Stage III Chorioamnionitis Is Associated with Reduced Risk of Severe Retinopathy of Prematurity.

OBJECTIVE: To identify whether histologically confirmed chorioamnionitis (hCAM) is associated with development of retinopathy of prematurity (ROP). STUDY DESIGN: We retrospectively analyzed two different cohorts. Cohort 1 was the national database of newborns in Japan born at ≤1500g or <32 weeks' gestation (January 2003 through April 2021, n=38,013). Cohort 2 was babies born at <1500g from a single institution in Tsuchiura, Japan, (April 2015 through March 2018, n=118). RESULTS: For Cohort1, after adjusting for potential confounders, stage III CAM (n=5,554) was associated with lower odds of severe ROP (stage ≥3 or required peripheral retinal ablation) by 14% (odds ratio [OR]: 0.86; 95% confidence interval [CI]: 0.78-0.94]. CAM of stage I (n=3,277) and II (N=4,319) was not associated with the risk of ROP. For Cohort 2, the odds of severe ROP were significantly reduced in moderate to severe hCAM groups (stage II, OR: 0.06, 95% CI: 0.05-0.82; stage III, OR: 0.10, 95% CI: 0.01-0.84). Neonates with funisitis, comorbidity of hCAM, and a finding of fetal inflammatory response had lower odds of severe ROP (OR: 0.11; 95% CI: 0.01-0.93). CONCLUSIONS: After adjusting for confounders, severe hCAM with fetal inflammatory response was associated with reduced risk of ROP.

Home visitors' needs and perceptions of the benefits of a home visiting program for childcare support in Japan: A qualitative study of home visitors.

BACKGROUND: The Home Visiting Program for Childcare Support (HV-CCS; "Yoiku Shien Homon Jigyo" in Japanese) has targeted families in need of parenting support and those at risk of child maltreatment in Japan. OBJECTIVE: The aim of this study was to explore the needs and perceptions of benefits of home visitors in HV-CCS. PARTICIPANTS AND SETTING: Sixteen home visitors agreed to participate in the interview. METHODS: This study conducted 1-hour semi-structured interviews with 16 home visitors and analyzed approximately 18 h of interview data using thematic analysis. RESULTS: The findings suggested that home visitors required training to enhance individual skills and knowledge about mental health of caregivers or children. Additionally, they required environmental support, particularly for transportation expenses and parking places. Multidisciplinary communicative support is also necessary, as well as system to improve the process of support. Home visitor perceived the HV-CCS as beneficial in preventing child maltreatment by improving parenting skills and home environment, providing psychological support for mothers, and entering families' intimate spaces. CONCLUSIONS: To ensure the continuity and improvement of home visits for parents and children in Japan, it is essential to address the identified needs of home visitors.

Exploring viral infections' role in Kawasaki disease onset: A study during the COVID-19 pandemic.

During the coronavirus disease 2019 (COVID-19) pandemic, known viral diseases declined in all ages. By using the current situation as a natural experiment, this study aimed to evaluate whether the change in the incidence of Kawasaki disease (KD) during the COVID-19 pandemic varies with age and whether a specific infectious disease mediates the occurrence of KD. Monthly number of KD patients were extracted from the nationwide inpatient database. Segmented regression analysis was conducted on the interrupted time series data. Additionally, causal mediation analysis was performed to examine the role of viral infections in the changes in the number of KD patients. After the first emergency declaration for COVID-19 in Japan, there was an immediate decrease in the number of KD patients per 100 000 population aged between 6 months and 4 years (immediate change = -2.66; 95% confidence interval [CI]: -5.16 to -0.16) and aged 5-15 years (immediate change = -0.26; 95% CI: -0.49 to -0.04). However, no immediate change was observed in patients under 6 months of age. In the causal mediation analysis for each viral infection, it was found that the decrease in the number of patients with KD was mediated by changes in the number of patients with pharyngoconjunctival fever and infectious gastroenteritis. The current results suggest that viral infections may be one of the etiological agents for KD, while they may not be the main cause in early infancy. Specifically, we found that adenovirus infection and gastroenteritis was closely related to the onset of KD in some areas of Japan.

Association of excess visceral fat and severe illness in hospitalized COVID-19 patients in Japan: a retrospective cohort study.

