Varicella outbreak at nursery school under routine immunization in Japan in 2017 and 2018 and vaccine effectiveness.

BACKGROUND: In Japan, routine administration to one-year-old children of two-dose immunization for varicella was introduced in October 2014. Object The object of this study was to report outbreaks of varicella under routine immunization at a nursery school and in its surrounding area using data of surrounding areas from the (Nursery) School Absenteeism Surveillance System. Then, we measured the effectiveness of routine two-dose immunization for varicella to onset. We tentatively assessed its severity in a nursery school. METHOD: The study period extended from April 2017 through March 2018. The study area comprised Nursery school B and other nursery schools, and elementary and junior high schools in City A. Subjects in Nursery school B were 120 children. We analyzed vaccine effectiveness (VE) as an observational study and assessed severity using Fisher's exact test. We also assessed VE for severity using linear regression. Severity was defined as the length of nursery school absence attributable to varicella infection. RESULTS: During the one month preceding a period of two weeks before the initial case at Nursery school B, there were 16 cases of varicella infection in nursery schools, 45 cases in elementary schools, and one case in junior high schools in City A. For children who had received one vaccine dose or more, VE was 48.1% for all ages and 49.2% among children three years old and older. No significant VE against infection was found. Vaccination using one dose or more can reduce severity significantly. DISCUSSION AND CONCLUSION: Because many nursery school children who had received two doses of vaccine were infected, VE was estimated as low in the nursery school and not significant. Although VE for severity with more than one dose was confirmed, a second dose might not reduce severity compared to one dose.

[Evaluation of the relationship between household economic situation and food group intake in children attending nursery school].

Objectives　The relationship between household income and dietary intake among older children and adults in Japan has been studied. However, few studies have examined the relationship in younger children, and we believe that this should be taken into consideration from early childhood to correct health disparities. In this study, we examined the relationship between family income and dietary food group intake, and investigated the adequacy of food intake based on the Japanese Food Guide Spinning Top for young children aged 3 to 6 years attending nursery school. The goal of this study was to obtain trends in food intake that can be used to improve poor dietary intake of young children caused by socioeconomic factors.Methods　A dietary survey using the food weighing or recording method and a self-administered questionnaire on dietary status were conducted on two non-consecutive days, including weekdays and weekends, from October to December 2019 or 2020. The participants were 761 young children (423 boys and 338 girls) attending nursery schools in seven cities in Japan. Equivalent income was calculated from household income and the number of family members indicated in the dietary status survey. Intake of each food group and consistency with the Japanese Food Guide Spinning Top were compared in five quintiles.Results　Compared to the low equivalent income group, the high equivalent income group showed a decreasing trend in cereal intake and an increasing trend in the intake of sugar and sweeteners, green and yellow vegetables, and dairy products. The percentage of the low-income group who did not meet the definition of adequate intake using the Japanese Food Guide Spinning Top was lower for meals that include cereals and grain products, and higher for meals that include meat and fish, vegetable, milk and dairy products, and fruits.Conclusion　The lower income group had higher intake of cereals and lower intake of vegetables and fruits compared to the higher income group. This finding is similar to the results of studies in adults and older children. However, based on the Japanese Food Guide Spinning Top, >90% of young children have a diet that fall below the adequate intake of meals, including vegetable dishes and even on weekdays, which suggests a general vegetable deficiency in young children. Multifaceted support is required to address this concern, including measures to correct disparities of income and to ensure desirable nutrient intake in early childhood.

Persistence of Low Back Pain and Predictive Ability of Pain Intensity and Disability in Daily Life among Nursery School Workers in Japan: A Five-Year Panel Study.

