Oita Prefecture Research Articles

Measuring Household Thermal Discomfort Time: A Japanese Case Study

This study proposes a metric to measure households’ discomfort related to thermal consumption time (hereafter referred to as t-discomfort). This metric relies on an ideal thermal consumption and calculates the gap between the usage times of thermal devices in vulnerable households compared to the ideal household. The t-discomfort is quantified using thermal data collected from 1298 households in the Tokyo and Oita prefectures in Japan. To create the ideal usage times of thermal devices, households are categorized into three clusters—Vulnerable (Vu), Semi-vulnerable (SVu), and Invulnerable (IVu)—based on their energy poverty ratio, and t-discomfort is subsequently calculated for each group. The IVu households are used as the ideal reference point for measuring thermal device usage in the other two categories. The findings of the study indicate that energy poverty does not necessarily lead to t-discomfort. Interestingly, the consumption time of heating devices among Vu households in both prefectures is longer than that of IVu households, despite the high energy prices. Conversely, SVu households, which do not experience severe energy poverty, tend to sacrifice their comfort by reducing their thermal consumption time. Additionally, the consumption time of cooling devices among Vu households in Oita is longer than that of IVu households, whereas in Tokyo, it is shorter. Two treatment strategies are evaluated to mitigate thermal discomfort in households without compromising resource availability. The first strategy integrates the thermal device consumption time with Japan’s current regulated time-of-use rates plan (daytime and nighttime). The results propose a three-tiered tariff plan (off-peak, mid-peak, and peak) to reduce the energy cost burden for Vu households. The second strategy recommends the installation of 12 rooftop solar panels for households in Tokyo and 11 panels for households in Oita. This strategy aims to maintain thermal comfort via a sustainable natural energy resource while minimizing energy costs.

Analysing referral patterns from a primary dermatological clinic to other medical institutions for further care: A survey on patients with certain skin diseases in Japan

AbstractBackgroundVarious skin diseases exist; some require specialist treatment. Consequently, patients with these conditions are often referred from primary dermatological clinics to other medical institutions for further secondary or tertiary care. However, it has yet to be fully evaluated at primary dermatological clinics which skin conditions necessitate such referrals.ObjectivesThis study aims to identify skin conditions that often require further care when treated at a primary dermatological clinic.MethodsThis study enroled 14,306 patients who had visited the Ueo Dermatology Clinic (a primary dermatological clinic in Saiki City, Oita prefecture, Japan) from 1 January 2020 to 31 December 2022. The following clinical information was examined: the primary disease, age, sex, whether referrals (general or emergency) were made after the clinic visit or not, and the reasons for the referrals.Results'Eczema and dermatitis' was the most frequent category in the clinic, although the referral rates for this category were not exceptionally high compared to other categories. A large number of emergency referrals was observed for 'Viral infections (herpes zoster),' 'Drug‐induced skin reactions,' and 'Bacterial infections (cellulitis)'; a large number of general referrals was observed for 'Malignant skin tumours and melanomas' and 'Benign skin tumours.' Although low numbers, the rates for general and emergency referrals were high in the categories of 'Blistering Diseases,' 'Connective Tissue Diseases,' and 'Vasculitis, Purpura, and Other Vascular Diseases.' In an analysis of the reasons for the referrals, the following reasons ranked highest: requirement for high‐level medical treatment, surgical operation, or hospitalisation, and consultation with doctors in departments other than dermatology.ConclusionsThis study identified several skin conditions often requiring additional care when treated at a primary dermatological clinic. Based on these findings, seamless cooperation between primary clinics and specialised medical institutions is anticipated.

Survey of Medical Referral by Japanese Dentists for Patients With Hepatitis B, Hepatitis C, and Lichen Planus.

This study aimed to investigate the referral rates of oral lichen planus (OLP) and untreated hepatitis virus-infected patients by dentists to hepatologists. The study was conducted at three dental clinics in the Oita prefecture between November 2021 and June 2023. Two distinct groups of patients who visited the dentist for dental treatment were included: those with liver disease and concurrent hepatitis C virus (HCV) or hepatitis B virus (HBV) infection and those diagnosed with OLP. The rate of medical referrals to a hepatologist was investigated. Data on the number of patients, gender, age, diagnosis of liver disease, and referral practices were collected from the records submitted by each dental clinic. Information about the HCV and HBV infection status was collected through interviews with the dentists. A total of 1,665 patients were included, of which 10 were HCV-infected, five were HBV-infected, and six were diagnosed with OLP. None of the 15 patients with liver disease were referred to a hepatologist by their dentists. Nine out of the 10 HCV-infected patients had achieved sustained virological response (SVR) after antiviral treatment. Of the six patients with OLP, one had a history of HBV infection, one had severe fatty liver, and the remaining four had normal livers; five of the OLP patients were referred to a hepatologist (83.3%). A high referral rate from dentists to hepatologists was observed among the OLP patients. However, the study highlighted the difficulties in identifying hepatitis patients and establishing appropriate medical coordination in dental institutions.