BACKGROUND/OBJECTIVES: Obesity, defined by body mass index (BMI), is a well-known risk factor for the severity of coronavirus disease 2019 (COVID-19). Adipose tissue distribution has also been implicated as an important factor in the body's response to infection, and excess visceral fat (VF), which is prevalent in Japanese, may contribute significantly to the severity. Therefore, this study aimed to evaluate the association of obesity and VF with COVID-19 severe illness in Japan. SUBJECTS/METHODS: This retrospective cohort study involved 550 COVID-19 patients admitted to a tertiary care hospital with BMI and body composition data, including VF. The primary endpoint was severe illness, including death, due to COVID-19 during hospitalization. Logistic regression analysis was applied to examine the quartiles of BMI and VF on severe illness after adjusting for covariates such as age, sex, subcutaneous fat, paraspinal muscle radiodensity, and comorbidities affecting VF (COPD, cancer within 5 years, immunosuppressive agent use). RESULTS: The median age was 56.0 years; 71.8% were males. During hospitalization, 82 (14.9%) experienced COVID-19 severe illness. In the multivariate logistic regression analysis, Q4 of BMI was not significantly associated with severe illness compared to Q1 of BMI (OR 1.03; 95% CI 0.37-2.86; p = 0.95). Conversely, Q3 and Q4 of VF showed a higher risk for severe illness compared to Q1 of VF (OR 2.68; 95% CI 1.01-7.11; p = 0.04, OR 3.66; 95% CI 1.30-10.26; p = 0.01, respectively). Stratified analysis by BMI and adjusted for covariates showed the positive association of VF with severe illness only in the BMI < 25 kg/m2 group. CONCLUSIONS: High BMI was not an independent risk factor for COVID-19 severe illness in hospitalized patients in Japan, whereas excess VF significantly influenced severe illness, especially in patients with a BMI < 25 kg/m2.

Association between the number of convenience stores and caries status in permanent teeth among elementary school children: results from the A-CHILD population-based longitudinal cohort study.

Background: In Japan, people have rich access to 24-h convenience stores where they can buy sweets, juice and fluoride hygiene products, among others. However, the association between the number of convenience stores in a neighbourhood and caries in elementary school children status has not been studied. This study aimed to investigate this particular association. Methods: Data were derived from a population-based longitudinal cohort study (A-CHILD study) of elementary school children from first-grade to fourth-grade in Adachi City, Tokyo. Caregivers were asked to complete a questionnaire in 2015, 2016, and 2018. A total of 3,136 caregivers provided a valid response. We analysed the association using multilevel Poisson regression. Results: The mean number of caries among children in school districts with low, middle, and high number of convenience stores was 0.31 (SD: 0.81), 0.21 (SD: 0.69), and 0.16 (SD: 0.58). After covariate adjustment, children in the school districts with high and middle number of convenience stores had 44% (mean ratio 0.56, 95% CI: 0.31, 0.998) and 31% (mean ratio 0.69, 95% CI: 0.42, 1.13) fewer caries in their permanent teeth, respectively, than children in the school districts with low number of convenience stores. We also found dose-response relationship (p for trend: 0.042). Conclusion: Higher number of convenience stores in a school district was associated with fewer caries in permanent teeth among elementary school children. Further study elucidating the mechanism on this protective association is warranted.

Elucidation of the needs for telecritical care services in Japan: a qualitative study.

OBJECTIVE: To clarify the reasons for consultation, advice sought by frontline physicians and relationship between the patient's pathology and the type of advice provided to guide the future development of telecritical care services. DESIGN: Secondary analysis of transcripts of telephone calls originally recorded for quality control purposes was conducted using a thematic content analysis. The calls were conducted between December 2019 and April 2021 (total cases: 70; total time: ~15 hour). SETTINGS: Intensivists provided consultation services to frontline physicians at secondary care institutions in the Kansai and Chubu regions. PARTICIPANTS: Non-intensive care frontline physicians working in five secondary care institutions in the Kansai and Chubu regions and intensivists providing a consultation service (n=26). INTERVENTIONS: Not applicable. PRIMARY AND SECONDARY OUTCOME MEASURES: The main outcome was the themes emerging from the language used during telephone and video consultations, indicating the gap filled by the telecritical care service. FINDINGS: We analysed 70 cases and approximately 15 hours of anonymised audio data. We identified the following reasons for consultation: 'lack of competence in treatment and diagnostic testing' and 'lack of access to consultation in their own hospital'. Frontline physicians most often sought advice related to 'treatment', followed by 'patient triage and transfer', 'diagnosis' and 'diagnostic testing and evaluation'. Regarding the relationship between the patient's pathology and type of advice provided, the most commonly sought advice by frontline physicians varied based on the patient's pathology. CONCLUSION: This study explored the characteristics of 70 telecritical sessions and identified the reasons for and nature of the consultations. These findings can be used to guide the future provision and scale up of telecritical services.