Nursery school workers are known for having a high prevalence of low back pain (LBP). The natural history of LBP and the determinants of persistent LBP remain unclear. We examined the prevalence of persistent LBP and whether pain intensity and disability in daily life due to LBP affected the persistence of LBP among these workers. A five-year panel study was conducted for 446 nursery school workers in Japan. LBP, pain intensity, and disability in daily life due to LBP were assessed with a self-administered questionnaire survey. Pain intensity was assessed using the numerical rating scale (NRS). The Roland-Morris Disability Questionnaire (RDQ) was used to assess disability in daily life due to LBP. At baseline, 270 nursery school workers (60.5%) suffered from LBP. The estimated prevalence of persistent LBP was 84.6% (80.3-88.9%), 82.2% (77.7-86.8%), and 82.0% (77.4-86.5%) at 1, 3, and 5 years after the initial study, respectively. NRS scores of 5 or greater predicted the persistence of LBP at 1 and 3 years after the initial survey (adjusted odds ratios: 4.01 (1.27-12.6) and 8.51 (1.87-38.7), respectively), while RDQ scores did not. In conclusion, LBP highly persisted for a long time and pain intensity predicted persistent LBP among nursery school workers in Japan.

Microbiological analysis concerning the antibacterial effect of atomized Ionless® hypochlorous acid water in a nursery school environment.

INTRODUCTION: In daycare centers, infants come in close contact with each other, and contact, droplet, and mouth-to-mouth infections may occur owing to sharing of toys. Additional effective disinfection methods should be considered aside from wiping with disinfectants-including alcohol or sodium hypochlorite solution-for environmental disinfection of daycare centers. We aimed to examine the usefulness of hypochlorous acid water atomization in the effective disinfection of the classroom environment and toys at a nursery school. METHODS: Environmental cultures of the nursery and toys were prepared to evaluate the species and bacterial load and to assess the contaminated areas. Staphylococcus aureus petri dishes were placed at high-frequency contact sites, and hypochlorous acid water was atomized to achieve a 0.03-ppm atmospheric chlorine concentration. After the atomization, the amount of S. aureus bacteria on the Petri dish and the changes in bacterial count isolated from the environment and toys were evaluated. RESULTS: Hypochlorous acid water atomization was performed for 5 h to avoid condensation. After a 3-h atomization, ≥99.99% of S. aureus was eliminated on petri dishes; furthermore, a significant disinfection effect was observed on environmental bacteria at least 1 h after atomization. For rubber and textile toys, the significant disinfection effect was observed 1 h after atomization, and for plastic toys, the effect was observed 3 h after atomization. CONCLUSIONS: Hypochlorous acid water atomization is a useful strategy to disinfect nursery school classrooms.

The ESSENCE-Q: Can specialist supervision improve scoring agreement across specialist and public health nurses/nursery teachers?

AIM: This study aimed to explore whether the supervision of community public health nurses (PHNs) and nursery school teachers (NSTs) by a specialist, familiar with Early Symptomatic Syndromes Eliciting Neurodevelopmental Clinical Examinations (ESSENCE), improved the agreement of ESSENCE-Questionnaire (ESSENCE-Q) scoring, across raters. METHODS: A PHN, two NSTs, and a speech-language pathologist (SLP), familiar with ESSENCE, independently assessed 32 children. The ESSENCE-Q results were divided into the first (child 1-18) and second groups (the 19th child and the following children). Changes in score discrepancies were analysed for ESSENCE-Q cutoff scores and total ESSENCE-Q scores across raters. The SLP scores were used as a reference to evaluate sensitivity and specificity. RESULTS: The total ESSENCE-Q scores of the PHN and NSTs showed higher concordance in the second group (p < 0.05). Comparisons of the differences between the PHN/NSTs and SLP in total ESSENCE-Q scores showed a significantly smaller difference in the NSTs' scores in the second group (p < 0.05). CONCLUSION: The findings suggest that specialist supervision may lead to a better agreement between PHN and NSTs regarding ESSENCE-Q scores.

Long-Term Effects of the Kumamoto Earthquake on Young Children's Mental Health.