Current status and issues regarding surgical education in the region: a questionnaire survey in Oita prefecture in Japan

BackgroundThe shortage and aging of surgeons in regional surgical care has been remarkable, and the importance of surgical education for young surgeons in the region is only increasing. However, there are very few reports about regional surgical education. This study aimed to clarify the current status and issues regarding surgical education in regional surgical care and to examine the ideal way to provide surgical education in the region.MethodsTwo questionnaire surveys were carried out. (1) “Survey on the awareness regarding the education of young surgeons” was conducted by mail in institutions where surgeons worked. (2) “Survey on the current status of surgical education for young surgeons” was conducted via the Internet with surgeons under 40 years old and mentors at the same facility.ResultsThere were 175 respondents to survey (1), among whom 131 (75%) surgeons were interested in educating young surgeons, and 112 (64%) were actively participating in this educating. Regarding the best evaluation methods for mentors who are educating young surgeons, the most frequent answer was “I don’t know (51%)”. The number of respondents in survey (2) was 87, including 27 (31%) young surgeons and 60 (69%) mentors. Although there was no difference between young surgeons and mentors in the level of satisfaction with the current status of young surgeons, 37% of young surgeons in urban areas were dissatisfied with their current status, compared to 0% in the regional area (p < 0.05).ConclusionsAlthough surgeons did not have confidence in their own education, the level of satisfaction among young surgeons was high even in those providing regional surgical care. Development of an evaluation system for surgical education is necessary for young surgeons to receive more effective surgical education in the region.

Hepatitis B and C infections among Japanese dental health workers: Insights from vaccination rates and screening results in the Oita prefecture.

This study examined the hepatitis B virus (HBV) and hepatitis C virus (HCV) infection rates and vaccination rates for hepatitis B (HB) among dental healthcare workers (DHCWs) in the Oita prefecture, Japan. Hepatitis virus testing was conducted on 1920 participants (486 dentists and 1434 dental staff). Anonymous data on age, gender, occupation, hepatitis B surface antigen (HBsAg), antibodies to hepatitis B surface antigen (anti-HBs), antibodies to HCV (anti-HCV), history of HB vaccination, and antiviral treatment for individuals with positive anti-HCV were collected. The positivity rates for HBsAg, anti-HBs, and anti-HCV were 0.5%, 39.7%, and 0.6%, respectively. Dentists had significantly higher rates of anti-HBs positivity (53.9% vs. 34.9%; p < .0001) and anti-HCV positivity (1.4% vs. 0.3%; p = .0080) compared to dental staff. The vaccination and non-vaccination rates among 1395 with a known HB vaccination history were 59.1% and 40.9%, respectively. Dentists had a significantly higher HB vaccine vaccination rate than the dental staff (73.6% vs. 54.0%; p < .0001). Those in the vaccination group were younger (p < .0001), had a higher proportion of males (p = .0022) and dentists (p < .0001), a lower HBsAg positivity rate (p < .0097), and a higher anti-HBs positivity rate (p < .0001) compared to those in the non-vaccination group. The positivity rate of HBsAg and anti-HBs in the unvaccinated group increased with age, with HBsAg positivity reaching 3.8% in the 70s and anti-HBs positivity reaching 40.4% in the 70s and 66.7% in the 80s. This study highlights the need to raise awareness about hepatitis prevention vaccination, particularly among dental staff, due to differences in HB vaccination rates across occupations. In particular, they indicated that elderly DHCWs may be more vulnerable to HBV infection. Regular monitoring of the vaccination rate and infection risk is crucial.

