Nobutoshi Nawa

Background: School refusal has negative consequences throughout life. While parental education and child poverty are closely linked to school refusal, the mechanism by which parental low education influences school refusal in offspring remains unclear. This cross‐sectional study examined the association between parental low education and several dimensions of child poverty (low income and deprivation) with school refusal among first grade (6–7 years old) elementary school students in Japan. Methods: Data were obtained from the Adachi Child Health Impact of Living Difficulty (A‐CHILD) study conducted in 2015, 2017, 2019 and 2021 in Adachi City, Tokyo, Japan ( N = 13 258). Parental education was classified as none, one or both parents graduated from some college or more. Inability to afford essential items or service payments was used to measure deprivation. A multivariate logistic regression model was used for the analysis, adjusting for other sociodemographic characteristics. Results: The prevalence of school refusal was 3.1% ( N = 416). We found a positive association between parental low education and school refusal after adjusting for covariates (OR = 1.40, 95% CI: 1.08, 1.82). The association was attenuated by further adjustment by low income and deprivation, which showed a higher risk of school refusal (OR = 1.45, 95% CI: 0.98, 2.13 and OR = 1.62, 95% CI: 1.25, 2.10, respectively). Low income and deprivation explained 9.2% and 39.4% of the association between parental low education and school refusal of the offspring, respectively. Conclusions: Lower educational attainment of parents was a risk of school refusal from an early stage of mandatory education in Japan, which can be explained partially by low income and deprivation. Policymakers should be aware that school refusal from an early age is common in families with low socio‐economic status and should proactively reach out to these parents.

The well-being of resident physicians is a globally recognized concern, with high rates of burnout, stress, and attrition. Studies proposed grit-a personality trait defined as perseverance and passion for long-term goals-as a protective factor against poor psychological outcomes. Although studies in Western countries have linked grit with lower burnout and depression among residents, evidence from collectivist cultures, such as Japan, remains limited. This nationwide cross-sectional study included data from 2,876 postgraduate year (PGY) 1-2 resident physicians across 553 hospitals in Japan. Participants completed self-administered surveys following the 2024 General Medicine In-Training Examination. Grit was measured using the validated Japanese version of the Short Grit Scale (Grit-S); wellness outcomes-including burnout, job satisfaction, stress, and depressive symptoms-were assessed using the single Mini-Z 2.0 item and the two-item Patient Health Questionnaire. Multilevel logistic regression models with a random intercept for hospital were used to evaluate the associations between grit and wellness outcomes, adjusting for demographic and institutional covariates. Higher Grit-S scores were significantly associated with lower odds of burnout (adjusted odds ratio [AOR], 0.54; 95% CI, 0.45-0.64), high stress (AOR, 0.63; 95% CI, 0.55-0.71), and depressive symptoms (AOR, 0.54; 95% CI, 0.48-0.62). Grit was also associated with greater job satisfaction (AOR, 2.09; 95% CI, 1.80-2.43). In this national sample of Japanese resident physicians, higher grit was consistently associated with improved psychological well-being, including lower burnout, reduced stress, fewer depressive symptoms, and increased job satisfaction. These findings suggest that grit is a critical protective trait for residents, even within a collectivist culture. Future research should explore whether the identification of residents with lower grit, especially those with reduced perseverance or inconsistent interests, can help inform customized support programs such as mentoring or structured stress management to enhance well-being.

Ghanaian migrants in Japan, who make up the second-largest population of African migrants in the country, may have faced heightened racial prejudice and challenges during the COVID-19 pandemic, impacting their well-being. This study explored cultural factors shaping the well-being of Ghanaians living in Japan during the COVID-19 pandemic through a qualitative study using the socioecological model. From June 2022 to August 2022, 18 in-depth interviews and 2 focus group discussions were conducted among Ghanaian migrants in Japan. Interviews were audio recorded and transcribed, and an inductive thematic approach was used to analyze the data. At the individual level, the internalized face mask culture, financial constraints, reluctance to access mental healthcare services, and hesitancy toward COVID-19 vaccine played major roles in the well-being of Ghanaian migrants. Adherence to social distancing and coping using religious and social circles influenced their well-being at the interpersonal level. At the community and societal levels, important influences on well-being were language barriers, discrimination and COVID-19-related stigma, and trust in Japan's healthcare system. In conclusion, while Ghanaian migrants in Japan faced challenges during the pandemic, affecting them physically and psychologically, they were able to cope through the religious and social ties from Ghana that they maintained.

Gestational diabetes mellitus (GDM) is common in Japanese women, posing serious risks to mothers and offspring. This study investigated the influence of maternal genotypes on the risk of GDM and examined how these genotypes modify the effects of psychological and dietary factors during pregnancy. We analyzed data from 20,399 women in the Tohoku Medical Megabank Project Birth and Three-Generation Cohort. Utilizing two customized SNP arrays for the Japanese population (Affymetrix Axiom Japonica Array v2 and NEO), we performed a meta-analysis to combine the datasets. Gene-environment interactions were assessed by modeling interaction terms between genome-wide significant single nucleotide polymorphisms (SNPs) and psychological and dietary factors. Our analysis identified two SNP variants, rs7643571 (p = 9.14 × 10⁻⁹) and rs140353742 (p = 1.24 × 10⁻⁸), located in an intron of the MDFIC2 gene, as being associated with an increased risk of GDM. Additionally, although there were suggestive patterns for interactions between these SNPs and both dietary factors (e.g., carbohydrate and fruit intake) and psychological distress, none of the interaction terms remained significant after Bonferroni correction (p < 0.05/8). While nominal significance was observed in some models (e.g., psychological distress, p = 0.04), the data did not provide robust evidence of effect modification on GDM risk once adjusted for multiple comparisons. These findings reveal novel genetic associations with GDM in Japanese women and highlight the importance of gene-environment interactions in its etiology. Given that previous genome-wide association studies (GWAS) on GDM have primarily focused on Western populations, our study provides new insights by examining an Asian population using a population-specific array.

Background Exposure to heat may increase the risk of intussusception through various mechanisms, including alterations in dietary intake. However, no nationwide studies have examined the association between daily heat exposure and intussusception in children. This study aims to examine the association between higher daily ambient temperatures and intussusception in children. Methods The daily number of intussusception hospitalizations among children up to 5 years old from 2011 to 2022 was extracted from Japan’s nationwide administrative claims database. Daily mean temperature data were obtained from the Japan Meteorological Agency. Since the focus is on heat exposure, the analysis examines hospitalizations that occurred during the five warmest months (May to September). A time-stratified case-crossover design with conditional quasi-Poisson regression analysis was applied to estimate the relative risk of heat exposure on intussusception with a lag of 0–4 days. Results There were 13,083 cases of intussusception hospitalizations. Higher daily mean temperatures were associated with an elevated risk of intussusception hospitalizations. Specifically, exposure to extremely high daily mean temperatures at the 99th percentile was associated with a 39% increase in hospitalization risk (95% CI: 1.05, 1.83). Conclusion The study found the association between higher daily mean temperatures and an increased risk of hospitalization for intussusception. Future research should clarify the mechanisms of the association between higher daily mean temperatures and the increased risk of intussusception hospitalizations. Impact While exposure to heat may increase the risk of intussusception through mechanisms such as alterations in dietary intake and intestinal motility, no nationwide studies have investigated the association between daily heat exposure and intussusception in children. The study found the association between higher daily mean temperatures and an increased risk of hospitalization for intussusception. Both caregivers and healthcare providers should be aware of a potential increase in pediatric intussusception cases during warmer days, which may become even more critical as climate change results in more frequent and severe heat events.