BackgroundThe Japan Academy of Midwifery developed and disseminated the ‘2012 Evidence-based Guidelines for Midwifery Care (Guidelines for Midwives)’ for low-risk births to achieve a more uniform standard of care during childbirth in Japan. The objective of this study was to cross-sectional survey policy implementation regarding care during the second stage of labor at Japanese hospitals, clinics, and midwifery birth centers, and to compare those policies with the recommendations in Guidelines for Midwives.MethodsThis study was conducted in the four major urbanized areas (e.g. Tokyo) of the Kanto region of Japan. Respondents were chiefs of the institutions (obstetricians/midwives), nurse administrators (including midwives) of the obstetrical departments, or other nurse/midwives who were well versed in the routine care of the targeted institutions. The Guidelines implementation questionnaire comprised 12 items. Data was collected from October 2010 to July 2011.ResultsThe overall response was 255 of the 684 institutions (37 %). Of the total responses 46 % were hospitals, 26 % were clinics and 28 % were midwifery birth centers. Few institutions reported perineal massage education for ‘almost all cases’. Using ‘active birth’ were all midwifery birth centers, 56 % hospitals and 32 % clinics. Few institutions used water births. The majority of hospitals (73 %) and clinics (80 %) but a minority (39 %) of midwifery birth centers reported ‘not implemented’ about applying warm compress to the perineum. Few midwifery birth centers (10 %) and more hospitals (38 %) and clinics (50 %) had a policy for valsalva as routine care. Many hospitals (90 %) and clinics (88 %) and fewer midwifery birth centers (54 %) offered hands-on technique to provide perineal support during birth. A majority of institutions used antiseptic solution for perineal disinfection. Few institutions routinely used episiotomies for multiparas, however routine use for primiparas was slightly more in hospitals (21 %) and clinics (25 %). All respondents used fundal pressure as consistent with guidelines. Not many institutions implemented the hands and knees position for correcting fetal abnormal rotation.ConclusionsThis survey has provided new information about the policies instituted in three types of institutions guiding second stage labor in four metropolitan areas of Japan. There existed considerable differences among institutions’ practice. There were also many gaps between reported policies and evidence-based Guidelines for Midwives, therefore new strategies are needed in Japan to realign institution’s care policies with evidenced based guidelines.

Background Adolescent loneliness is a growing public health issue owing to its adverse health impact. Although adolescent loneliness is common, its trajectories can show distinct patterns over time. However, there is limited knowledge regarding their determinants, particularly for chronic loneliness. We aimed to determine the predictors of loneliness trajectories across early-to-mid adolescence and examine their association with later suicidality. Methods Data were collected from 3165 participants from the population-based Tokyo Teen Cohort. Participants reported their loneliness at 10, 12, 14, and 16 years. Loneliness trajectories were identified using latent class growth analysis. We examined the predictive role of bullying victimization and parental psychological distress at age 10 via a multinomial logistic regression. Sociodemographic and child-related factors (i.e., chronic health conditions and cognitive delay) were included as covariates. The association between the trajectories, self-harm, and suicidal ideation by age 16 was investigated using Poisson regression. Results Four trajectories were identified: “consistently low” (2448, 77.3%), “moderate–decreasing” (185, 5.8%), “moderate–increasing” (508, 16.1%), and “consistently high” (24, 0.8%). Taking “consistently low” as a reference, experiences of bullying victimization predicted all the remaining trajectories [adjusted relative risk ratio 1.64, 95% confidence interval (CI) 1.18–2.28 for “moderate–decreasing,” 1.88, 1.52–2.33 for “moderate–increasing,” and 4.57, 1.97–10.59 for “consistently high”]. Parental psychological distress predicted the “moderate–increasing” (1.84, 1.25–2.71) and “consistently high” (5.07, 1.78–14.42) trajectories. The “consistently high” trajectory showed the greatest risk for self-harm and suicidal ideation (adjusted relative risk ratio 6.01, 95% CI 4.40–8.22; 2.48, 1.82–3.37, respectively); however, the “moderate–increasing” and “moderate–decreasing” trajectories were also at increased risk (moderate–increasing: 2.71, 2.23–3.30 for self-harm, 1.93, 1.69–2.19 for suicidal ideation; moderate–decreasing: 2.49, 1.91–3.26 for self-harm, 1.59, 1.33–1.91 for suicidal ideation). Conclusions Bullying victimization and parental psychological distress at age 10 were independent determinants of increased and chronic loneliness trajectories across early-to-mid adolescence. Compared with “consistently low,” all other loneliness trajectories were associated with an increased risk of adolescent suicidality. Interventions targeting adolescent loneliness should include approaches to mitigate bullying and parental psychological distress. These strategies may help prevent adolescent suicidality.

