated using well-validated scales to evaluate burden of care (eight-item short version of the Japanese version of the Zarit Caregiver Burden Interview), general health status (General Health Questionnaire 12-item version), difficulty in life, coping strategies, emotional support, and understanding of mental illness and disorders.

RESULTS

Burden of care was significantly associated with general health status and difficulty in life.

CONCLUSION

On multiple regression it was found that 'social interests' and 'resignation', both of which are the subscales of coping strategies, exerted significant and independent effects with respect to burden of care.

Pulmonary Mycobacterium avium complex infection associated with the IVS8-T5 allele of the CFTR gene

BACKGROUND

The T5 allele in intron 8 (IVS8) on specific haplotype backgrounds (e.g., long TG repeats) causes abnormal splicing in the cystic fibrosis transmembrane conductance regulator (CFTR) gene, and is also known to be associated with chronic airway diseases.

OBJECTIVE

To investigate the role of CFTR variations for susceptibility to pulmonary Mycobacterium avium complex (MAC) infection.

PARTICIPANTS

Three hundred patients with pulmonary MAC infection (72 males, 228 females; mean age at onset 61.6 + or - 12.4 years) took part in this study. Diagnosis of MAC infection was based on American Thoracic Society criteria. Clinical profiles were collected and blood samples were genotyped for TG repeats, poly-T and M470V polymorphisms.

RESULTS

We found significantly higher T5 frequency in MAC patients than in healthy controls from our own study (0.035 and 0.005, respectively, P = 0.023) and other reports. Homozygote for the T5 allele was found in two MAC patients. All T5 alleles were associated with longer TG repeats, the TG12 or TG13 allele. Seventeen of the 21 T5 alleles appeared to be associated with the V470 allele. Other polymorphisms did not show any significant differences in frequency.

CONCLUSIONS

These findings suggest that the IVS8 5T allele might be involved in susceptibility to pulmonary MAC infection.

Pulmonary Mycobacterium avium complex infection: association with NRAMP1 polymorphisms

The present study aimed to elucidate risk factors for nonimmunocompromised pulmonary Mycobacterium avium complex (MAC) infection. Epidemiological data and variations of candidate genes for mycobacterial diseases were analysed in 111 patients with pulmonary MAC infection. Four polymorphisms of the human natural resistance-associated macrophage protein (NRAMP)1 gene, the 5'(GT)n, 469+14 G/C, D543N and the 3'untranslated region (3'TGTG) insertion/deletion, were genotyped using PCR-based methods. Fok I and Taq I polymorphisms of the vitamin D receptor gene and -221 X/Y and codon 54 A/B polymorphisms of the mannose binding lectin gene were also evaluated. Females were more susceptible to MAC infection mainly affecting the right middle lobe or lingular segment of the lung. Patients' residence at the onset of the disease was distributed evenly irrespective of a waterfront or city water supply system. As compared with homozygotes for major alleles of the D543N and TGTG insertion/deletion polymorphism of the NRAMP1 gene, heterozygotes containing minor alleles were less often observed in MAC cases than in controls. This genetic effect was more significant in patients without comorbidity but not in patients with comorbidity. Other polymorphisms did not show any association with the MAC infection. The human natural resistance-associated macrophage protein 1 gene might be involved in susceptibility to pulmonary Mycobacterium avium complex infection.

Clear distinction between preattentive and attentive process in schizophrenia by visual search performance

Visual information-processing deficits were investigated in patients with schizophrenia using visual search tasks. Subjects comprised 20 patients with schizophrenia and 20 normal subjects. Visual search tasks were modified from those used previously to reveal more distinct differences between feature and conjunction search tasks. The presentation area of items in the present study was more than double the area used in our previous study [Mori, S., Tanaka, G., Ayaka, Y., Michitsuji, S., Niwa, H., Uemura, M., Ohta, Y., 1996. Preattentive and focal attentional processes in schizophrenia: a visual search study. Schizophrenia Research 22, 69-76], and items were distributed over the area randomly in each trial to produce a certain range of locational jitter for each item across trials that prevented a matrix-like presentation of items at fixed positions [Mori, S., Tanaka, G., Ayaka, Y., Michitsuji, S., Niwa, H., Uemura, M., Ohta, Y., 1996. Preattentive and focal attentional processes in schizophrenia: a visual search study. Schizophrenia Research 22, 69-76]. The target was a red square, and distractors were red circles in the feature search task and red circles and green squares in the conjunction search task. Slopes and intercepts of a linear function relating reaction times to set size were computed. In the feature search task, slopes for both groups were almost zero. In the conjunction search task, significant differences in slopes were seen between the two groups irrespective of target presence or absence. Moreover, the slopes were approximately twice as steep during target absence as during target presence. These results indicate more definitively than the results of our previous study [Mori, S., Tanaka, G., Ayaka, Y., Michitsuji, S., Niwa, H., Uemura, M., Ohta, Y., 1996. Preattentive and focal attentional processes in schizophrenia: a visual search study. Schizophrenia Research 22, 69-76] that patients with schizophrenia have deficits in focal attentional processing, although their preattentive processing functions at a normal level.