Current status and issues of emergency stroke transport in Oita Prefecture

Current status and issues of emergency stroke transport in Oita Prefecture

Predicting positron emission tomography brain amyloid positivity using interpretable machine learning models with wearable sensor data and lifestyle factors

BackgroundDeveloping a screening method for identifying individuals at higher risk of elevated brain amyloid burden is important to reduce costs and burden to patients in clinical trials on Alzheimer’s disease or the clinical setting. We developed machine learning models using objectively measured lifestyle factors to predict elevated brain amyloid burden on positron emission tomography.MethodsOur prospective cohort study of non-demented, community-dwelling older adults aged ≥ 65 years was conducted from August 2015 to September 2019 in Usuki, Oita Prefecture, Japan. One hundred and twenty-two individuals with mild cognitive impairment or subjective memory complaints (54 men and 68 women, median age: 75.50 years) wore wearable sensors and completed self-reported questionnaires, cognitive test, and positron emission tomography imaging at baseline. Moreover, 99 individuals in the second year and 61 individuals in the third year were followed up. In total, 282 eligible records with valid wearable sensors, cognitive test results, and amyloid imaging and data on demographic characteristics, living environments, and health behaviors were used in the machine learning models. Amyloid positivity was defined as a standardized uptake value ratio of ≥ 1.4. Models were constructed using kernel support vector machine, Elastic Net, and logistic regression for predicting amyloid positivity. The mean score among 10 times fivefold cross-validation repeats was utilized for evaluation.ResultsIn Elastic Net, the mean area under the receiver operating characteristic curve of the model using objectively measured lifestyle factors alone was 0.70, whereas that of the models using wearable sensors in combination with demographic characteristics and health and life environment questionnaires was 0.79. Moreover, 22 variables were common to all machine learning models.ConclusionOur machine learning models are useful for predicting elevated brain amyloid burden using readily-available and noninvasive variables without the need to visit a hospital.Trial registrationThis prospective study was conducted in accordance with the Declaration of Helsinki and was approved by the local ethics committee of Oita University Hospital (UMIN000017442). A written informed consent was obtained from all participants. This research was performed based on the Strengthening the Reporting of Observational Studies in Epidemiology reporting guideline.

A Questionnaire Survey of Prescription Preferences and Leftover Medication Conversations: Comparisons Among Kidney Disease Patients and Healthcare Professionals.

Patients with chronic kidney disease (CKD) and patients with kidney failure receiving hemodialysis (HD) receive various types of medications. However, little is known about the differences in medication preference and how to deal with leftover medication among CKD patients and HD patients. The purpose of this study was to investigate the differences in medication preference and ways of dealing with leftover medication between CKD patients, HD patients, physicians, and pharmacists via a questionnaire survey. The ethics committee of Oita University, Oita, Japan, approved this survey. Outpatients undergoing treatment by a nephrologist in four facilities in Oita prefecture, Japan, were asked to answer a questionnaire on their preference for medication and how to deal with leftover medication. Respondents gave their informed written consent. The same questionnaire was administered to nephrologists and pharmacists online. In this survey, 383 patients (260 patients with CKD and 123 patients with HD), 22 nephrologists, and 28 pharmacists responded. The response rate of valid responses was more than 90% for each of the groups. In particular, 41% of patients with CKD and 56% of patients with HD never inform their doctor about leftover medication or only inform them when there is a lot of leftover medication. On the other hand, 23% of physicians have never asked their patients about them. Ordinary logistic regression analysis indicated that there is no significant relationship between how often patients talk about leftover medication, patients' preferences, or patient states. Despite the age and state of the patients, it is important to discuss the perception of medication with each other and confirm the condition of the remaining medication to improve concordance and obtain the desired treatment effect.

Long-term trends of pediatric type 1 diabetes incidence in Japan before and after the COVID-19 pandemic

Type 1 diabetes incidence has increased worldwide, although the long-term trends on pediatric type 1 diabetes in Japan remain elusive. To investigate the incidence and secular trend of pediatric type 1 diabetes from 1999 to 2021, including the coronavirus disease 2019 (COVID-19) pandemic years, in Oita Prefecture, Japan. We investigated the number of newly diagnosed patients with type 1 diabetes aged < 15 years from 1999 to 2021. We surveyed hospital databases in Oita Prefecture in Japan. The type 1 diabetes incidence in children aged < 15 years increased annually by 5.3% among all children, especially in boys aged 10–14 years by 8.1%, over the past 23 years. The average incidence rate of 3.9/100,000/year was nearly consistent with the previous reports on Asian countries. No significant change was found in the increasing incidence trend of type 1 diabetes before and during the COVID-19 pandemic. The incidence of pediatric type 1 diabetes has significantly increased over the past 23 years in Oita Prefecture, Japan, which is consistent with the worldwide trend.

