ObjectivesProviding sufficient information about potential benefits and harms is essential in decision-making about participation in screening programs. Thyroid cancer screening (CS) with ultrasound is generally considered harmful and is not currently recommended. However, after nuclear accidents, thyroid CS has historically been performed as part of radiation effect surveys and post-accident response. Influencing factors must be considered when providing decision-making information to people in the area surrounding the Fukushima nuclear accident regarding the local government-led present opt-out screening. We aimed to identify factors associated with the decision to participate in thyroid CS in Fukushima using a scenario-based questionnaire survey among young people of the same age as the subjects of this screening.MethodsWe presented a scenario to female university students as if they were offered thyroid CS after the nuclear accident, and asked whether they would participate. We then provided a handout currently used in Fukushima regarding the potential benefits and harms of the screening, and asked respondents again about their willingness to participate. Next, we provided a leaflet outlining specific examples of overdiagnosis and its harms, and gave lectures on radiation health risks, radiation exposure doses in Fukushima, and CS. We again asked about respondents’ decisions about participation at each step. We assessed risk perception regarding cancer onset caused by radiation exposure and estimation of the potential benefits and harms of thyroid CS.Results16% of the 76 questionnaire respondents included the real subjects for thyroid CS in Fukushima. Immediately after reading the scenario and after providing the existing handout, 75% and 60% of respondents said they would participate in the screening, respectively. The most common reason for participation was seeking reassurance. After providing the leaflet about overdiagnosis and its harms and after giving lectures, the proportions of respondents who chose to participate decreased to 19% and 11%, respectively. In contrast, the proportions of respondents who chose not to participate increased to 15%, 24%, 53%, and 66% at each step. Decision-making at each step was not related to cancer risk perception of radiation, but to the estimation of potential harms.ConclusionsMany young residents participated in the local government-led thyroid CS in Fukushima because they were designated as targets. The current findings suggest that individuals chose to undergo screening to relieve anxiety when benefits were estimated to exceed harms. The handout currently used for thyroid CS does not adequately address overdiagnosis as the most significant harm of screening. Providing a leaflet with explanations of the harms of overdiagnosis changed the decision-making process and increased the number of respondents who chose not to participate because of potentially significant harmful effects. Furthermore, the decision to participate in the screening was influenced by explaining scientific evidence regarding low radiation exposure and low cancer risk from radiation in Fukushima, and the magnitude of overdiagnosis in thyroid CS. To develop adequate decision-making aids regarding CS with a high risk of overdiagnosis, specific tools explaining the harms of overdiagnosis are needed, in writing and through dialogue.

This study aimed to develop a scale to screen for eating disorders in female athletes. Preliminary survey: A total of 275 female athletes (mean age: 19.4 ± 1.0 years) and 7 female athletes diagnosed with eating disorders (mean age: 20.1 ± 2.5 years) were administered screening items prepared based on an existing scale, followed by exploratory factor analysis. Main survey: Six items, relating to three factors, were extracted, and 201 female athletes (mean age: 22.3 ± 4.8 years) and 6 female athletes diagnosed with current or a history of eating disorders (mean age: 18.8 ± 2.9 years) were queried. The diagnostic validity of the scale was then evaluated. Preliminary survey: Questions (α=0.71) were extracted from six items, relating to three factors, and collectively termed the University of Tokyo's eating disorders inventory in female athletes (TEDIFA). To determine the scale cut-off score, ROC analysis was performed with the total score, and the cut-off and gray zone scores were set at 13 and 11, respectively. Main survey: At the cut-off score of 13, AUC, sensitivity, and specificity were 0.83 (p < 0.05), 75%, and 90%, respectively. The scale that was developed, TEDIFA, consisted of six items. The cut-off scores were set at 11 for the gray zone (sensitivity: 75%; specificity: 56%; accurate diagnosis rate: 60%), and 13 for positivity (sensitivity: 75%; specificity: 90%; accurate diagnosis rate: 87%), demonstrating the reliability and validity of the scale.