Impact of preoperative intervention for smoking cessation on postoperative length of stay and cost for spine surgery patients: Propensity score matching analysis.

BACKGROUND: Preoperative intervention for smoking cessation reduces the prevalence of postoperative complications in spine surgery. To date, however, the impact of these interventions on the length of stay (LOS) and cost for patients is unclear. PATIENTS/METHODS: This retrospective cohort study analyzed data from 317 patients who were current smokers and underwent spine surgery between January 2014 and December 2019 at a single facility in Tokyo, Japan. Most patients (262) received preoperative intervention for smoking cessation within 60 days before spine surgery; the remaining 55 patients did not receive the intervention. The postoperative LOS was compared using propensity score matching. Patients were matched for age, gender, body mass index, surgical plan (cervical surgery, anterior approach surgery, minimally invasive surgery), preoperative comorbidities (diabetes mellitus, hypertension, ischemic cardiac disease, chronic lung disease), and recent history of steroid therapy, which yielded 48 pairs of patients. RESULTS: The length of postoperative hospital stay was significantly shorter in the intervention group (-10.60 days, [95% CI, -15.79 to -5.42]). The cost for service was significantly lower in the intervention group (coefficient, Japanese yen [JPY] -1,515,529; [95% CI, -2,130,631 to -900,426]; 110 JPY equivalent to 1 United States dollar). CONCLUSIONS: Preoperative interventions for smoking cessation may decrease postoperative hospital stay and hospitalization costs.

Hedonic Risk Preference Associated with High-Risk Behaviors under COVID-19 Pandemic among Medical Students in Japan.

BACKGROUND: Public health measures to mitigate the spread of COVID-19 have focused on raising awareness and disseminating knowledge. Few considered people's risk preferences and no measurement was adapted to the context of COVID-19. This study aims (1) to investigate the association between risk preference and risk behaviors and (2) to compare a novel hedonic preference question with traditional risk preference assessment tools in the context of the COVID-19 pandemic among medical students in Japan. METHODS: An online survey of fourth-year medical students was conducted. Logistic regression analysis adjusted for gender, age, household income, and the overconfidence effect were performed to investigate the association. RESULTS: We observed significantly higher odds of high-risk behaviors in general risk preference (odds ratio (OR): 4.04; 95% confidence interval (CI): 1.05-15.50) and hedonic preference (OR: 6.58; 95% CI: 1.86-23.28) when adjusted, whereas monetary preference showed no significant association. Concerning specific risky behaviors, hedonic preference were significantly associated with four items after adjusting for covariates ("dine out" (OR: 2.78, 95% CI: 1.13-6.85), "go out" (OR: 4.35, 95% CI: 1.65-11.46), "not practicing safety precautions" (OR: 2.79, 95% CI: 1.11-7.04) and "travel" (OR: 4.36, 95% CI: 1.42-13.44)), and general preference in two ("dine out" (OR: 4.82, 95% CI: 1.66-14.00) and "go out" (OR: 6.48, 95% CI: 2.07-20.24)). CONCLUSION: Hedonic and general risk preferences were significantly associated with high-risk behaviors during the COVID-19 pandemic. Future application of the novel risk-for-pleasure-seeking preference question is warranted.

Association between Grit and depressive symptoms at the timing of job start among medical residents during the COVID-19 pandemic in Japan: a cross-sectional study.