Tumour necrosis factor and lymphotoxin A polymorphisms and lung function in smokers

Genetic variants in the tumour necrosis factor (TNF) gene have been investigated in chronic obstructive pulmonary disease (COPD). However, there are many instances of nonreplication of these associations due to insufficient power or other factors. In this study, a large number of subjects were examined to elucidate whether genetic variations of TNF and/or lymphotoxin A (LTA), which is clustered with TNF, are associated with variations in lung function among smokers. The present authors designed two nested case-control studies in the National Heart, Lung, and Blood Institute Lung Health Study (LHS), which enrolled 5,887 smokers. The first design included continuous smokers who had the fastest (n = 279) and the slowest (n = 304) decline of lung function during the 5-yr follow-up period, and the second included the subjects who had the lowest (n = 533) and the highest (n = 532) post-bronchodilator % predicted forced expiratory volume in one second at the start of the LHS. Within the TNF and LTA region, 10 tagging single-nucleotide polymorphisms were selected and genotyped. Unlike the previous associations between TNF-308 and COPD in Asians, the current study found no association between either of the two phenotypes and the LTA and TNF polymorphisms. In conclusion, these results support the findings of previous studies in late-onset chronic obstructive pulmonary disease in Caucasian populations.

Efficacy of 3-year psychiatric daycare treatment in patients with schizophrenia

The present study investigated the efficacy of a 3-year psychiatric daycare (DC) program with regard to psychiatric symptoms and difficulties with daily living experienced by patients with schizophrenia. The subjects were 28 patients who met the diagnostic criteria from the 4th edition of the Diagnostic and Statistical Manual for schizophrenia and continued DC treatment for 3 years. The present study assessed participants at two points: at the start of DC and after 3 years, by evaluating socioeconomic factors and Brief Psychiatric Rating Scale (BPRS) scores. In addition, in order to measure difficulties with daily living, the Life Assessment Scale for the Mentally Ill (LASMI) and the Etoh Daycare Assessment Scale (ETODAS) developed at the Etoh Hospital, were used. Results indicated that no significant changes in socioeconomic factors or BPRS scores occurred during the 3-year period of DC treatment. However, over this period, mean scores (+/- standard deviation [SD]) for LASMI subcategories decreased from 1.6 +/- 0.8 points to 0.9 +/- 0.7 for daily living and from 1.7 +/- 0.8 to 1.2 +/- 0.7 for interpersonal relations, indicating significant improvement (P < 0.05). In addition, mean scores (+/-SD) for the ETODAS subcategories increased from 3.4 +/- 0.8 to 4.1 +/- 0.8 for expressiveness, from 3.3 +/- 0.9 to 4.0 +/- 0.8 for communication, from 3.1 +/- 0.6 to 3.6 +/- 1.0 for initiative within a group, and from 3.4 +/- 0.5 to 3.8 +/- 0.7 for cooperation in work activities, indicating significant improvement (P < 0.05). The present study suggests that DC can enable patients with schizophrenia to maintain their condition without worsening the psychiatric symptoms, and to improve their daily living skills, social skills in human relations, and work skills.