The Process and Challenges of Resident-Led Reconstruction in a Mountain Community Damaged by the Northern Kyushu Torrential Rain Disaster: A Case Study of the Hiraenoki Community, Asakura City, Fukuoka Prefecture, Japan

Frequent torrential rainfall disasters have occurred worldwide in recent years. In Japan, the Northern Kyushu Torrential Rainfall disaster in July 2017 caused extensive damage to Fukuoka and Oita prefectures and significantly impacted local landscapes, from which residents derive pride and identity and, hence, are of the utmost importance. Local communities in Japan are also at risk of extinction due to progressive depopulation. This study discusses community revitalization through landscape creation and related challenges based on the case of the Hiraenoki Community affected by the Northern Kyushu Torrential Rainfall disaster. We conducted long-term participant observations over two years and semi-structured interviews with all households in the community. We found that the landscape project revitalized local pride and involved numerous people outside the community, including the prefectural extension center, university, and Non-Profit Organization (NPO), and provided them with an opportunity to connect. On the other hand, our investigation also revealed the danger of obscuring the original purpose of reconstruction activities because of collaboration with outsiders. This case study elucidates the possibilities and challenges of resident-led reconstruction activities in communities that are facing depopulation and aging problems and are working with organizations within and outside the community.

New experimental approaches enabling the continuous monitoring of gas species in hydrothermal fluids

Hot thermal fluids flow through the Earth's crust and carry valuable information about the deep subsurface. The monitoring of natural tracers transported in geothermal fluids, such as gases or ions, are relevant to better understand the geological processes in the Earth's subsurface and their relation to deep fluid dynamics. Recently developed technologies (e.g., portable gas-equilibrium membrane-inlet mass spectrometry) allow for the continuous monitoring of gas species at a much higher temporal resolution than the sampling procedures commonly used, based on a few individual samples. However, the monitoring of gas species from hot thermal fluids still poses experimental challenges tied to unwanted water vapor condensation in the headspace of the separation module, which irremediably leads to clogging (e.g., of the connecting capillaries) and failure of the detection device. In this contribution, we present two new experimental methods that provide suitable technical conditions to measure gases, even in high temperature geothermal fluids, using a portable gas analyzer. Two sites with different thermal water temperatures (first one ranging from 50 °C to 65 °C and second one close to boiling temperature) were selected. The first method was deployed on the thermal waters of Lavey-les-Bains (Vaud, Switzerland), for which we report results from October 2021. The second method was used in Beppu (Oita Prefecture, Japan), for which we report results from April 2018. Our results show that at both sites, our methods allow for continuous measurements of gas species (N2, Ar, O2, Kr, He, CH4, CO2 and H2) in thermal waters. Furthermore, they show that the variability of gas emanation from the two sites can only be adequately described by measurements with high temporal resolution, which both methods allow.

Prevalence of antimicrobial resistant genes in Bacteroides spp. isolated in Oita Prefecture, Japan

IntroductionBacteroides spp. are the most common anaerobic bacteria isolated from the human gastrointestinal tract. Several resistant genes are present in Bacteroides spp. However, most studies have focused on the prevalence of the cfiA gene in Bacteroides fragilis alone. We assessed the susceptibility to antimicrobial agents and the prevalence of cepA, cfiA, cfxA, ermF, nim, and tetQ genes in Bacteroides strains isolated from clinical specimens in our hospital. MethodsWe isolated 86 B. fragilis and 58 non-fragilis Bacteroides strains from human clinical specimens collected from January 2011 to November 2021. Resistance against piperacillin (PIPC), cefotaxime (CTX), cefepime (CFPM), meropenem (MEPM), clindamycin, and minocycline was determined. ResultsThe resistant rates of penicillins and cephalosporins in non-fragilis isolates were significantly higher than those in B. fragilis isolates. In B. fragilis isolates, the resistant rates of PIPC, CTX, and CFPM in cfxA-positive isolates were significantly higher than those in cfxA-negative isolates (71% vs. 16%, 77% vs. 19%, and 77% vs. 30%, respectively). Thirteen B. fragilis isolates harbored the cfiA gene, two of which were resistant to MEPM. Six of the 13 cfiA-positive B. fragilis isolates were heterogeneously resistant to MEPM. ConclusionIt is important to evaluate the use of MEPM as empirical therapy for Bacteroides spp. infections, considering the emergence of carbapenem resistance during treatment, existence of MEPM-resistant strains, and heterogeneous resistance.