INTRODUCTION: The COVID-19 pandemic had an additional negative impact on the mental health of healthcare workers, including residents. Previous studies revealed that grit, which is an individual trait to achieve long-term goals unrelated to intelligence quotient, is not only positively associated with academic achievement and career success but also negatively correlated with depression. This study aimed to examine the association between grit and depressive symptoms among residents at the time of job start during the coronavirus disease 2019 (COVID-19) pandemic in Japan. MATERIALS AND METHODS: This cross-sectional study used data from all post-graduate year 1 residents from March 2020 to April 2022 at Tokyo Medical and Dental University, Tokyo, Japan. Grit was measured by the Japanese version of Grit-S. The resident's depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale. The association of interest was examined using logistic regression analysis. RESULTS: Among 221 residents, 28 (12.7%) have depressive symptoms. One unit increase in Grit-S score after adjusting for age, sex, graduated university, and sleeping hours was associated with lower odds of having depressive symptoms by 63% (odds ratio [OR]: 0.37; 95% confidence interval [CI]: 0.19-0.74). Further, the perseverance of effort subscale score was associated with lower odds of having depressive symptoms after covariate adjustment (OR: 0.43; 95% CI: 0.22-0.84). CONCLUSIONS: Higher grit scores were associated with lower odds of having depressive symptoms among residents at the timing of job start during the COVID-19 pandemic. Regular mental health assessment is particularly important for residents with low grit scores at entry.

Association between the initiation of insurance coverage for fetal echocardiography and mortality from congenital heart disease in infants: An interrupted time series analysis.

BACKGROUND: The effectiveness of fetal echocardiography in reducing the mortality from congenital heart disease (CHD) is largely unknown. OBJECTIVES: This study aimed to evaluate whether the widespread use of fetal echocardiography owing to the initiation of insurance coverage in Japan was associated with a decreasing trend in the annual number of CHD-related deaths. METHODS: Data regarding the number of deaths from CHD in infants aged <12 months were extracted from Japanese demographic statistics (2000-2018). Segmented regression analysis was performed on the interrupted time series data by stratifying the sample into CHD subgroups based on ICD-10 classification and sex. RESULTS: After the initiation of insurance coverage for fetal echocardiography in 2010, a decrease was observed in the trends of annual deaths in patients with congenital malformations of aortic and mitral valves (ratio of trends before and after the initiation of insurance coverage for fetal echocardiography 0.96, 95% confidence interval 0.93, 0.99). In this group, the decrease persisted after adjusting for annual total infant deaths and cardiac surgery mortality and in the analysis of trends in the proportion of deaths in this group per total CHD deaths. However, a decrease in trends was not observed in other patient groups with CHD. In the sex-stratified analysis, a decrease was noted only in male patients with congenital malformations of aortic and mitral valves. CONCLUSIONS: The nationwide trend in annual CHD deaths decreased after the initiation of insurance coverage for fetal echocardiography only among patients with congenital malformation of aortic and mitral valves. These findings suggest that prenatal diagnosis with fetal echocardiography has led to improved mortality outcomes among these patients in Japan.

Association of revision of Money Lending Business Act and suicide rate in Japan: An interrupted time series analysis.

OBJECTIVE: Debt problems are associated with suicide. In Japan, the Money Lending Business (MLB) Act was revised in December 2006 and fully enforced in June 2010 to reduce multiple debt problems. This study aimed to examine the association between the full enforcement of the revised act and suicide rates. METHODS: An interrupted time series analysis was used to the national registry data of death records between January 2000 and December 2016. Stratified analysis was conducted to assess the differences between gender and age groups. RESULTS: The effects of the full enforcement on the suicide rate were the greatest among men aged 40-64 years; after the enforcement, there was a significant decrease of -0.3085 per 100,000 persons in the level of the suicide rate (95% confidence interval [CI] -0.529 to -0.0881) and -0.0165 per 100,000 persons (95% CI -0.0215 to -0.0115) in the trend. Among women aged 40-64 and ≥65 years, an increase in the level of the suicide rate was observed after the enforcement. CONCLUSIONS: The full enforcement of the revised MLB Act was associated with decreased suicide rates, particularly among middle-aged men. Policy interventions for addressing debt problems may have the potential to prevent suicide.

Association between skipping breakfast and prediabetes among adolescence in Japan: Results from A-CHILD study.