【方法】2019年8月～10月に，国内8市の1,538の保育所等を対象に，郵送法により質問紙を配布し，979施設より回答を得た。このうち，運営形態に私立と回答し，栄養管理加算の認定の有無に回答があった684施設を本研究の解析対象とした。栄養管理については食事提供のPDCAサイクルとして12項目，保護者への栄養教育として栄養・食生活に関する情報提供について8項目を尋ねた。

We previously reported that treatment with thiazolidinediones (TZDs), such as troglitazone (Tro), downregulates the protein levels of peroxisome proliferator-activated receptor gamma (PPARγ), with enhanced lipid accumulation during 3T3-L1 murine adipocyte differentiation in the presence of 3-isobutyl methylxanthine, dexamethasone, and insulin (MDI). In this study, we performed DNA microarray analysis to compare the gene expression profiles of MDI-induced and MDI/Tro-induced 3T3-L1 adipocytes to elucidate the mechanism underlying the reduction in PPARγ protein expression by Tro treatment. Apoptotic process genes of Gene Ontology were selected from the upregulated genes in MDI/Tro-induced cells and analyzed using real-time RT-PCR and western blotting. For several proteins, higher expression was detected in MDI/Tro-treated 3T3-L1 cells than in MDI-treated cells. Plasmid expression analysis using 293T cells revealed that the expression of cell death-inducing DFFA-like effector C (Cidec) or Cbp/P300-interacting transactivator with Glu/Asp-rich carboxy-terminal domain 1 (Cited1) reduced PPARγ protein expression compared with the vector control. When 3T3-L1 preadipocytes transfected with small interfering RNA targeting Cidec or Cited1 were differentiated in response to MDI or MDI/Tro treatment, the reduction in PPARγ expression in MDI/Tro-treated 3T3-L1 adipocytes was partially suppressed. Our findings indicate that the expression of PPARγ protein is regulated in part by the induction of Cidec and Cited1 in MDI/Tro-treated 3T3-L1 adipocytes.

BackgroundThe Brief Sense of Community Scale is a widely accepted eight-item scale that measures the four dimensions of sense of community; however, the factor structure of the Japanese version of this scale has never been confirmed. In this study, we demonstrated the reliability and validity of the Japanese version of the Brief Sense of Community Scale.MethodsAfter completing the back translation of the scale, a sample of 993 Japanese individuals completed the Japanese version of the Brief Sense of Community Scale.ResultsThe results indicate that the Japanese version of the Brief Sense of Community Scale is comparable to the original scale and demonstrated adequate goodness-of-fit for both the four-factor and second-order models, which demonstrates its validity. Nonetheless, it remains necessary to consider possible cross-national cultural concerns when utilizing the scale.ConclusionsThe Japanese version of the Brief Sense of Community Scale will contribute toward the creation of a community in which all members feel comfortable.

BackgroundRelative age effect is defined as a phenomenon where children born early generally perform better than children born later in the same cohort. Physical activity is an important factor that might be influenced by the relative age effect. Socioeconomic factors (e.g., parent’s income, education level) are also associated with the adolescent’s physical activity. However, no existing study has examined whether socioeconomic factors moderate the relative age effect on the adolescent’s physical activity. This study aims to clarify whether and how birth month and socioeconomic factors relate to organized sports and physical activity among adolescents in Japan.MethodsWe conducted a questionnaire survey targeting 21,491 adolescents who live in a widespread neighborhood. We included 8102 adolescents (4087 males and 4015 females: mean age 13.1 ± 1.4) in the analysis. Based on the participants’ birth months, we divided them into four groups (April to June, July to September, October to December, January to March). We asked participants to report their organized sports participation. Using the International Physical Activity Questionnaire for Japanese Early Adolescents, we identified their moderate to vigorous physical activity (MVPA). Neighborhood-level socioeconomic factors (areal deprivation, average annual income, education level) were analyzed based on national surveys, such as the population census. We performed multilevel logistic and linear regression analysis for organized sports participation and MVPA, respectively. Moreover, a simple slope analysis was implemented if the interaction between birth month and socioeconomic factor was significant in the multilevel linear regression analysis.ResultsAmong males, relatively younger adolescents (adolescents who were born later in the same grade) were less likely to participate in organized sports activites (OR=0.90, 95% CI 0.82–0.97, p<0.05), while both males and females engaged in less MVPA (b=-0.54, b=-0.25, p< 0.01, respectively). We observed an interaction between birth month and socioeconomic factors. Among males in low-income neighborhoods, and females in more deprived neighborhoods, relatively younger adolescents engaged in less MVPA.ConclusionsSocioeconomic factors moderate the relative age effect on adolescents’ physical activity. The relative age effect on adolescents’ physical activity might be more likely to appear among adolescents from socioeconomically disadvantaged neighborhoods.

