Unraveling the landscape of pediatric pancreatic tumors:Insights from Japan

Pediatric pancreatic tumors,though rare,pose significant diagnostic and manage-ment challenges.The recent,22-year nationwide survey on pediatric pancreatic tumors in Japan by Makita et al offers valuable insights into this uncommon enti-ty,revealing striking geographical variations and questioning current treatment paradigms.This editorial commentary analyzes the study's key findings,inclu-ding the predominance of solid pseudopapillary neoplasms and their younger age of onset,which contrast sharply with Western data.It explores the implications for clinical practice and research,emphasizing the need for population-specific approaches to diagnosis and treatment.The revealed limited institutional expe-rience and surgical management patterns prompt a reevaluation of optimal care delivery for these complex cases,suggesting benefits of centralizing healthcare services.Furthermore,the commentary advocates for international collaborative studies to elucidate the genetic,environmental,and lifestyle factors influencing the development and progression of pediatric pancreatic tumors across diverse populations.It also outlines future directions,calling for advancements in precision medicine and innovative care delivery models to improve global patient outcomes.Unraveling Makita et al's findings within the broader landscape of pediatric oncology can stimulate further research and clinical advancements in managing pancreatic and other rare tumors in children.

Effective use of the Japan Narrow Band Imaging Expert Team classification based on diagnostic performance and confidence level

Five years have passed since the Japan Narrow Band Imaging Expert Team (JNET) classification was proposed in 2014. However, the diagnostic performance of this classification has not yet been established. We conducted a retrospective study and a systematic search of Medical Literature Analysis and Retrieval System On-Line. There were three retrospective single center studies about the diagnostic performance of this classification. In order to clarify this issue, we reviewed our study and three previous studies. This review revealed the diagnostic performance in regards to three important differentiations.(1) Neoplasia from non-neoplasia;(2) malignant neoplasia from benign neoplasia;and (3) deep submucosal invasive cancer (D-SMC) from other neoplasia. The sensitivity in differentiating neoplasia from non-neoplasia was 98.1%-99.8%. The specificity in differentiating malignant neoplasia from benign neoplasia was 84.7%-98.2% and the specificity in the differentiation D-SMC from other neoplasia was 99.8%-100.0%. This classification would enable endoscopists to identify almost all neoplasia, to appropriately determine whether to perform en bloc resection or not, and to avoid unnecessary surgery. This article is the first review about the diagnostic performance of the JNET classification. Previous reports about the diagnostic performance have all been retrospective single center studies. A large-scale prospective multicenter evaluation study is awaited for the validation.

An Inquiry into the Approach to Asian Regional Trade Integration Under the Belt and Road Initiative——The Case of the Alignment of a China-Japan-South Korea Free Trade Area

It has been five years since the Belt and Road Initiative (BRI) was first introduced. Though there has been a growing body of literature on regional cooperation between covered countries, Japan and South Korea have been barely discussed. This paper starts with the consensus-based mechanism of a China-Japan-South Korea Free Trade Area (FTA) to probe the approach of its alignment with the BRI in terms of the sequence of “master plans,”“viability of cooperation,” and “embedding of rules.” This inquiry found that the three countries have a shared interest in cooperation in Central Asia to which China prefers a pragmatic approach, while Japan and South Korea an approach combining idealism with pragmatism. Given the huge potential of cooperation between the trio, it is suggested that a “Central Asia chapter” be incorporated in the negotiation framework of this trilateral FTA, and that the design feature three aspects;fundamental principles, specific rules, and an executive body with a view to functionally contributing to regional trade integration in Asia. This approach may also be applied to the alignment of other Asian areas with the BRI.