Objective: Adolescents with prediabetes are at high risk of developing type 2 diabetes in later life. It is necessary to identify risk factors for prediabetes in adolescents. This study aimed to examine the association between skipping breakfast and prediabetes among adolescents in Japan. Study design: We used the population-based cross-sectional data of eighth grade in junior high school students from the Adachi Child Health Impact of Living Difficulty (A-CHILD) study conducted in Adachi City, Tokyo, Japan, in 2016, 2018, and 2020. Skipping breakfast was assessed using self-reported questionnaires (N=1510). Prediabetes was defined as hemoglobin A1c (HbA1c) levels of 5.6-6.4%. The association between skipping breakfast and prediabetes was evaluated using multivariate logistic regression analysis. Stratified analysis was also performed using BMI, 1 SD or more, or less than 1SD, as overweight was defined as 1SD or more. Results: Students who skipped breakfast were 16.4% (n=248). The prevalence of prediabetes was 3.8% (n=58). Skipping breakfast exhibited a significant association with prediabetes (OR:1.95, 95% CI: 1.03 to 3.69) after adjusting for sex, annual household income, family history of diabetes mellitus, BMI, and survey year. Stratified analysis showed stronger association among students with overweight (BMI ≥1SD) (OR=4.31, 95% CI 1.06-17.58), while non-sigificant among students without overweight (BMI<1SD) (OR=1.62, 95% CI 0.76-3.47). Conclusions: Skipping breakfast in Japanese adolescents, especially those with overweight, was associated with prediabetes. The promotion of avoiding skipping breakfast may help to prevent prediabetes.

Stressors and coping strategies among single mothers during the COVID-19 pandemic.

OBJECTIVES: Increased levels of stress have been reported among parents due to the factors associated with the COVID-19 pandemic. Although social support is known as a protective factor for the stressors, restrictions due to the pandemic could influence the provision and forms of social support. To date, few qualitative studies have examined the stressors and coping strategies in detail. In particular, the role of social support for single mothers during the pandemic remains largely unclear. The purpose of this study is to explore the stressors and coping strategies of single parents during the COVID-19 pandemic, with a focus on social support as a coping strategy. METHODS: In-depth interviews with 20 single mothers were conducted in Japan between October and November 2021. Data were deductively coded using thematic coding based on codes related to stressors and coping strategies, focusing on social support as a coping strategy. RESULTS: Most interviewees recognized additional stressors after the COVID-19 outbreak. Five stressors were mentioned by the participants: (1) fear of infection, (2) financial concerns, (3) stress caused by interactions with their children, (4) restrictions on childcare facilities, and (5) stress related to staying at home. The major coping strategies were (1) informal social support from family, friends, and coworkers, (2) formal social support from municipalities or nonprofit organizations, and (3) self-coping strategies. CONCLUSION: Single mothers in Japan recognized additional stressors after the COVID-19 outbreak. Our results support the importance of both formal and informal social support for single mothers, either in-person or online, to cope with stress during the pandemic.

Association between socioeconomic status and net survival after primary lung cancer surgery: a tertiary university hospital retrospective observational study in Japan.

BACKGROUND: Inequalities in opportunities for primary lung cancer surgery due to socioeconomic status exist. We investigated whether socioeconomic inequalities exist in net survival after curative intent surgery at a tertiary university hospital, in Japan. METHODS: Data from the hospital-based cancer registry on primary lung cancer patients who received lung resection between 2010 and 2018 were linked to the surgical dataset. An area deprivation index, calculated from small area statistics and ranked into tertiles based on Japan-wide distribution, was linked with the patient's address as a proxy measure for individual socioeconomic status. We estimated net survival of up to 5 years by deprivation tertiles. Socioeconomic inequalities in cancer survival were analyzed using an excess hazard model. RESULTS: Of the 1039 patient-sample, advanced stage (Stage IIIA+) was more prevalent in the most deprived group (28.1%) than the least deprived group (18.0%). The 5-year net survival rates (95% confidence interval) from the least to the most deprived tertiles were 82.1% (76.2-86.6), 77.6% (70.8-83.0) and 71.4% (62.7-78.4), respectively. The sex- and age-adjusted excess hazard ratio of 5-year death was significantly higher in the most deprived group than the least deprived (excess hazard ratio = 1.64, 95% confidence interval: 1.09-2.47). The hazard ratio reduced toward null after additionally accounting for disease stage, suggesting that the advanced stage may explain the poor prognosis among the deprived group. CONCLUSION: There was socioeconomic inequality in the net survival of patients who received curative intent surgery for primary lung cancer. The lower socioeconomic status group might be less likely to receive early curative surgery.

Association between the social network of medical students and their academic performance on the anatomy written examination.