Natural disasters cause numerous short- and long-term psychosocial effects on young children because of their increased vulnerability. This study aimed to examine the mental health of young children at 15 months after the Kumamoto earthquake. We conducted a self-administered questionnaire survey on the parents of 363 children aged 4-6 years across Kumamoto Prefecture. The questionnaire items included current residence, housing damage and evacuation experience during the disaster, as well as the Strengths and Difficulties Questionnaire (SDQ). The results showed that children who could stay in their home during the disaster had lower percentages of scores in the clinical range for conduct problems (odds ratio [OR] = 0.33, 95% confidence interval [CI]: 0.13-0.85) and hyperactivity/inattention (OR = 0.42, 95%CI: 0.19-0.93) on the SDQ. Furthermore, children who experienced living apart from their parents during the disaster had a higher percentage of scores in the clinical range for conduct problems (OR = 2.39, 95%CI: 1.05-5.42). At 15 months post-disaster, the mental health of the sample was worse than the normative data of Japan, indicating that the mental health of young children who experienced living at home and apart from their parents during the disaster was still affected.

Susceptibility of nursery teachers to measles, rubella, varicella and mumps in Japan.

BACKGROUND: A guideline published in 2018 by the Ministry of Health, Labour and Welfare stipulated confirmation of the vaccine history of nursery staff members. OBJECT: This study was conducted to elucidate nursery teachers' vaccine and infection histories for measles, mumps, rubella, and varicella through survey responses. METHOD: After sending questionnaires through the mail to 5000 nursery teachers in November 2022, we received responses through December 2022. We measured the proportion of susceptibility in three ways. Additionally, we compared the proportions of susceptibility by disease by age class. RESULTS: After receiving 1620 responses in all, the data of 1229 respondents under 50 years old were analyzed. Under the broad definition by which "no answer" was also regarded as unvaccinated or uinfected as well as "unknown," the proportions of susceptibility for measles, rubella, and varicella were higher: 22-23%. For mumps, the proportion was 42%. For varicella, they were 31% for respondents in their 30 s, and 14% for respondents in their 40 s. For mumps, the respective values were 58% and 26%. DISCUSSION: Respondents assessed for this study were less susceptible and unknown in comparison with earlier studies investigating health care workers, school teachers, university students, and pregnant women. CONCLUSION: The survey revealed that measles and rubella susceptibility was higher among respondents in their 30 s. However, it was higher for varicella and mumps among respondents in their 20 s.

Nursery school absenteeism surveillance system and infection control measures in nursery schools.

INTRODUCTION: The Nursery School Absenteeism Surveillance System (NSASSy), which includes 40% of all nursery schools in Japan, has a degree of effectiveness that is difficult to prove: nursery schools and areas without NSASSy cannot be evaluated for their incidence of infectious diseases as precisely as those with NSASSy. Instead, we examine nursery school countermeasures against infectious diseases by considering the endogeneity bias of NSASSy. METHOD: After sending questionnaires to 500 Tokyo metropolitan and nearby nursery schools in November 2022, we received their responses through the end of 2022. Questionnaires asked about infection control measures of nursery schools: (1) cooperation with public health centers; (2) cooperation with staff; (3) cooperation with children's parents; (4) precautions among children; (5) countermeasure systems; (6) precaution systems; (7) recording of health conditions of children; (8) usefulness of studying while students; and (9) usefulness of training at nursery schools. Ordered probit with inverse probability weighted adjustment was used as the estimation procedure. The explanatory variable was a dummy variable for using NSASSy. Probability in weight was estimated using the first-step probit for NSASSy. Explanatory variables were a dummy variable for publicly funded nursery schools and a dummy variable for local governments that had adopted NSASSy. RESULTS: We analyzed 193 nursery schools. NSASSy was negative and associated significantly with (3) cooperation with children's parents and (7) recording of health conditions of children. These countermeasures were more likely to have been taken by NSASSy nursery schools.

Association of influenza vaccination or influenza virus infection history with subsequent infection risk among children: The Japan Environment and Children's Study (JECS).

