Ayako Senju

Assessment of Autistic Traits in Children Aged 2 to 4½ Years With the Preschool Version of the Social Responsiveness Scale (SRS-P): Findings from Japan

The recent development and use of autism measures for the general population has led to a growing body of evidence which suggests that autistic traits are distributed along a continuum. However, as most existing autism measures were designed for use in children older than age 4, to date, little is known about the autistic continuum in children younger than age 4. As autistic symptoms are evident in the first few years, to address this research gap, the current study tested the preschool version of the Social Responsiveness Scale (SRS‐P) in children aged 2 to 4½ years in clinical (N = 74, average age 40 months, 26–51 months) and community settings (N = 357, average age 39 months, 25–50 months) in Japan. Using information obtained from different raters (mothers, other caregivers, and teachers) it was found that the scale demonstrated a good degree of internal consistency, inter‐rater reliability and test‐retest reliability, and a satisfactory degree of convergent validity for the clinical sample when compared with scores from diagnostic “gold standard” autism measures. Receiver operating characteristic analyses and the group comparisons also showed that the SRS‐P total score discriminated well between children with autism spectrum disorder (ASD) and those without ASD. Importantly, this scale could identify autistic symptoms or traits distributed continually across the child population at this age irrespective of the presence of an ASD diagnosis. These findings suggest that the SRS‐P might be a sensitive instrument for case identification including subthreshold ASD, as well as a potentially useful research tool for exploring ASD endophenotypes. Autism Res 2017, 10: 852–865.

Non-reassuring foetal status and neonatal irritability in the Japan Environment and Children’s Study: A cohort study

The aim of this study was to investigate whether non-reassuring foetal status (NRFS) affected an infant’s temperament, or if the temperament formed prenatally resulted in an excessive heart rate reaction that was diagnosed as NRFS. We examined the correlation between NRFS and difficulty in holding a baby, and the amount of crying in the one month after birth, which was considered an indicator of the newborn’s temperament. We divided the cases with NRFS into positive NRFS and false positive NRFS. NRFS was associated with bad mood, frequent crying for a long duration, and intense crying. After adjustment for other covariates, NRFS was associated with bad mood (odds ratio, OR = 1.15, 95% confidence interval, CI = 1.00–1.33), and intense crying (1.12, 1.02–1.24). In the multi-variable model, positive and false positive NRFS were not clearly associated with neonatal irritability. When stratified by parity, NRFS and false positive NRFS were likely to be positively associated with neonatal irritability in parous women. The clear association between NRFS and intense crying was observed in parous women (multi-variable adjusted OR = 1.46, 95% CI = 1.16–1.83), but not in nulliparae (1.01, 0.91–1.12) (p for effect modification <0.01). Similarly, increased odds of intense crying associated with false positive NRFS were only found in parous women (multi-variable adjusted OR = 1.40, 95% CI = 1.09–1.81) (p for effect modification = 0.03). There was no association observed between positive NRFS and irritability; therefore, NRFS has no effect on an infant’s temperament.

Regional differences in infant 25-Hydroxyvitamin D: Pilot study of the Japan Environment and Children’s Study

In recent years, a resurgence in the number of infants with vitamin D deficiency has been noted. In addition to seasonal differences in exposure to ultraviolet (UV) rays, regional differences in dietary habits and lifestyles may affect susceptibility to vitamin D deficiency. No studies have been conducted, however, on infants in multiple regions of Japan to determine the extent of differences in vitamin D status.

Inability of infants to push up in the prone position and subsequent development

During routine health screening, some infants cannot maintain the prone position with extended arm support at 6 months. Little is known, however, about the development of full‐term infants with this developmental deviation. We investigated the developmental course of infants with this characteristic.