MINERALOGY OF COASTAL DEPOSITS OF NORTH-WESTERN SEA OF JAPAN

Distribution of heavy, light and clay minerals in Late Pleistocene—Holocene deposits from different coastal environments (beaches, lagoons, dunes, relict lakes, ria bays and inlets, open inlets) was analysed. It was established that mineralogical composition of coastal deposits was a result of provenance and its hypergenous changes, transformation of material within transit zone, and accumulative conditions of inshore zone. Contents of stable minerals increase in deposits of the inlets confined to mouths of the small streams and in horizons of the sections, formed during regressive phases. Unstable minerals amount is higher in deposits of inlets, confined to mouths of the large river. The clay mineral fraction of shelf sediments consists mostly of illite. Authigenous pyrites dominate in deposits of ria bays, lagoons and relict lakes, formed during transgressive phases. Volcanic glass, found in deposits, is product of Holocene eruptions of Baegdusan (Baitushen) Volcano.

Susceptibility of Aedes flavopictus miyarai and Aedes galloisi mosquito species in Japan to dengue type 2 virus

Objective: To evaluate the potential of local mosquitoes to act as vectors for dengue transmission in Japan.Methods: Serotype 2 Th NH28/93 was used to test the dengue susceptibility profiles of Aedes flavopictus miyarai(Ae. f. miyarai), Aedes galloisi(Ae. galloisi) and Aedes albopictus(Ae.albopictus), which were collected in Japan. We used Aedes aegypti from Thailand as a positive control. The mosquitoes were infected with the virus intrathoracically or orally. At 10 or 14 days post infection, the mosquitoes were dissected and total RNA was extracted from their abdomens, thoraxes, heads and legs. Mosquito susceptibility to dengue virus was evaluated using RT-PCR with dengue virus-specific primers. Differences in the infection and mortality rates of the different mosquito species were tested using Fisher's exact probability test.Results: The infection rates for dengue virus administered intrathoracically to Ae. f. miyarai,Ae. galloisi and Aedes aegypti mosquitoes were identical by RT-PCR on Day 10 post infection.All of the body parts we tested were RT-PCR-positive for dengue virus. For the orally administered virus, the infection rates in the different body parts of the Ae. f. miyarai mosquitoes were slightly higher than those of Ae. albopictus mosquitoes, but were similar to the control mosquitoes(P > 0.05). The mortality rates for Ae. f. miyarai and Ae. albopictus mosquitoes were similar(P = 0.19). Our data indicated that dengue virus was able to replicate and disseminate to secondary infection sites in all of the four mosquito species(Japanese and Thai).Conclusions: Ae. albopictus is a well-known candidate for dengue transmission in Japan. However, our data suggest that Ae. f. miyarai from Ishigaki Island(near Okinawa Island) and Ae. galloisi from Hokkaido(Northern Japan) should also be regarded as potential vectors for dengue transmission in these regions. Further studies on these mosquitoes should be conducted.

Differences in Self-Assessment Regarding Eating Behaviors among Female University Students Living in Japan, Korea, and Austria

Objective: To investigate cross-cultural differences in self-assessments of eating behaviors of female university students who bear responsibility for their own eating behaviors and who will, in the future, likely determine a family’s eating style. Design: A cross-cultural comparison. Setting: Japan, South Korea, and Austria. Subjects: Female university students from Japan (n = 276), Korea (n = 103), and Austria (n = 127). The survey comprised a questionnaire containing ten sections about eating behaviors (eating habits, regular meal times, and frequency of food intake) and eating attitudes. Results: Eating behaviors and attitudes differed significantly among the three cultures. Japanese students practiced healthier eating behaviors than did Korean and Austrian students, on the basis of their variety of food intake and regular consumption of three meals, but rated themselves lower on healthy eating behaviors. Austrian students tended to have more independent attitudes toward eating and food preparation (e.g., “I want to eat only my favorite dishes”) than Japanese or Korean students. Conclusions: Effects of cultural differences in psychological processes, such as self-cognition, emotion, motivation, and values, on self-assessment of eating behaviors is suggested.