We measured the association between history of influenza vaccination by age 2 years and influenza virus (IFV) infection at ages 3 and 4 years by relative risk reduction. We also examined the association between history of IFV infection by age 2 years and recurrent IFV infection at age 3 years. This study included 73,666 children from a large Japanese birth cohort. Among children vaccinated never, once or twice when aged under 2 years, 16.0%, 10.8% and 11.3%, respectively, had been infected with IFV by age 3 years, and 19.2%, 14.5% and 16.0%, respectively, by age 4 years. Compared with no history of influenza vaccination, vaccination at ages 1 and/or 2 years reduced the risk of IFV infection at age 3 by 30%-32% and at age 4 by 17%-24%. The relative risk of recurrent IFV infection at ages 3 and 4 years increased in proportion to the number of prior infections by age 2. One-season-prior influenza vaccination history reduced the IFV infection risk at age 3 years by 25%-42%. Influenza vaccination most effectively protected children at age 3 who lacked older sibling(s) and did not attend nursery school. One-season-prior IFV infection increased the relative risk of recurrent infection at age 3 years (1.72-3.33). In conclusion, influenza vaccination-induced protection may partly extend to the next season. Owing to the relative risk reduction by influenza vaccination and the increased relative risk of IFV infection from prior-season infection, annual influenza vaccination is recommended.

Increase in children with developmental delay: Survey on 18-month-old children in Togane city, Japan.

BACKGROUND: Individuals who visit hospitals with neurodevelopmental disorders have recently increased. To locate the cause for this increase, various factors, such as environmental and genetic ones, are being investigated. The objective of this study is to analyze the developmental delay in children and their background. METHODS: The participants were children who underwent the checkup for 18-month-old children in Togane city, Japan, from 2011 to 2021; 4,145 children-2,147 boys and 1,998 girls with a mean age of 18.8 months-were included. To examine the tendency over time and the background, we used the questionnaire about development and lifestyle reported by parents. RESULTS: The number of children who did not produce pointing gestures or respond to their names and low-volume sounds tended to increase over the survey period (p = 0.0125, p = 0.0435, p = 0.0275). Next, we examined the relationship between pointing gestures and lifestyle and found that there was a relationship between attending a nursery school and bedtime and pointing gestures. CONCLUSION: A slow developmental trend over the last decade has been observed among children. The background was related to attending a nursery school and bedtime, suggesting that interaction with others and sleep are important for the development of children.

Creating Meaningful Interactions for Young Children, Older Friends, and Nursery School Practitioners within an Intergenerational Project.

Intergenerational practice, where children and older adults come together for shared activities, has grown in popularity in many Western countries. However, research about intergenerational practice, particularly in the UK, is limited. This paper reports on the findings from an exploratory case study about a small intergenerational project between a maintained nursery school and a residential care home for older adults with dementia in the South-East of England. The methodology was informed by a narrative dialogic approach drawing on the work of Bakhtin. Data was collected using naturalistic observations of children's weekly visits to the care home and qualitative interviews with nursery school practitioners. The analysis explores how meaningful interactions were created between the children, the older adults, and the nursery school practitioners. Our findings suggest that singing, unstructured moments, continuity, context (open spaces/flexible sessions), and objects contribute to meaningful interactions between young children and older adults. The ability to be flexible and "go with the moment" were identified as key skills for practitioners supporting children and older adults. We conclude that intergenerational projects afford benefits not just for children and older adults, but also for practitioners in the form of "emotional rewards". The importance of re-establishing intergenerational practice is recognised, as well as the ways in which barriers created by social distancing might safely be addressed through the use of outdoor spaces and digital technologies. Supplementary Information: The online version contains supplementary material available at 10.1007/s10643-022-01330-5.