Dietary Differences in Male Workers among Smaller Occupational Groups within Large Occupational Categories: Findings from the Japan Environment and Children’s Study (JECS)

Studies examining workers’ diet according to smaller occupational groups within “large occupational categories” are sparse. The aim of this study was to examine the potential differences in workers’ diets based on the classification of workers into smaller occupational groups that comprise “large occupational categories”. The subjects of this study were working fathers who had participated in the Japan Environment and Children’s Study (N = 38,656). Energy and nutrient intake were calculated based on data collected from the Food Frequency Questionnaire. Occupations were classified according to the Japanese Standard Occupational Classification. Logistic regression analyses were performed to examine the adherence to current dietary recommendations within smaller occupational groups. In particular, significant differences were observed among the categorical groups of “professional and engineering workers”, “service workers”, and “agricultural, forestry, and fishery workers”. In “professional and engineering workers”, teachers showed higher odds of adherence to calcium intake recommendations compared with nurses (OR, 2.54; 95% CI, 2.02–3.14; p < 0.001). In “agricultural, forestry, and fishery workers”, agriculture workers showed higher odds of adherence to calcium (OR, 2.15; 95% CI, 1.46–3.15; p < 0.001) and vitamin C (OR 1.90, 95% CI 1.31–2.74, p = 0.001) intake recommendations compared with forestry and fishery workers. These findings may be beneficial from a research perspective as well as in the development of more effective techniques to improve workers’ diet and health.

The association between whole blood concentrations of heavy metals in pregnant women and premature births: The Japan Environment and Children's Study (JECS)

Background: Heavy metals are widely distributed in the environment. Recent reports have demonstrated the risk of preterm birth following heavy metal exposure. Preterm births are classified as early and late, depending on the duration of pregnancy, and are associated with increased risk of congenital illnesses such as heart failure, asthma, etc. Particularly, early preterm births carry a higher risk of mortality; however, the differential effects of heavy metal exposure on early and late preterm births are unknown. Objectives: To analyze the association between maternal whole blood concentrations of heavy metals, such as cadmium (Cd), lead (Pb), mercury (Hg), selenium (Se), and manganese (Mn) that are common toxicants in Japan, and early and late preterm births. Methods: The data of 14,847 pregnant women who were participants of the Japan Environment and Childrens Study were used. Data of the self‐questionnaire pertaining to the first trimester (T1), second/third trimester (T2), and medical records after delivery were analyzed. We divided preterm birth into two groups: early preterm (22 to < 34 weeks) and late preterm (34 to < 37 weeks). Maternal blood samples for measuring heavy metal concentrations were collected in T2 (pregnancy weeks: 14–39). The participants were classified into four quartiles (Q1–Q4) according to increasing heavy metal levels. Results: The rate of preterm birth was 4.5%. After controlling for confounding factors, such as age, pre‐pregnancy body mass index, smoking, partners smoking, drinking habits, gravidity, parity, number of cesarean deliveries, uterine infections, household income, educational levels, and sex of infant, Cd levels were found, by multivariable logistic regression analysis, to be significantly associated with early preterm birth (p = 0.002), with odds ratio for early preterm birth of 1.91 (95% confidence interval: 1.12–3.27, P = 0.018) in subjects of Q4 compared with in subjects with term birth (≧ 37 weeks). Conclusion: Maternal blood Cd levels during pregnancy are positively associated with the risk of early preterm birth among Japanese women. Identification of the main source of maternal Cd exposure may contribute to the prevention of early preterm births and health maintenance of mothers and their infants in the future. Graphical abstract: Figure. No caption available. HighlightsThis is the first large‐cohort study associating heavy metals with preterm births.Serum concentrations of Cd in pregnant women are related to early preterm births.Pb, Hg, Se and Mn concentrations did not seem to be related with preterm births.

Variation in Men’s Dietary Intake Between Occupations, Based on Data From the Japan Environment and Children’s Study