Hemorrhagic gastric and duodenal ulcers after the Great East Japan Earthquake Disaster

AIM:To elucidate the characteristics of hemorrhagic gastric/duodenal ulcers in a post-earthquake period within one medical district.METHODS:Hemorrhagic gastric/duodenal ulcers in the Iwate Prefectural Kamaishi Hospital during the 6-mo period after the Great East Japan Earthquake Disaster were reviewed retrospectively.The subjects were 27patients who visited our hospital with a chief complaint of hematemesis or hemorrhagic stool and were diagnosed as having hemorrhagic gastric/duodenal ulcers by upper gastrointestinal endoscopy during a 6-mo period starting on March 11,2011.This period was divided into two phases:the acute stress phase,comprising the first month after the earthquake disaster,and the chronic stress phase,from the second through the sixth month.The following items were analyzed according to these phases:age,sex,sites and number of ulcers,peptic ulcer history,status of Helicobacter pylori(H.pylori)infection,intake of non-steroidal anti-inflammatory drugs,and degree of impact of the earthquake disaster.RESULTS:In the acute stress phase from 10 d to 1mo after the disaster,the number of patients increased rapidly,with a nearly equal male-to-female ratio,and the rate of multiple ulcers was significantly higher than in the previous year(88.9%vs 25%,P<0.005).In the chronic stress phase starting 1 mo after the earthquake disaster,the number of patients decreased to a level similar to that of the previous year.There were more male patients during this period,and many patients tended to have a solitary ulcer.All patients with duodenal ulcers found in the acute stress phase were negative for serum H.pylori antibodies,and this was significantly different from the previous year’s positive rate of 75%(P<0.05).CONCLUSION:Severe stress caused by an earthquake disaster may have affected the characteristics of hemorrhagic gastric/duodenal ulcers.

Global Warming in Japanese Cities from 1960 to 2019 Using Machine Learning

In this study, we investigated the variations in warming between Japanese cities for 1960-1989, and 1990-2019 using principal component analysis (PCA) and k-means clustering. The precipitation and sunshine hours exhibited opposite tendencies in the PCA results. It was found that 1960M and 1990M had a correlation (r = 0.51). The 1960M and 1990M are the mean temperature anomalies in Japanese cities for 1960-1989 and 1990-2019, respectively. There was a strong correlation between temperature and precipitation (r = 0.62). There was an inverse correlation between 1960M and sunshine hours (r = −0.25), but a correlation between 1990M and sunshine hours (r = 0.11). Sunshine hours had less effect on the 1960M but more impact on the 1990M. The k-means clustering for 1960M and 1990M can be classified into four types: high 1960M and high 1990M, which indicates that global warming is progressing rapidly (Sapporo, Tokyo, Kyoto, Osaka, Fukuoka, Nagasaki), low 1960M and low 1990M, global warming is progressing slowly (Nemuro, Ishinomaki, Yamagata, Niigata, Fushiki, Nagano, Karuizawa, Mito, Suwa, Iida, Hamada, Miyazaki, Naha), low 1960M and high 1990M, global warming has accelerated since 1990 (Utsunomiya, Kofu, Okayama, Hiroshima), and normal 1960M and normal 1990M, the rate of warming is normal among the 38 cities (Asahikawa, Aomori, Akita, Kanazawa, Maebashi, Matsumoto, Yokohama, Gifu, Nagoya, Hamamatsu, Kochi, Kagoshima). Higher annual temperatures were correlated with higher annual precipitation according to the k-means clustering of temperature and precipitation. Two of the four categories consisted of places with high annual temperatures and high precipitation (Fushiki, Kanazawa, Kochi, Miyazaki, Kagoshima, Naha, Ishigakijima), and places with low annual temperatures and low precipitation (Asahikawa, Nemuro, Sapporo, Karuizawa).