Issues Concerning the Administration of Medication to Children by Nursery School Staff in Tokyo: Exploring the Possibility of Community Pharmacist Support and Collaboration / 社会薬学

Anxiety and difficulty in administering medication to nursery school children has been reported among nursery school teachers. This study aimed to elucidate these issues and explore the possibility of pharmacist support and collaboration. We conducted a postal survey in September 2019 among nursery schools in Tokyo that are categorized as government-authorized schools, certified childcare centers, and prefectural governor-certified schools. A total of 1,537 schools responded to the self-report questionnaires (response rate: 41.2%), and 1,533 responses were analyzed. Of these, 1,488 schools were asked if they would accept requests to administer medication to their school children, and 60.1% of the nursery schools responded that their staff (including teachers and nurses) found it difficult to administer medication. The issues identified included psychological burdens (such as nervousness and pressure about giving the correct medication), staff shortage, insufficient time with the children, and human factors (such as personal perceptions of medication). Additionally, excessive requests to administer medication, caregiver behavior such as low awareness of children’s health and appropriate medication, and poor medication adherence at home were identified as issues. It was suggested that pharmacists could help alleviate these problems through their daily work at the pharmacy. Approximately 49-62% of schools responded that they would request the collaboration of community pharmacists to conduct training sessions for nursery school staff, provide health support for caregivers, and provide general health and medication consultations. The collaboration between nursery schools and community pharmacists may gain importance in the future.

Psychosocial work characteristics and low back pain in daycare (nursery) workers in Japan: a prospective cohort study.

BACKGROUND: Low back pain (LBP) is one of the most common musculoskeletal problems affecting daycare (nursery) workers. We aimed to identify the psychosocial factors influencing LBP in daycare workers. METHODS: We conducted a prospective cohort study with a one-year observation period. The baseline sample was a convenience sample of 444 daycare workers from 34 daycare facilities in Nagoya, Japan, and its suburbs. All the data were collected through a questionnaire survey. The question "Where are you currently feeling LBP?" was used to determine whether the subjects suffered from LBP. We examined the prospective relationships of the psychosocial work characteristics, i.e., high job strain, low social support, effort-reward imbalance, and overcommitment, at baseline and LBP after one year. We used multiple logistic regression analyses to calculate the odds ratios of psychosocial work characteristics for the persistence and onset of LBP, adjusted for age, sex, body mass index, smoking, employment status, occupation, and working schedule. RESULTS: At baseline, 270 (60.8%) subjects suffered from LBP. Of 208 who also gave information on LBP one year later, 176 (84.6%) suffered from the persistence of LBP. Low social support at baseline was significantly related to persistent LBP one year later. The incidence of persistent LBP was 89.9% and 80.0% among those with and without low social support at baseline, respectively. The adjusted odds ratio (95% confidence interval) of low social support at baseline for the persistence of LBP was 2.43 (1.01-5.87). Of 150 who were without LBP at baseline and provided information on LBP one year later, 45 (30.0%) suffered from the onset of LBP. None of the psychosocial work characteristics showed significant relationships with the onset of LBP one year later. CONCLUSION: Low social support was related to the persistence, but not to the onset of LBP in a prospective cohort analysis among daycare workers in Japan. High job strain, ERI, or overcommitment did not show a significant prospective effect on LBP.

Mask wearing in Japanese and French nursery schools: The perceived impact of masks on communication.

Due to the global COVID-19 pandemic, covering the mouth region with a face mask became pervasive in many regions of the world, potentially impacting how people communicate with and around children. To explore the characteristics of this masked communication, we asked nursery school educators, who have been at the forefront of daily masked interaction with children, about their perception of daily communicative interactions while wearing a mask in an online survey. We collected data from French and Japanese nursery school educators to gain an understanding of commonalities and differences in communicative behavior with face masks given documented cultural differences in pre-pandemic mask wearing habits, face scanning patterns, and communicative behavior. Participants (177 French and 138 Japanese educators) reported a perceived change in their own communicative behavior while wearing a mask, with decreases in language quantity and increases in language quality and non-verbal cues. Comparable changes in their team members' and children's communicative behaviors were also reported. Moreover, our results suggest that these changes in educators' communicative behaviors are linked to their attitudes toward mask wearing and their potential difficulty in communicating following its use. These findings shed light on the impact of pandemic-induced mask wearing on children's daily communicative environment.

Developmental Changes in the Magnitude of Representational Momentum Among Nursery School Children: A Longitudinal Study.