Root-knot nematode species in Oita Prefecture and occurrence of resistance-breaking nematode populations on tomato

Root-knot nematode species in Oita Prefecture and occurrence of resistance-breaking nematode populations on tomato

Using multisource satellite products to estimate forest aboveground biomass in Oita prefecture: a novel approach with improved accuracy and computational efficiency

Accurate estimation of forest aboveground biomass (AGB) using satellite information is crucial for quantitatively evaluating forest carbon stock for climate change mitigation. However, with the emergence of an enormous number of identical data, selecting the most valuable dataset for estimation is essential to improve model efficiency and accuracy. Here, we present a novel framework using principal component analysis (PCA)-derived textures to tackle redundant variables and the integration of multisource satellite images using the random forest regression algorithm with recursive feature elimination to map the AGB of deciduous broadleaf forests in Oita prefecture, Japan. Our results highlighted that the model using PCA and derivative features had the best performance [R2 = 0.69, root mean square error (RMSE) = 33.59 Mg/ha, mean absolute error = 25.01 Mg/ha, relative RMSE = 0.27]. In this case, of the 34 variables selected by RFE for the model, 19 were derived from principal components and corresponding textures, indicating a considerable improvement in using our novel framework to estimate AGB. Together, this study provides a valuable strategy for feature selection to lessen multicollinearity and redundancy.

Education and Awareness Activities Regarding Hepatitis B and C Among Japanese Dental Health Workers in the Oita Prefecture

Hepatitis B virus (HBV) and Hepatitis C virus (HCV) infections are known to pose a major threat for dental health workers (DHWs). Previously, we reported that the HBV and HCV infection rates among DHWs in the Oita Prefecture in Japan were higher than those among the general population. The aim of this study was to disseminate knowledge about hepatitis and its prevention among the DHWs. Educational booklets were mailed to 2,197 DHWs working in 487 dental clinics. After anonymously responding to online questions about their experience with HBV and HCV testing, Hepatitis B vaccination, and percutaneous injury, the subjects were required to respond to additional questions about their understanding of hepatitis. A total of 521 DHWs (205 males and 316 females) responded to the questionnaires. Among them, 61.6% had experienced percutaneous injuries, but only 19.4% were fully aware of how to deal with them before reading the booklet, and also 10.6% had sufficient knowledge about hepatitis. The past Hepatitis B vaccination, past HBV testing rate, and past HCV testing rate were 62.4%, 71.8%, and 43.2%, respectively. The DHWs who are not dentists (n = 293) had significantly lower rates of past testing for their own hepatitis virus, knowledge about treatment of percutaneous injuries, and awareness of hepatitis as compared to dentists (n = 228). After reading the booklet, 99.5% of subjects found the booklet useful and 87.3% said it would influence their future hepatitis testing. The educational booklet was effective way to increase DHWs' knowledge about Hepatitis B and C and how to manage percutaneous injuries.

Whole-genome analysis of red sea bream iridovirus spread in 2021 in Japan provided epidemiological and viral traits insight.

Red sea bream iridovirus (RSIV) is the pathogen that causes red sea bream iridoviral disease. It causes a huge loss to the Japanese aquaculture industry. In 2021, outbreaks of red sea bream iridovirus occurred in South Japan. This study analysed nine whole-genome sequences of RSIV isolated in Oita and Ehime Prefectures in 2021 using a short-read next-generation sequencer. Nine isolates had highly uniform sequences, and there was no variant depending on locations or host species. Phylogenetic analyses with other reported megalocytivirus isolates showed that RSIV isolated in 2021 was genetically different from RSIV previously isolated in Oita and Ehime Prefectures in 2017-2019. These results suggest that RSIV isolated in Oita and Ehime Prefectures in 2021 might spread from a common ancestor different from the recent one. Additionally, it was found that RSIV isolated in 2021 had sequence mutations on protein-coding sequences that may be involved in viral pathogenicity and infectivity.

Application of Methods for a Morphological Analysis of the Femoral Diaphysis Based on Clinical CT Images to Prehistoric Human Bone: Comparison of Modern Japanese and Jomon Populations from Hegi Cave, Oita, Japan.