Application of appropriate use criteria for percutaneous coronary intervention in Japan

The aim of this review was to summarize the concept of appropriate use criteria(AUC) regarding percutaneous coronary intervention(PCI) and document AUC use and impact on clinical practice in Japan, in comparison with its application in the United States. AUC were originally developed to subjectively evaluate the indications and performance of various diagnostic and therapeutic modalities, including revascularization techniques. Over the years, application of AUC has significantly impacted patient selection for PCI in the United States, particularly in non-acute settings. After the broad implementation of AUC in 2009, the rate of inappropriate PCI decreased by half by 2014. The effect was further accentuated by incorporation of financial incentives(e.g., restriction of reimbursement for inappropriate procedures). On the other hand, when the United States-derived AUC were applied to Japanese patients undergoing elective PCI from 2008 to 2013, about one-third were classified as inappropriate, largely due to the perception gap between American and Japanese experts. For example, PCI for low-risk non-left atrial ascending artery lesion was more likely to be classified as appropriate by Japanese standards, and anatomical imaging with coronary computed tomography angiography was used relatively frequently in Japan, but no scenario within the current AUC includes this modality. To extrapolate the current AUC to Japan or any other region outside of the United States, these local discrepancies must be taken into consideration, and scenarios should be revised to reflect contemporary practice. Understanding the concept of AUC as well as its perception gap between different counties will result in the broader implementation of AUC, and lead to the quality improvement of patients' care in the field of coronary intervention.

Evolution History of Gassan Volcano, Northeast Japan Arc

Evolution history of the volcano is essential not only to characterize the volcano, but also consider magma genesis beneath the volcano. Most of the stratovolcanoes in northeast Japan follow a general evolutional course: cone building, horse-shoe shaped caldera forming collapse, and post-caldera stages. However, the detailed history of each stage is not well investigated. We investigated evolution history of young edifice of Gassan volcano, representative stratovolcano in rear side of northeast Japan arc. Most of the products are lavas, which are divided into two groups by geomorphologic and geologic features. The former (Gassan lower lavas) is composed of relatively thin and fluidal lavas, whose original geomorphology remains a little, while the latter (Gassan upper lavas) is composed of relatively thick and viscous lavas, whose original geomorphology is moderately preserved. Based on geologic features, the upper lavas can be further divided into Gassan upper north lavas and upper summit lavas in ascending order. After the formation of the thick lavas, horse-shoe shaped caldera was formed by the instability of the edifice, probably triggered by fault activity. No evidence of post caldera activity inner part of it is observed. Based on K-Ar data, estimated age of Gassan lower lavas is ca. 0.75 to ca. 0.6 Ma, those of Gassan upper north and upper summit lavas are ca. 0.60 to ca. 0.55 Ma and ca. 0.55 to ca. 0.45 Ma. The eruption rate is estimated to be ca. 0.0004 km3/1000 years in Gassan lower lavas and ca. 0.02 km3/1000 years in Gassan upper summit lavas. These values are lower than the eruption rate of representative Japanese stratovolcanoes.

Comparison of price, volume and composition of services provided to inpatients for two procedures between a US and a Japanese academic hospital

Background: To drill down into why per capita health expenditures vary between the US and Japan, this exploratory study compares the price, volume and composition of services provided to inpatients for two procedures in an academic hospital in the US, and one in Japan. Methods: Detailed analysis of the amount reimbursed and services delivered was made from claims data for 449 acute myocardial infarction treated with coronary stents placed by percutaneous coronary intervention (PCI) and 115 heart valve dysfunction with heart valve replacement (HVR) cases in Johns Hopkins Hospital (JHH) Baltimore, Maryland, and 34 PCI and 21 HVR cases in Keio University Hospital (KUH), Tokyo. Results: After making appropriate adjustments, the reimbursed amount per discharge at JHH was significantly higher (Wilcoxon ranksum test, p < 0.01) for both medical conditions. This was due to more use of higher priced technology and higher prices for the same technology at JHH compared with KUH. However, medical imaging was performed more frequently at KUH and the reimbursed amounts per unit for the devices were higher at KUH. Analysis of room and board costs showed that the higher staffing level and wages of nurses at JHH was compensated by its shorter average length of stay for PCI, but not for HVR. Conclusion: Detailed analysis of the reimbursed amount and the utilization of services are needed to understand international variations in healthcare spending.