Representational momentum (RM) is a well-known phenomenon that occurs when a moving object vanishes suddenly and the memory of its final or vanishing position is displaced forward in the direction of its motion. Many studies have shown evidence of various perceptual and cognitive characteristics of RM in various daily aspects, sports, development, and aging. Here we examined the longitudinal developmental changes in the displacement magnitudes of RM among younger (5-year-old) and older (6-year-old) nursery school children for pointing and judging tasks. In our experiments, the children were asked to point at by their finger (pointing task) and judge the spatial location (judging task) of the vanishing point of a moving stimulus. Our results showed that the mean magnitudes of RM significantly decreased from 5- to 6-year-old children for the pointing and judging tasks, although the mean magnitude of RM was significantly greater in the 5-year-old children for the pointing task but not for the judging task. We further examined the developmental changes in RM for a wide range of ages based on data from the present study (5-year-old children) and our previous study (7- and 11-year-old children and 22-year-old adults). This ad hoc examination showed that the magnitude of RM was significantly greater in 5-year-old children than in adults for the pointing and judging tasks. Our findings suggest that the magnitude of RM was significantly greater in young children than in adults and significantly decreased in young children through adults for the pointing and judging tasks.

Depressive Symptoms and Their Associated Factors in Nursery School Teachers: A Multicenter Cross-Sectional Study.

Background Although nursery school teachers may experience depressive symptoms, there have been few studies exploring the associated factors. The objective of this study was to determine the prevalence of depression and explore its associated factors in nursery school teachers. Methods This cross-sectional study surveyed nursery school teachers in Sakyo-ku, Kyoto City to determine the prevalence of depressive symptoms as measured by the five-item Mental Health Inventory. We used a logistic regression model to assess the factors. Results Respondents were 148 teachers (36%) out of 410 nursery school teachers in 21 nursery schools, and 65 (44%) indicated that they had depressive symptoms. Using the Work Limitation Questionnaire (WLQ), productivity loss score (adjusted risk ratio [ARR], 1.17; 95% confidence interval [95% CI], 1.02 to 1.34) and psychological demands (ARR, 1.25; 95% CI, 1.02 to 1.53) were found to be associated with depressive symptoms. Conclusions The associated factors with depressive symptoms were high psychological demands and a high degree of presenteeism. Further prospective cohort studies with larger sample sizes should be conducted to confirm these relationships.

Study on the Causes, Types, and Mechanisms of Childhood Injuries-Age and Disease Specificity.

INTRODUCTION: To clarify the causes, types, and mechanisms of injuries in children, we collected injury cases and analyzed their causes. METHODS: During the 3-year period from 2013, we collected injury cases from three sources: nursery schools and kindergartens (A), emergency clinics of hospitals (B), and schools and a clinic for the developmentally disabled (C), using a format designed by Safe Kids Japan. RESULTS: In all, 383 cases were collected during the 3-year period. The causes of the injuries in group A were crashes, falls, and so on. The types of injuries were cuts, bruises, fractures, injuries of teeth, etc. Dislocations and abrasions were prominent in nursery school children (aged less than 3 years) and bone fractures were prominent in kindergarten children aged more than 3 years.Group B consisted of 144 cases. The most common causes of injuries were falls, traffic accidents, and so on, and the types of injuries were fractures, abrasions, sprains, etc. The incidence of fractures was particularly high and 50% of the accidents were bicycle accidents.Group C consisted of 41 cases. Although the age distribution was similar to that of group B, the types of accidents and injuries were similar to those of group A.The Bodygraphic Injury Surveillance System (BISS) analysis showed that groups A and C were similar, that is, injuries occurred mainly to the head, whereas in group B, the extremities were mainly affected. CONCLUSIONS: We analyzed the causes, types, and mechanisms of childhood injuries. The BISS may help to clarify the mechanisms of injuries in childhood.

[Mothers' Attitudes regarding Medication Administration at Nursery School: A Survey among Mothers with Prior Request Experience to Evaluate Factors Related to the Frequency of Requests to Administer Medication].