Although medical students learn human anatomy within a social network of friends/classmates, limited research has examined how social network structure is related to student's performance in human anatomy examinations. This study aimed to examine the association between centrality (i.e., the degree to which a student is connected to other students in class) before the start of the anatomy laboratory and changes in centrality owing to the start of the laboratory and failing the written examination taken on the last day of the course. Data included all 211 medical students at Tokyo Medical and Dental University who took anatomy classes in 2018 and 2019. The in-class social network before the laboratory was defined as "connected" if the student had more than one connection to the same individual in terms of the type of club activity, high school, and affiliation with an extracurricular program. The laboratory group adds the connection to the prelaboratory network, resulting in a postlaboratory network. Logistic regression models were used to estimate the association of degree and eigenvector centrality and changes in centrality after the laboratory with failing the written examination. Of the 211 students, 38 failed the examination. A one standard deviation increase in eigenvector centrality before the laboratory was significantly associated with a 44% decrease in odds of failing the examination (OR: 0.56, 95% CI: 0.34, 0.92). Changes in centrality measures were not associated with the performance of students in the examination. Higher in-class network centrality was associated with lower odds of failing the written examination.

Impact of Antibiotic Time-Outs in Multidisciplinary ICU Rounds for Antimicrobial Stewardship Program on Patient Survival: A Controlled Before-and-After Study.

The antimicrobial stewardship program (ASP) is an important quality improvement initiative that is recommended in the ICU. However, the shortage of infectious disease physicians in Japan has led to the need for simpler methods for implementing ASPs. We investigated whether antibiotic time-outs (ATOs) during multidisciplinary rounds as part of an ASP can improve patient survival and reduce the number of days of therapy (DOT) with antibiotics. DESIGN: Single-center controlled before-and-after study. SETTING: Medical/surgical ICU in a tertiary university medical center in Tokyo, Japan. PATIENTS: All patients 16 years old or older admitted consecutively in the ICU between October 2016 and March 2020. INTERVENTIONS: An intensivist-driven ICU multidisciplinary round was introduced in October 2016, and ATOs with ICU rounds were implemented in June 2018. ATOs were conducted 3, 7, and 14 days after initiation of antibiotics. MEASUREMENTS AND MAIN RESULTS: The primary outcome was the subdistribution hazard ratio (SHR) of survival to hospital discharge compared between multidisciplinary rounds (phase 1) and ATO during multidisciplinary rounds (phase 2) using the multivariable Fine-Gray model. The secondary outcomes were the SHR of survival to ICU discharge and the trends in the DOT with IV antibiotics per 1,000 patient-days between October 2016 and March 2020 by using interrupted time-series analysis. The number of patients in phases 1 and 2 was 777 and 796, respectively. The group that underwent ATO during multidisciplinary rounds showed a significant increase in the survival to hospital discharge in comparison with the multidisciplinary round-only group (SHR, 1.13; 95% CI, 1.02-1.25); however, the SHR of survival to ICU discharge showed no significant intergroup difference. The DOT with total IV antibiotics decreased after ATO implementation (change in intercept, -178.26; 95% CI, -317.74 to -38.78; change in slope, -7.00; 95% CI, -15.77 to 1.78). CONCLUSIONS: ATOs during multidisciplinary rounds are associated with improved patient survival and reduced DOT.

Development, validation, and feature extraction of a deep learning model predicting in-hospital mortality using Japan's largest national ICU database: a validation framework for transparent clinical Artificial Intelligence (cAI) development.

OBJECTIVE: While clinical Artificial Intelligence (cAI) mortality prediction models and relevant studies have increased, limitations including the lack of external validation studies and inadequate model calibration leading to decreased overall accuracy have been observed. To combat this, we developed and evaluated a novel deep neural network (DNN) and a validation framework to promote transparent cAI development. METHODS: Data from Japan's largest ICU database was used to develop the DNN model, predicting in-hospital mortality including ICU and post-ICU mortality by days since ICU discharge. The most important variables to the model were extracted with SHapley Additive exPlanations (SHAP) to examine the DNN's efficacy as well as develop models that were also externally validated. MAIN RESULTS: The area under the receiver operating characteristic curve (AUC) for predicting ICU mortality was 0.94 [0.93-0.95], and 0.91 [0.90-0.92] for in-hospital mortality, ranging between 0.91-0.95 throughout one year since ICU discharge. An external validation using only the top 20 variables resulted with higher AUCs than traditional severity scores. CONCLUSIONS: Our DNN model consistently generated AUCs between 0.91-0.95 regardless of days since ICU discharge. The 20 most important variables to our DNN, also generated higher AUCs than traditional severity scores regardless of days since ICU discharge. To our knowledge, this is the first study that predicts ICU and in-hospital mortality using cAI by post-ICU discharge days up to over a year. This finding could contribute to increased transparency on cAI applications.