New Trends in Japan's“Indo-Pacific”Strategy

Introduced by the late Prime Minister Shinzo Abe and inherited and developed by Fumio Kishida,Japan's“Indo–Pacific”strategy has gradually taken shape.This strategy can be deemed a broad vision,covering a wide range of topics and an extensive network of partners,with a strong trend of pan-securitization.It is a comprehensive inter national st rateg y based on Japan's alliance policy and China containment strategy,following a global,security-oriented approach.Driven by considerations such as maintaining its economic status,realizing its long-cherished dream of becoming a political powerhouse,and containing China,Japan has stepped up its“Indo–Pacific”strategy,which may influence global development,undermine regional maritime security,and impede China's reunification process.Meanwhile,Japan's“Indo–Pacific”strategy faces the triple challenge of a strategic overdraft,the unstable economic foundations,and the weak external support.These constraints may not suffice to reverse the direction of Japan's“Indo–Pacific”strategy in the short term but will limit its effectiveness.

Recognition in Shape and Form’s Characteristics of Japanese&Vietnamese Traditional Daily Products

This paper presents the major analyses carried out on shape and form’s characteristic database from Japanese and Vietnamese traditional daily products(TDPs).The aim of the research is to recognize the vital specifications representing for a national style by comparing two different countries together.By using Quantification Theory Type III and Cluster analysis,firstly,the analyses were undergone separately for Japanese and then Vietnamese product data in succession so that a view of general direction for each country was caught.The result showing a difference in scale of“Complexity”and“Specification”axis between Japan and Vietnam leads to performance of the analysis done on combine database of the two countries to get a clearer view of correlation between them.However,the biggest difference between the two countries lies in“Form”(Geometric—Organic)axis.Continuously,for studying more deeply into outline of product shape,the main ratios that affect the appearance or gorgeousness of product’s outline were taken into account and analyzed.By comparing this result to the previous ones,finally a wider and more detail perspective of Japan and Vietnam shape’s specification in a mutual relationship was discovered.

The accumulation characteristics and exploration potential of oil and gas in the back-arc basin of Japan under the background of high heat flow

The Sea of Japan is located in the southeast margin of Eurasia, in the triangle area of the western Pacific Ocean. Due to the interaction of the Pacific plate, Eurasian plate and Philippine plate, its tectonic environment is complex, forming a typical trench-arc-basin system. At present, 148 oil and gas fields have been discovered in Japan, with an oil and gas resource of 255.78×10^(6) t, showing a good prospect for oil and gas exploration. Based on the previous research and the recently collected geological and geophysical data, the characteristics of tectonic-sedimentary evolution and geothermal field in the basins around the Sea of Japan are analyzed. The results show that the tectonic evolution of the basin is mainly controlled by plate subduction and back-arc oceanic crust expansion, and it mainly undergone four tectonic-sedimentary evolution stages: Subduction period, basin development period, subsidence period and compression deformation period. The overall heat flow value of Japan Sea is high, and it is distributed annularly along Yamato Ridge. The geothermal heat flow value is about 50–130 MW/m^(2), and the average heat flow is75.9±19.8 MW/m^(2), which has a typical “hot basin ”. The high heat flow background provides unique thermal evolution conditions for hydrocarbon generation, which leads to the high temperature and rapid evolution. The authors summarized as “early hydrocarbon generation, rapid maturity and shallow and narrow hydrocarbon generation window”. The type of oil and gas is mainly natural gas, and it mainly distributed in Neogene oil and gas reservoirs. The trap types are mainly structural traps, lithologic traps and composite traps. In addition, the pre-Neogene bedrock oil and gas reservoirs also show a good exploration prospect. The resource prospecting indicates that Niigata Basin, Ulleung Basin and kitakami Basin are the main target areas for future exploration and development.