Abstract Background: Relative age effect is defined as a phenomenon where children born early generally perform better than children born later in the same cohort. Physical activity is an important factor that mitigates the relative age effect. Socioeconomic factors (e.g., parent’s income, education level) are also associated with the adolescent’s physical activity. However, no existing study has examined whether socioeconomic factors moderate the relative age effect on the adolescent’s physical activity. This study aims to clarify how birth month and socioeconomic factors moderate sports and physical activity among adolescents in Japan.Methods: We conducted a questionnaire survey targeting 21491 adolescents who live in a widespread neighborhood. We included 7138 adolescents (3701 males and 3437 females: mean age 13.06±1.44) in the analysis. Based on the participants’ birth month, we divided them into four groups (April-June, July-September, October-December, January-March). We asked participants to report their organized sports participation. Using the International Physical Activity Questionnaire for Japanese Early Adolescents, we identified their levels of sports activity and moderate to vigorous physical activity (MVPA). Neighborhood-level socioeconomic factors (areal deprivation, average annual income, education level) were analyzed based on national surveys, such as the population census. We performed multilevel logistic and linear regression analysis for organized sports participation and MVPA, respectively. Moreover, a simple slope analysis was implemented if the interaction between birth month and socioeconomic factor was significant in the multilevel linear regression analysis.Results: Among relatively younger adolescents (adolescents who were born later in the same grade), females were less likely to participate in organized sports activities (OR=0.91, 95% CI 0.85-0.98, p&lt;0.01), while both males and females engaged in less MVPA (b=-4.08, b=-2.50, p&lt;0.01, respectively). We observed an interaction between birth month and socioeconomic factors. Only low-income participants, females from more deprived neighborhoods, and relatively younger adolescents engaged in less MVPA. Conclusions: Socioeconomic factors moderate the relative age effect on adolescents’ physical activity. The relative age effect on adolescents’ physical activity might be more likely to appear among adolescents from socioeconomically disadvantaged neighborhoods.

BackgroundOverdiagnosis of thyroid cancer has become a major global medical issue. Ultrasound-based thyroid cancer screening has promoted overdiagnosis, and recently international recommendations state that it should not be conducted, even after a nuclear accident. The Fukushima thyroid cancer screening program was initiated in 2011 as a health policy after the nuclear accident. The risk of radiation-induced thyroid cancer was unlikely given the low radiation levels, but the thyroid cancer screening program has continued at 2-year intervals with a relatively high participation rate and is now in its fifth round. It is therefore crucial to clarify whether those targeted for screening understand the disadvantages of screening, and to identify factors that influenced their decision to participate.MethodsWe conducted an anonymous mail-based questionnaire among young people from Fukushima Prefecture (subjects) and a neighboring prefecture that was not targeted for screening (non-subjects). We asked them about the significance of the thyroid cancer screening in Fukushima Prefecture, their reasons for accepting or refusing screening, their perception of the harms of screening, and their opinions on thyroid examination at school. We compared the results of the questionnaire between subjects and non-subjects and between examinees (who were screened) and non-examinees (who declined screening).ResultsOnly 16.5% of respondents were aware of the harms associated with thyroid cancer screening, with most perceiving that the benefits outweighed the harms. Comparison of subjects’ and non-subjects’ responses showed there were no significant differences between the two groups. Among subjects, there were also no differences in responses between examinees and non-examinees. The most common reason for participation in screening was that the screening was conducted in schools and perceived as obligatory.ConclusionsThese results highlighted a serious ethical issue in that school-based screening leads to making young people think that it is mandatory screening in an opt-out and default setting manner, with a lack of knowledge about the disadvantages of screening. Based on the autonomy of the subjects and the ethical principle of the post-disaster, surveys after a nuclear disaster should be conducted in an opt-in style without an opt-out style such as school-based screening.