The difficulty and anxiety of nursery staff in administering medication to children at nursery schools has been reported, and its reduction is desired. However, the attitudes of mothers in requesting medication and the factors related to a high frequency of requests are not clear. We conducted an online survey of 600 mothers from April to May 2019 regarding the administration of medication at nursery school, and 301 mothers who had previously made such requests were analyzed. The results showed that 100.0% and 76.4% of the mothers felt gratitude and were apologetic for requesting medicine administration, respectively. In total, 47.5% of mothers expected pharmacists to support nursery staff in administering medication. Mothers' attitude of "I think the nursery staff should administer medication to my child more often" was significantly positively associated with a high frequency of the request in adjusted Model [adjusted odds ratio (AOR) 2.75, 95% confidence interval (CI) 1.36-5.55, p=0.005], while "I think the parents should manage so that the children do not have to take medicine in the nursery school so often" showed a negative association (AOR 0.33, 95% CI 0.17-0.66, p=0.002). Factors related to the involvement of community pharmacists were not significant. It is suggested that a change in mothers' attitudes could decrease the frequency of requests and consequently reduce the burden on nursery staff. Community pharmacists may support nursery staff to contribute to changing mothers' attitudes through medication consultations at the pharmacy.

[The Situation Concerning Medication Administration at Nursery Schools from the Mothers' Perspective Evaluated Using a Questionnaire].

Previous studies have reported the inappropriate administration of medication at nursery schools by the staff and a lack of drug-related information from caregivers at the time of request. However, the situation concerning medication administration at nursery schools from the mothers' perspective is unknown and it is not clear what information the mothers provided to nursery staff at the request. We conducted an online survey between April and May 2019 regarding the administration of medication at the nursery school with input from 600 mothers. Overall, 510 (85%) individuals replied that the requests to administer medication were acceptable for all or some of the medications. Application forms for medications were used by 91% of the 301 mothers who had previously made such requests. Although information including the child's name, medication times, illness of the child, parent's name, and dosage form was specified by over 70% of mothers, drug-related information such as effectiveness, side effects, and drug interactions was insufficient. In total, 41 instances of inappropriate medication administration by staff were reported by 35 mothers. It is suggested that the drug information sheets provided by community pharmacies should make up for inadequate drug-related information on application forms for medications to avoid the risk of adverse events and reduce staff burden. Toward this end, it is necessary to provide easily understandable information sheets for nursery staff, as the medication is usually administered by nursery staff, not a nurse. Community pharmacists should support these measures as pharmaceutical professionals.

Sleep and the General Behavior of Infants and Parents during the Closure of Schools as a Result of the COVID-19 Pandemic: Comparison with 2019 Data.

This study compared cross-sectional data from online surveys describing the sleep behavior of infants and caregivers in March 2020 (the school closure period during the early stages of the COVID-19 pandemic; n = 295, 23.8 ± 3.8 months old) and March 2019 (before the pandemic; n = 2017, 24.2 ± 3.8 months old). In comparing those two points in time, no significant differences were found in wake-up times (2019: 7:19 ± 0:46 am vs. 2020: 7:18 ± 0:47 am, p = 0.289), bedtimes (21:01 ± 0:48 pm vs. 21:04 ± 0:53 pm, p = 0.144), or nocturnal sleep times (593.7 ± 43.9 min vs. 588.1 ± 50.3 min, p = 0.613). Regarding the caregivers, in 2020, wake-up times (2019: 6:46 ± 0:50 am vs. 2020: 6:39 ± 0:50 am, p = 0.017) and bedtimes (22:53 ± 1:17 pm vs. 22:42 ± 1:04 pm, p = 0.016) became significantly earlier compared to 2019. Among infants staying at home, total sleep time and percentage of outdoor play decreased significantly, and media use increased significantly in 2020. Lower levels of exercise and more frequent media viewing may have caused prolonged sleep latency in these children. The percentage of caregivers responding with "negative childcare feelings" was significantly higher in the group with less than three nursery school attendance days. Caregivers and infants staying at home are a high-risk group during the pandemic.