GENERAL FEATURES OF POLAR LOWS OVER THE JAPAN SEA AND THE NORTHWESTERN PACIFIC

This study of the general features of occurrence frequencies, spatial distribution of locations, life time and cloud patterns of polar lows over the Japan Sea and the neighboring Northwestern Pacific in winter of 1995/1996 based on observation and satellite data showed that polar lows develop most frequently in mid winter over the Japan Sea (35-45°N ) and the Northwestern Pacific (30-50°N). They rarely form over the Eurasian Continent. Polar lows over the Northwestern Pacific are usually long lived (2-3 days). But polar lows over the Japan Sea are relatively short lived (1-2 days), because the east west width of the Japan Sea is relatively narrow and polar lows tend to decay after their passing over the Japan Islands. Generally speaking, polar lows over the Japan Sea are characterized by tight, spiral (or comma) cloud patterns on satellite images. It was observed that polar lows over the Japan Sea have a typically spiral cloud band with clear “eye” at their mature stage. In winter, because of the effect of the warm Tsushima Current, the annual mean SST of the Japan Sea is 5-9℃ higher than that of the same latitude oceans. The large sea air temperature difference sustained over the Japan Sea provides favorable condition for polar low formation. The general features of polar lows over the Japan Sea are compared with those of other areas where polar lows often occur.

Financial literacy,behavioral traits,and ePayment adoption and usage in Japan

This study investigates how financial literacy and behavioral traits affect the adoption of electronic payment(ePayment)services in Japan.We construct a financial literacy index using a representative sample of 25,000 individuals from the Bank of Japan’s 2019 Financial Literacy Survey.We then analyze the relationship between this index and the extensive and intensive usage of two types of payment services:electronic money(e-money)and mobile payment apps.Using an instrumental variable approach,we find that higher financial literacy is positively associated with a higher likelihood of adopting ePayment services.The empirical results suggest that individuals with higher financial literacy use payment services more frequently.We also find that risk-averse people are less likely to adopt and use ePayment services,whereas people with herd behavior tend to adopt and use ePayment services more.Our empirical results also suggest that the effects of financial literacy on the adoption and use of ePayment differ among people with different behavioral traits.

Assessment of Quality of Life, Family Function and Family Empowerment for Families Who Provide Home Care for a Child with Severe Motor and Intellectual Disabilities in Japan

Background: About 70% of Japanese children with severe motor and intellectual disabilities (SMID) live at home, and the number is increasing. Family members have an enormous burden of daily physical care for these children. A top priority is to understand quality of life (QoL), family function, and family empowerment to effectively support these families. We aimed to assess current living situations of families with a SMID child, and to reveal the relationships between QoL, family function, and family empowerment. Methods: Sixty-five family members from 34 families with a SMID child participated in this study. We assessed 5 parameters using the Japanese versions of the following instruments: World Health Organization Quality of Life 26 (WHOQOL26), Kinder Lebensqualitats Fragebogen (KINDL), Family Assessment Device (FAD), Family Adaptability and Cohesion Evaluation Scale KG-4 (FACESKG-4), and Family Empowerment Scale (FES). Correlation and multiple regression analyses were conducted;QoL score was the objective variable. Results: Participants included 54 parents (34 mothers, 20 fathers) and 11 siblings. The mean age of SMID children was 10.4 ± 5.03 years. Twenty-two children needed multiple types of medical care. The mean age of parents and siblings was 41.5 ± 6.16 years and 15.5 ± 2.35 years, respectively. The mean QoL score (3.28 ± 0.5) was similar to the Japanese average. The mean KINDL score (77.2 ± 12.1) was higher than those of previous studies. The mean FAD score was 1.97 ± 0.32. For FACEKG-4, the score of adaptability was correlated with WHOQOL score (r = 0.459, p < 0.05). The mean score of FES was 113.6 ± 14. As the result of multiple regression analysis, lower family FAD scores ([sb] = ?0.61, p < 0.01) indicated higher family function and greater age of participants (sb = 0.495, p < 0.01) was correlated with higher WHOQOL scores (F = 15.208, p < 0.01). Conclusions: Our results indicated that the individual QoL depended on the age of participants (equals the years of experience caring for a SMID child) and the recognition of family function as a whole. Thus, to improve family members’ QoL, we should focus on individuals and also approach the family as a whole.