Evaluating community attitudes to people with schizophrenia and mental disorders using a case vignette method

Utilizing the case vignette method, community attitudes about people with schizophrenia and mental disorders, and perceived causes of and images regarding schizophrenia were investigated. Participants comprised 1596 respondents living in the area covered by the K health center in N prefecture. The survey utilized the Mental Disorder Prejudice Scale, a case vignette, and other basic attributes. The case vignette survey yielded the following results: when asked about a landlord refusing to rent an apartment to the vignette subject, approximately 80% of respondents agreed with the landlord's decision. However, when asked about necessary conditions for the vignette subject to live in an apartment independently, only 2.4% of respondents chose 'difficult under any circumstance'. Approximately half of the respondents chose the following conditions: 'periodic visits to the hospital', 'availability of a system where people can discuss and address any problems that might arise' and 'attending a sheltered workshop or making attempts to rehabilitate'. Regarding acceptance as a neighbor after meeting the listed conditions, most respondents stated they would 'treat him just like any other neighbor' (47.3%), followed by 'help as much as possible in times of need' (36.3%). In other words, approximately 80.0% of respondents were willing to have the vignette subject as their neighbor. In addition, many respondents thought that schizophrenia is caused by problems in interpersonal relationships (64.8%) and represents an unstable disease (69.9%). When asked about having the subject as a neighbor, respondents were more willing to accept him as a neighbor after clarifying conditions for living arrangements.

Crisis-induced intermittency in two coupled chaotic maps: towards understanding chaotic itinerancy

The present paper considers crisis-induced intermittency in a system composed of two coupled logistic maps. Its purpose is to clarify a bifurcation scenario generating such intermittent behaviors that can be regarded as a simple example of chaotic itinerancy. The intermittent dynamics appears immediately after an attractor-merging crisis of two off-diagonal chaotic attractors in a symmetrically coupled system. The scenario for the crisis is investigated through analyses of sequential bifurcations leading to the two chaotic attractors and successive changes in basin structures with variation of a system parameter. The successive changes of the basins are also characterized by variation of a dimension of a fractal basin boundary. A numerical analysis shows that simultaneous contacts between the attractors and the fractal basin boundary bring about the crisis and a snap-back repeller generated at the crisis produces the intermittent transitions. Furthermore, a modified scenario for intermittent behaviors in an asymmetrically coupled system is also discussed.

Expression of glucose transporter 5 by microglia in human gliomas

Our previous studies indicate that glucose transporter 5 (GLUT5) is a microglial marker in routine paraffin sections, and is rarely present in monocytes/macrophages of the peripheral organs. We examined the expression of GLUT5 in 91 cases of human gliomas to characterize the microglial phenotype in glioma tissues. Immunohistochemistry was performed on formalin-fixed, paraffin-embedded sections using such antibodies as a GLUT5 antibody, two markers for activated microglia: major histocompatibility complex (MHC) class II Ag and macrophage scavenger receptor class A (MSR-A), and MIB-1 antibody. The immunoreactivity of GLUT5 was present in three microglial phenotypes: ramified (resting), activated, and ameboid (macrophagic) microglia in most of the cases. A double-labelling study of astrocytic tumours using GLUT5 and MIB-1 antibodies demonstrated a proportion of proliferating microglia. However, no morphological difference between MIB-1-positive, microglial cells and MIB-1-negative, microglial cells was found. The number of GLUT5-positive microglia was significantly (P < 0.001) higher in astrocytic tumours than in oligodendroglial tumours. Many GLUT5-positive microglia (up to 52% in total cells) were often observed in pilocytic astrocytomas, where microglial cells were predominantly ramified, and the number of MHC class II- or MSR-A-positive microglia was less than GLUT5-positive microglia. Thus, the present study indicated that intrinsic microglia can be a source of microglia/macrophages cell populations in astrocytic tumours, and that pilocytic astrocytomas often have a high proportion of microglial cells with mild activation.

Evaluating stigma against mental disorder and related factors

This study attempted to identify forms of stigma against individuals with mental disorders and related factors. The subjects comprised 2632 people living in the area covered by the K health center in N prefecture. Factor analysis of the Mental Disorder Prejudice Scale (1211 valid responses) identified three factors: 'rejection', 'peculiarity' and 'human rights alienation'. Regression analysis revealed that age, welfare activities, an active problem-solving attitude, lecture attendance, and previous contact, exerted independent effects with respect to 'rejection'. These results suggest the importance of disseminating accurate information and creating more opportunities for people to have meaningful interactions with people with mental disorders in order to dispell the stigma.