A morphological analysis of ancient human bones is essential for understanding life history, medical history, and genetic characteristics. In addition to external measurements, a three-dimensional structural analysis using CT will provide more detailed information. The present study examined adult male human skeletons excavated from Hegi cave, Nakatsu city, Oita Prefecture. CT images were taken from the femurs of adult males (Initial/Early Jomon Period (n = 10) and Late Jomon Period (n = 5)). Cross-sectional images of the diaphysis from below the lesser trochanter to above the adductor tubercle were obtained using the method established by Imamura et al. (2019) and Imamura et al. (2021). Using Excel formulas and macros, the area of cortical bone, thickness, and degree of curvature were quantitatively analyzed. The results were compared with data on modern Japanese. The maximum thickness of cortical bone in the diaphysis and the degree of the anterior curvature were significantly greater in Late Jomon humans than in the other groups. In contrast to modern humans, the majority of Jomon femurs showed the S-shaped curvature with the medial side at the top position and the lateral side at the lower position. The present results demonstrate that Late Jomon humans had a wider range of activity than the other groups and also provide insights into diseases in the hip and knee joints of Jomon humans.

Distribution of Severe Fever with Thrombocytopenia Syndrome Virus and Antiviral Antibodies in Wild and Domestic Animals in Oita Prefecture, Japan.

Severe fever with thrombocytopenia syndrome (SFTS) is an emerging life-threatening infectious disease caused by the tickborne SFTS virus (SFTSV), first identified in China in 2009 and then in Japan in 2013. Human SFTS cases were reported to be concentrated in western Japan, but the epidemiological conditions of SFTSV infection in a specific region are still obscure. We performed an epidemiological study of SFTSV in Oita Prefecture on the island of Kyushu, located in western Japan. For our research, we collected sera from wild and domestic animals (deer, wild boars, raccoons, cats, and dogs) and ticks from January 2010 to November 2020 in Oita. The anti-SFTSV antibody positivity rate of deer in 2014 was significantly higher than that in 2011 (65% versus 27%, P < 0.001). The anti-SFTSV antibody positivity rates of deer, wild boars, raccoons, wild dogs, domestic dogs, and domestic cats were 55%, 12%, 27%, 1.8%, 0.53%, and 1.4%, respectively. Moreover, RT-PCR could not detect SFTSV in any tick sample. Of the six areas of Oita Prefecture, only the Eastern area showed no incidence or possibility of SFTSV infection among wild and domestic animals, ticks, and human beings. Further investigation is required to assess whether local seroepidemiology in animals will help assess the risk of SFTSV infections in inhabitants.

Damaged Building Extraction Using Modified Mask R-CNN Model Using Post-Event Aerial Images of the 2016 Kumamoto Earthquake

Remote sensing is an effective method of evaluating building damage after a large-scale natural disaster, such as an earthquake or a typhoon. In recent years, with the development of computer vision technology, deep learning algorithms have been used for damage assessment from aerial images. In April 2016, a series of earthquakes hit the Kyushu region, Japan, and caused severe damage in the Kumamoto and Oita Prefectures. Numerous buildings collapsed because of the strong and continuous shaking. In this study, a deep learning model called Mask R-CNN was modified to extract residential buildings and estimate their damage levels from post-event aerial images. Our Mask R-CNN model employs an improved feature pyramid network and online hard example mining. Furthermore, a non-maximum suppression algorithm across multiple classes was also applied to improve prediction. The aerial images captured on 29 April 2016 (two weeks after the main shock) in Mashiki Town, Kumamoto Prefecture, were used as the training and test sets. Compared with the field survey results, our model achieved approximately 95% accuracy for building extraction and over 92% accuracy for the detection of severely damaged buildings. The overall classification accuracy for the four damage classes was approximately 88%, demonstrating acceptable performance.

Anaphylaxis and onsite treatment in schools, kindergartens, and nurseries.

There have been no reports on both anaphylaxis incidence rate in schools, kindergarten, and nurseries, or how teachers have treated these children. This study was a fact-finding survey aimed at determining if appropriate responses to anaphylaxis onset were implemented in Oita Prefecture, Japan. The Oita Prefectural Allergy Control Committee administered a questionnaire using Google forms to all public and private schools, public and private kindergartens, certified child-care facilities, and day-care centers in the prefecture. Responses to the questionnaire were obtained from 597 institutions, of which 125 890 children were affiliated with the responding institutions. Forty-eight children developed symptoms for which an adrenaline auto-injector was recommended in an Oita guideline. Among these children, three used the adrenaline auto-injector, three were prescribed the adrenaline auto-injector but were unable to use it, 27 were unable to use it as they were not prescribed an adrenaline auto-injector, and the final 15 responded that they handled their symptoms via another method because none of the above options apply. Most children who developed symptoms which an adrenaline auto-injector was recommended had no prescription for an adrenaline auto-injector. There is thus a need for appropriate response training to anaphylaxis whether or not an adrenaline auto-injector was prescribed.