The higher air temperature was closely associated with higher ambulance transports due to heat stroke in elderly Japanese

To investigate the link between higher air temperature and ambulance transports due to heat stroke, especially in elderly subjects, using daily data in Sai-tama prefecture in August, 2010, Japan. We obtained daily data of air temperature in Saitama prefecture in August, 2010, Japan from Japan Meteorological Agency. Number of ambulance transports due to heat stroke was also used by Saitama prefecture official website. The effect of high air temperature on am-bulance transports due to heat stroke was evaluated. A total of 1688 ambulance transports due to heat stroke was observed in Saitama prefecture in August, 2010, Japan. Seven hundred and twenty one subjects (42.7%) were over the age of 65. Mean air temperature, the highest air temperature and day light hours were significantly associated with ambulance transports due to heat stroke in total subjects (mean air temperature: r = 0.749, p < 0.0001) and the over the age of 7. In addition, by separate analysis as classified by age groups, the correlation coefficient between ambulance transports due to heat stroke and mean air temperature was the highest in subjects with over 65. However, the lowest air temperature was not cor-related with ambulance transports due to heat stroke. Higher air temperature was closely associated with higher ambulance transports due to heat stroke using daily data in Saitama prefecture in August, 2010, Ja-pan, especially in elderly subjects.

Family empowerment and associated factors in Japanese families raising a child with severe motor and intellectual disabilities

Objectives:Family caregivers raising children with severe motor and intellectual disabilities(SMID)experience the enormous burden of care.The concept of family empowerment is one of the important assessment indexes of family nursing from the perspective of providing comprehensive support for these families.The objective of this study was to identify the factors associated with the empowerment of families raising a child with SMID in Japan.Methods:We conducted a nationwide questionnaire survey involving 1659 primary caregivers raising a child with SMID through 89 special schools.We assessed the main outcomes using the Family Empowerment Scale(FES).We then conducted a multiple linear regression analysis to reveal the factors associated with family empowerment.Results:In total,1362 primary caregivers were included in our study.Our results show that factors contributing to high FES scores are higher age of the primary caregiver,higher education,greater recognition of regional support,lower childcare burden,higher utilization of home visit services,higher usage of a childcare institution,higher household income,and stronger family bonding.Conclusion:Healthcare professionals should carefully assess the state of family empowerment of the primary caregivers who are younger and those who have low education,low household income,high childcare burden,and fragile bonding with the family.Second,they should encourage such families to use regional support resources for childcare.That is,policy makers should consider ways to promote home visits and institutional services for the care of children with SMID,aiming especially for the provision of well-coordinated care and services.

Evaluation of the effects of a leader-training program on public health nurse leadership for staff in Japan

This paper is a report of a study of the effects of a leader-training program, focusing on how public health nurse (PHN) leaders manage staff. In Japan, a system of training after graduation or training after acquisition of the PHN license has not been established. At present, PHN leaders are unable to devote as much time as they previously could to in-service education, and this has made it difficult to establish a suitable full-fledged in-service education system. Therefore, it is paramount for PHN leaders to acquire the necessary competence to train staff efficiently and, ultimately, play a more prominent role in the in-service education of novice PHNs. The effecttiveness of this program was evaluated before and after conducting the program over a 1-year period. A total of 145 leaders working for local government agencies in Japan participated in the program, and data from 87 participants were analyzed. Before the training program, Plan-Do-Check-Act cycle activities were less frequent than after the program. Intervention using a leader-training program that combines group and on-the-job training is effective for PHN leaders.