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Background and Hypotheses A wealth of evidence suggests that adolescent psychotic experiences (PEs), and especially auditory hallucinations (AHs), are associated with an increased risk for self-injurious behavior (SIB). However, the directionality and specificity of this association are not well understood, and there are no published studies investigating within-person effects over time. The present study aimed to test whether AHs and SIB prospectively increase reciprocal risk at the individual level during early-to-middle adolescence. Study Design Three waves (12y, 14y, and 16y) of self-reported AHs and SIB data from a large Tokyo-based adolescent birth cohort (N = 2825) were used. Random Intercept Cross-Lagged Panel Model (RI-CLPM) analysis was conducted to test the within-person prospective associations between AHs and SIB. Study Results At the within-person level, AHs were associated with subsequent SIB over the observation period (12y–14y: β = .118, P < .001; 14–16y: β = .086, P = .012). The reverse SIB->AHs relationship was non-significant at 12–14y (β = .047, P = .112) but emerged from 14y to 16y as the primary direction of influence (β = .243, P < .001). Incorporating depression as a time-varying covariate did not meaningfully alter model estimates. Conclusions A complex bi-directional pattern of relationships was observed between AHs and SIB over the measurement period, and these relationships were independent of depressive symptoms. Adolescent AHs may be both a predictor of later SIB and also a manifestation of SIB-induced psychological distress.

The purpose of this study was to summarize the attributes, antecedents and consequences of the concept of child abuse and neglect, which could then serve as the bases for the development of a child abuse and neglect screening tool to guide the prevention of child abuse and neglect during the perinatal period. Method Literature was identified from nine databases: Ichushi-Web, CiNii, MEDLINE, CINAHL, PsycINFO, SocIN-DEX, Minds, National Guideline Clearinghouse, and TRIP database using the keywords child abuse, pregnant women, postnatal, and child care. Relevant findings of 26 articles in English, 32 articles in Japanese and the 2014 Japanese Guide for Medical Treatment of Child Abuse and Neglect were analyzed using Rodgers's 2000 concept analysis model. Findings Five attributes were identified: 1) one-sided controlling relation to the abused child, 2) caregivers either unaware or aware of own behavior, 3) child's experience, 4) harm to the child's well-being and 5) failure to protect child's well-being. Five antecedents were identified: 1) caregiver factors, 2) child factors, 3) socioeconomic factors, 4) the overlapping of multiple factors and 5) a lack of appropriate intervention. Five consequences were identified: 1) child's security, 2) caregiver denial and isolation, 3) effects on the prospective health of survivors, 4) distress of surviving mothers and 5) intergenerational diffusion of abuse. Lastly, one surrogate term, child maltreatment, and three related concepts, (discipline, shaken baby syndrome, Munchhausen syndrome by proxy) were found. Based on this analysis, the concept of child abuse and neglect was defined as: the child's experience of crisis with or without the caregiver's awareness, including harm to the child's well-being and a lack of action to guard the child's wellbeing based on the one-sided controlling relationship of the child's caregiver. Conclusion This analysis summarizes the current concept of child abuse and neglect, which could provide a basis upon which to develop a child abuse and neglect screening tool. The analysis clearly demonstrated the possibility of longterm harm to abused children, repeating child abuse and neglect and the importance of appropriate preventive interventions during the gestational period, especially, the importance of appropriate interventions for grown-up survivors to prevent their repetition of child abuse and neglect. Moreover, effective prevention entails recognizing interventions are required not only for pregnant women but also for their partners and children and must include improved instrumental support and other multiple factors.