Impact of exposure to secondhand smoke on the risk of obesity in early adolescence.

BACKGROUND: Exposure to secondhand smoke (SHS) might be associated with obesity in children. This study aimed to evaluate whether continuous, quit, or start exposure to SHS was associated with obesity risk in early adolescents. METHODS: We used population-based longitudinal data of primary school students in Adachi City, Tokyo, Japan, in 2018 (4th grade) and 2020 (6th grade) and studied 3605 students. The association between continuous, quit, start, or never exposed to SHS from 4th to 6th grade and BMI categories (underweight or normal weight, overweight, obesity) in 6th grade was investigated using ordinal logistic regression models. RESULTS: Continuous SHS group showed a higher risk of being in the high BMI category than no SHS group (OR = 1.51, 95% CI 1.16-1.96). The stratified analyses by sex showed a similar association in boys (OR = 1.74, 95% CI 1.25-2.44) but not in girls (OR = 1.14, 95% CI 0.74-1.76). Quitting SHS group did not show a higher risk of being in the high BMI category than no SHS group (OR = 1.11, 95% CI 0.75-1.66) and the same was true for boys (OR 1.46, 95% CI 0.88-2.41). CONCLUSIONS: Continuous SHS was a risk factor for obesity in boys in early adolescence; however, quitting SHS may help prevent it. IMPACT: Continuous secondhand smoke (SHS) was not associated with a higher risk of obesity in early adolescence in girls. Continuous SHS can be a risk factor for obesity in early adolescence in boys. Quitting SHS may help to prevent obesity in early adolescence in boys.

Effectiveness of remdesivir with corticosteroids for COVID-19 patients in intensive care unit: A hospital-based observational study.

The effectiveness of remdesivir on survival in coronavirus disease 2019 (COVID-19), especially in cases treated in the intensive care unit (ICU), is controversial. We investigated the effectiveness of remdesivir with corticosteroids on the survival of COVID-19 patients in a real ICU clinical practice. For laboratory-confirmed COVID-19 patients admitted to the ICU of a tertiary hospital in Tokyo (April 2020-November 2021) and who received corticosteroids, the effectiveness of remdesivir for survival, stratified by interval length (within 9 or 10+ days), was retrospectively analyzed using Cox regression model. A total of 168 patients were included: 35 with no remdesivir use (control), 96 with remdesivir use within 9 days, and 37 with remdesivir use with an interval of 10+ days. In-hospital mortality was 45.7%, 10.4%, and 16.2%, respectively. After adjusting for possible covariates including comorbidities, laboratory data, oxygen demand, or level of pneumonia, remdesivir use within 9 days from symptom onset reduced mortality risk (hazard ratio [HR]: 0.10; 95% confidence interval (CI): 0.025-0.428) compared to the control group. However, remdesivir use with an interval of 10+ days showed no significant association with mortality (HR: 0.42; 95% CI: 0.117-1.524). Among COVID-19 patients who received corticosteroids in ICU, remdesivir use within 9 days from symptom onset was associated with reduced in-hospital mortality risk.

Association between Cooperative Attitude and High-Risk Behaviors on the Spread of COVID-19 Infection among Medical Students in Japan.

The impact of high-risk behaviors on the spread of COVID-19 infection among young people is an important problem to address. This study analyzed the association between cooperativeness and high-risk behaviors. We conducted a cross-sectional study among fourth-year medical students at Tokyo Medical and Dental University. The students were asked about cooperative attitude in a hypothetical situation of performing a task together with an unfamiliar classmate, who did not cooperate to complete the task previously. The response items were as follows: "cooperate", "don't want to cooperate and do it alone (non-cooperative)", and "don't want to cooperate and let the partner do it alone (punishment)". Eating out and vaccine hesitancy were also treated as high-risk behaviors. Poisson regression was used to investigate the association between cooperative attitude and each high-risk behavior, adjusted for demographics. Of the 98 students, 23 (23.5%), 44 (44.9%), and 31 (31.6%) students chose "noncooperative", "cooperative", and "punishment", respectively. Cooperative-type students exhibited 2.77-fold (PR: 2.77, 95% CI: 1.03-7.46), and punishment-type students exhibited 3.16-fold greater risk of eating or drinking out (PR: 3.16, 95% CI: 1.14-8.75) compared with those of the noncooperative type. Among medical students, the "cooperative" type and "punishment" type comprised the high-risk group for eating out during the pandemic.