古橋 功一

BACKGROUND: School nurses play a key role in responding to sexual violence in school settings. However, it remains unclear whether recent case exposure is associated with greater awareness of institutional response systems and confidence in recognizing sexually inappropriate behaviors. METHODS: We conducted a cross-sectional survey of school nurses in a large Japanese municipality. The primary exposure was self-reported involvement in sexual violence-related cases within the past year (yes/no). The primary outcome was perceived awareness of institutional response procedures and interagency collaboration systems, and the secondary outcome was perceived confidence in recognizing sexually inappropriate behaviors, each measured using a 5-point Likert scale. Group differences were examined using the Mann-Whitney U test. RESULTS: Among 111 respondents, 50 (45.0%) reported recent exposure to a sexual violence-related case. Recent exposure was not associated with greater perceived awareness of institutional response systems (median 3 [IQR 2-4] vs. 3 [IQR 3-4], p = 0.336) or higher perceived confidence in recognizing sexually inappropriate behaviors (median 3 [IQR 3-4] in both groups, p = 0.877). CONCLUSIONS: In this sample of Japanese school nurses, recent exposure to sexual violence-related cases was not associated with greater perceived awareness of institutional response systems or higher perceived confidence in recognizing sexually inappropriate behaviors. Because cumulative prior experience, training history, and institutional context were not assessed, these findings should be interpreted cautiously. Future research should examine how professional experience, training opportunities, and organizational factors interact to influence preparedness and response practices related to sexual violence in school settings.

Abstract Background Child Guidance Centers (CGCs) play a central role in child protection in Japan, yet evidence on abused children referred to psychiatric services remains limited. Methods We retrospectively reviewed 84 children referred by CGCs (2019–2023) to a child and adolescent psychiatry department. Demographics, types of abuse, neurodevelopmental disorders (NDs), prior psychiatric care, hospitalization, and experiences of sexual violence by non-caregivers were extracted from medical records and CGC referral forms. Fisher’s exact test, Pearson’s chi-square test, and the Wilcoxon rank-sum test were used, and odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. Results Psychological abuse was most prevalent (80%), followed by physical (70%), neglect (35%), and sexual abuse (33%). Girls had higher odds of sexual abuse (OR 6.16, 95% CI 1.32–28.8) and were more frequently hospitalized. Children with NDs were less likely to have sexual abuse recorded (OR 0.29, 95% CI 0.10–0.83). Hospitalization was associated with experiencing a greater number of abuse types and with sexual abuse (OR 4.23, 95% CI 1.49–12.00), particularly when perpetrated by non-caregivers (OR 4.53, 95% CI 1.51–13.60). Conclusions Among CGC-referred children receiving psychiatric care, notable patterns included gender differences in abuse profiles, a high cumulative burden of maltreatment, and a lower recorded prevalence of sexual abuse among those with NDs. These findings highlight the need for careful clinical assessment and coordinated, ND-sensitive approaches that reduce under-recognition. Although derived from a CGC-based referral system, the results may inform efforts to integrate child protection and child and adolescent mental health services internationally.

BACKGROUND: The novel coronavirus disease (COVID-19) pandemic has no end in sight. Currently, the emphasis is on policies aimed at easing movement restrictions and maintaining socio-economic activities. However, infection control in psychiatric hospitals has been challenging. There have been reports on the impact on mental health and outpatient/inpatient treatment environments in the field of child psychiatry. An outbreak of COVID-19 was experienced in a child and adolescent psychiatric ward, and considering that there have been few similar reports, it was deemed meaningful to accumulate such experiences. CASE PRESENTATION: Three COVID-19-positive cases, all 14-year-old girls, were confirmed in a cluster among seven hospitalized patients in a child and adolescent psychiatric ward. Two patients presented symptoms of upper respiratory inflammation and one was asymptomatic. The main psychiatric diagnoses were post-traumatic stress disorder in one patient and autism spectrum disorder in the other two patients. The entire hospital ward was designated as a red zone (contaminated area), and infection control measures were adopted, such as halting group activities, wearing masks, and maintaining distance between patients. Additionally, it was necessary to use the infection control ward as it was difficult to ensure patient compliance. CONCLUSION: Infection control in COVID-19 clusters at child and adolescent psychiatric wards is difficult due to patient characteristics and symptoms. Restricted activities and care also result in psychobehavioral consequences, regardless of infection status. To achieve both infection control and a better treatment environment, it is necessary to make careful preparations while learning from these experiences.