Selection and concentration of obstetric facilities in Japan: Longitudinal study based on national census data

Aim: A shortage of obstetricians with an increased workload is a social problem in Japan. The government and professional bodies are trying to cope with this problem by accelerating “selection and concentration” of obstetric facilities. The aim of this study is to evaluate the recent trend of selection and concentration. Methods: We used data on the number of deliveries and of obstetricians in each hospital and clinic in Japan, according to the Static Survey of Medical Institutions in 2005, 2008 and 2011. To evaluate the inter-facility equity of the number of deliveries, number of obstetricians and number of deliveries per obstetrician, Gini coefficients were calculated. Results: The number of obstetric hospitals decreased by 20% and the number of deliveries per hospital increased by 26% between 2005 and 2011. Hospital obstetricians increased by 16% and the average number of obstetricians per hospital increased by 19% between 2008 and 2011. Gini coefficient of deliveries has significantly decreased. In contrast, Gini coefficient of deliveries per obstetrician has significantly increased. The degrees of increase in obstetricians and of decrease in deliveries per obstetrician were largest at the hospitals with the highest proportion of cesarean sections. The proportion of obstetric hospitals with the “optimal volume” of deliveries and obstetricians defined by Japan Society of Obstetrics and Gynecology was 4% in 2008, and it had doubled to 8.1% three years later. Conclusion: The selection and concentration of obstetric facilities is progressing rapidly and effectively in Japan.This study was supported by Health Labour Sciences Research Grant of the Ministry of Health, Labour and Welfare, Tokyo, Japan (H25 - Research on Region Medical - 006)

Population density, call-response interval, and survival of out-of-hospital cardiac arrest

<p>Abstract</p> <p>Background</p> <p>Little is known about the effects of geographic variation on outcomes of out-of-hospital cardiac arrest (OHCA). The present study investigated the relationship between population density, time between emergency call and ambulance arrival, and survival of OHCA, using the All-Japan Utstein-style registry database, coupled with geographic information system (GIS) data.</p> <p>Methods</p> <p>We examined data from 101,287 bystander-witnessed OHCA patients who received emergency medical services (EMS) through 4,729 ambulatory centers in Japan between 2005 and 2007. Latitudes and longitudes of each center were determined with address-match geocoding, and linked with the Population Census data using GIS. The endpoints were 1-month survival and neurologically favorable 1-month survival defined as Glasgow-Pittsburgh cerebral performance categories 1 or 2.</p> <p>Results</p> <p>Overall 1-month survival was 7.8%. Neurologically favorable 1-month survival was 3.6%. In very low-density (<250/km²) and very high-density (≥10,000/km²) areas, the mean call-response intervals were 9.3 and 6.2 minutes, 1-month survival rates were 5.4% and 9.1%, and neurologically favorable 1-month survival rates were 2.7% and 4.3%, respectively. After adjustment for age, sex, cause of arrest, first aid by bystander and the proportion of neighborhood elderly people ≥65 yrs, patients in very high-density areas had a significantly higher survival rate (odds ratio (OR), 1.64; 95% confidence interval (CI), 1.44 - 1.87; p < 0.001) and neurologically favorable 1-month survival rate (OR, 1.47; 95%CI, 1.22 - 1.77; p < 0.001) compared with those in very low-density areas.</p> <p>Conclusion</p> <p>Living in a low-density area was associated with an independent risk of delay in ambulance response, and a low survival rate in cases of OHCA. Distribution of EMS centers according to population size may lead to inequality in health outcomes between urban and rural areas.</p

Generation of spin-polarized currents in Zeeman-split Tomonaga-Luttinger models

In a magnetic field an interacting electron gas in one dimension may be described as a Tomonaga-Luttinger model comprising two components with different Fermi velocities due to the Zeeman splitting. This destroys the spin-charge separation, and even the quantities such as the density-density correlation involve spin and charge critical exponents (K). Specifically, the ratio of the up-spin and down-spin conductivities in a dirty system diverges at low temperatures like an inverse power of the temperature, $T^{-(K_{\uparrow}-K_{\downarrow})}$, resulting in a spin-polarized current. In finite, clean systems the conductance becomes different for up- and down-spins as another manifestation of the electron-electron interaction.Comment: 10 pages, RevTeX file, 3 figures available on request from [email protected]

Retention rate of physicians in public health administration agencies and their career paths in Japan

<p>Abstract</p> <p>Background</p> <p>Physicians who serve as public health specialists at public health centers and health departments in local or central government have significant roles because of their public health expertise. The aim of this study is to analyze the retention and career paths of such specialists in Japan.</p> <p>Method</p> <p>We analyzed the data of seven consecutive surveys, spanning 1994 to 2006. We first analyzed the 2006 survey data by sex, age group, and facility type. We then examined the changes over time in the proportion of physicians working in public health administration agencies. We also examined the distribution of the facility types and specialties in which physicians worked both before beginning and after leaving their jobs. These analyses were performed by using physician registration numbers to cross-link data from two consecutive surveys.</p> <p>Results</p> <p>The proportion of physicians working in public health administration agencies was 0.7% in 2006. The actual numbers for each survey ranged between 1,800 and 1,900. The overall rate remaining in public health administration agencies during the two-year survey interval was 72.8% for 1994-1996. The ratio declined to 67.2% for 2004-2006. Among younger physicians with 1-10 years of experience, the retention rate showed a sharp decline, dropping from 72.6% to 50.0%. Many of these physicians came from or left for a hospital position, with the proportion entering academic hospital institutions increasing in recent years. In many cases, physicians left or entered internal medicine clinical practices.</p> <p>Conclusion</p> <p>At present in Japan, the number of physicians who leave and the number who begin a position are almost the same; thus, some of the problems associated with physicians leaving are yet to become apparent. However, the fact that the retention period is shortening for younger physicians may represent a future problem for ensuring the quality of physicians in public health administration agencies. Possible strategies include: increasing the number of physicians entering positions; reducing the number leaving positions; and creating a system where physicians can easily reenter positions after leaving while also establishing a revolving door type of career development system, involving both public health departments and hospital clinical departments.</p