There has been increasing interest in dietary health promotion in the workplace. Although many previous studies have focused on dietary habits in specific occupations, variation between occupational groups requires clarification. The present study aimed to examine differences in food and nutrient intake between occupational groups, using detailed classification. A cross-sectional study was conducted using data from the Japan Environment and Children’s Study. The study included 38,721 employed Japanese expectant fathers aged between 20 and 65 years. Dietary intake was assessed using a food frequency questionnaire. Occupations were categorized into 11 categories according to the Japan Standard Occupational Classification. Analysis of variance and analysis of covariance were performed to compare dietary intake of occupational groups. Logistic regression analysis was performed to examine the differences in adherence to dietary recommendations across occupations. Dietary intake differed significantly between occupations. Specific dietary intake was observed in security and agricultural workers, who tended to exhibit higher consumption levels for numerous foods and nutrients. In addition, relative to other workers, security workers showed higher intake of dairy products and calcium, and agricultural workers consumed larger amounts of pickles and salt. The study categorized occupations into detailed categories using the Japan Standard Occupational Classification, which facilitated the clarification of overall dietary trends across occupations and identification of specific dietary characteristics in individual occupations. The findings could aid in workplace health promotion.

Successful, Short-Term Drug Exchange Protocol in Epilepsy: Transient Addon of Intravenous Anti-Epileptic Drugs

Newer antiepileptic drugs (AEDs) are supposed to be more beneficial at controlling seizures than older AEDs. We substituted newer AEDs for older AEDs while conducting a transient add-on of an intravenous (IV) antiepileptic drug (AED) as a base therapy (AED adjustment), and in the present paper we evaluate the efficacy and safety of this method. The study participants were 40 consecutive referral patients with intractable epilepsy who had been treated with two or more AEDs but had epileptic seizure which spoiled their quality of life. Five of the patients were excluded because any IV AEDs exacerbated their clinical seizures and electro-encephalography (EEG). The mean age of the remaining 35 patients was 7.5 (range: 1.2 - 20.5). The patients had been on two to five AEDs (mean 3.3), and experienced seizures ranging from 0.2 to 100 times/day (mean 13.0). We kept the patients on one or two key oral AEDs and terminated the other oral AEDs simultaneously while they were treated with a base IV AED. After adjusting their dose, the patients were on two to four oral AEDs (mean 2.8) two years later, and the frequency of seizures was reduced to 0 to 10 times/day (mean 1.4). It took about one month of hospitalization to adjust the AEDs, and both seizure frequency and the number of drugs decreased significantly after AED adjustment (p<0.001). There were no serious side effects of clinical seizures or in their blood and chemistry tests. The adjusted AEDs included newer ones, and the older ones were still necessary. AED adjustment was possible and useful for epileptic patients once a transient add-on of intravenous antiepileptic drugs was done.

A Short Commentary of Neuronal Ceroid Lipofuscinoses; Phenotypes inCongenital to Preschooler

The classification of neuronal ceroid lipofuscinoses (NCLs) had been clinically divided according to the age at the onset of symptoms: infantile, late infantile, juvenile and adult NCLs. However, this classification cannot always predict the causative gene; i.e., CLN1, for example, causes not only infantile NCL but also late onset infantile and adult NCLs. In 2012, a new classification for the NCLs that takes into account recent genetic and biochemical advances. This short review commentary focuses on the NCLs which might cause symptoms in children from neonate to preschooler age: CLN10 (neonatal), CLN1 (6-48 months), CLN14 (8-24 months), CLN2 (1-6 years), CLN3 (4-7 years), CLN5 (4-6 years), CLN6 (18 months-8 years), CLN7 (2-7 years) and CLN8 (5-10 years). There is no fundamental therapy, but there is the trial of some cures.

Comparative study on three different methods for arm-span measurement: the Japan environment and Children’s study pilot

BackgroundArm span is an important measure for the assessment of growth and hormone deficiency diseases. In an epidemiological survey, with a large number of subjects’ indicators, it is especially valuable to establish methods which can measure both quickly and accurately. However, there are various methods, and the length of arm span may vary according to the medical institution.MethodsThe arm span of nine 6-year old subjects was measured using two institutional standard methods, A and B, and a third method C which is an improved method and has been used for the first time in this study. A, No-Wall, with heels together the child stretches the arms out to the sides. B, Wall & No-Line, the child stands against the wall with heels together and spreads the arms against the wall. C, Wall & Line, the method is the same as B except a paper with horizontal lines is placed on the wall. We measured twice by each method.ResultsThe difference between the 1st and 2nd measurements was marginally significantly smaller by using method of C.ConclusionThe method C, which we improved, is the best way to measure arm span.