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)

Factors associated with quality of bystander CPR: The presence of multiple rescuers and bystander-initiated CPR without instruction

Aims: To identify the factors associated with good-quality bystander cardiopulmonary resuscitation (BCPR). Methods: Data were prospectively collected from 553 out-of-hospital cardiac arrests (OHCAs) managed with BCPR in the absence of emergency medical technicians (EMT) during 2012. The quality of BCPR was evaluated by EMTs at the scene and was assessed according to the standard recommendations for chest compressions, including proper hand positions, rates and depths. Results: Good-quality BCPR was more frequently confirmed in OHCAs that occurred in the central/urban region (56.3% [251/446] vs. 39.3% [42/107], p= 0.0015), had multiple rescuers (31.8% [142/446] vs. 11.2% [12/107], p< 0.0001) and received bystander-initiated BCPR (22.0% [98/446] vs. 5.6% [6/107], p< 0.0001). Good-quality BCPR was less frequently performed by family members (46.9% [209/446] vs. 67.3% [72/107], p= 0.0001), elderly bystanders (13.5% [60/446] vs. 28.0% [30/107], p= 0.0005) and in at-home OHCAs (51.1% [228/446] vs. 72.9% [78/107], p< 0.0001). BCPR duration was significantly longer in the good-quality group (median, 8 vs. 6. min, p= 0.0015). Multiple logistic regression analysis indicated that multiple rescuers (odds ratio. = 2.8, 95% CI 1.5-5.6), bystander-initiated BCPR (2.7, 1.1-7.3), non-elderly bystanders (1.9, 1.1-3.2), occurrence in the central region (2.1, 1.3-3.3) and duration of BCPR (1.1, 1.0-1.1) were associated with good-quality BCPR. Moreover, good-quality BCPR was initiated earlier after recognition/witness of cardiac arrest compared with poor-quality BCPR (3 vs. 4. min, p= 0.0052). The rate of neurologically favourable survival at one year was 2.7 and 0% in the good-quality and poor-quality groups, respectively (p= 0.1357). Conclusions: The presence of multiple rescuers and bystander-initiated CPR are predominantly associated with good-quality BCPR. © 2013 Elsevier Ireland Ltd

Basic life support training for single rescuers efficiently augments their willingness to make early emergency calls with no available help: A cross-over questionnaire survey

Background: The aim of this study was to investigate effects of basic life support (BLS) training on willingness of single rescuers to make emergency calls during out-of-hospital cardiac arrests (OHCAs) with no available help from others.Methods: A cross-over questionnaire survey was conducted with two questionnaires. Questionnaires were administered before and after two BLS courses in fire departments. One questionnaire included two scenarios which simulate OHCAs occurring in situations where help from other rescuers is available (Scenario-M) and not available (Scenario-S). The conventional BLS course was designed for multiple rescuers (Course-M), and the other was designed for single rescuers (Course-S).Results: Of 2,312 respondents, 2,218 (95.9%) answered all questions and were included in the analysis. Although both Course-M and Course-S significantly augmented willingness to make early emergency calls not only in Scenario-M but also in Scenario-S, the willingness for Scenario-M after training course was significantly higher in respondents of Course-S than in those of Course-M (odds ratio 1.706, 95% confidential interval 1.301-2.237). Multiple logistic regression analysis for Scenario-M disclosed that post training (adjusted odds ratio 11.6, 95% confidence interval 7.84-18.0), age (0.99, 0.98-0.99), male gender (1.77, 1.39-2.24), prior BLS experience of at least three times (1.46, 1.25-2.59), and time passed since most recent training during 3 years or less (1.80, 1.25-2.59) were independently associated with willingness to make early emergency calls and that type of BLS course was not independently associated with willingness. Therefore, both Course-M and Course-S similarly augmented willingness in Scenario-M. However, in multiple logistic regression analyses for Scenario-S, Course-S was independently associated with willingness to make early emergency calls in Scenario-S (1.26, 1.00-1.57), indicating that Course-S more efficiently augmented willingness. Moreover, post training (2.30, 1.86-2.83) and male gender (1.26, 1.02-1.57) were other independent factors associated with willingness in Scenario-S.Conclusions: BLS courses designed for single rescuers with no help available from others are likely to augment willingness to make early emergency calls more efficiently than conventional BLS courses designed for multiple rescuers. © 2014 Hirose et al

Endomucin, a CD34-like sialomucin, marks hematopoietic stem cells throughout development

To detect as yet unidentified cell-surface molecules specific to hematopoietic stem cells (HSCs), a modified signal sequence trap was successfully applied to mouse bone marrow (BM) CD34−c-Kit+Sca-1+Lin− (CD34−KSL) HSCs. One of the identified molecules, Endomucin, is an endothelial sialomucin closely related to CD34. High-level expression of Endomucin was confined to the BM KSL HSCs and progenitor cells, and, importantly, long-term repopulating (LTR)–HSCs were exclusively present in the Endomucin+CD34−KSL population. Notably, in the yolk sac, Endomucin expression separated multipotential hematopoietic cells from committed erythroid progenitors in the cell fraction positive for CD41, an early embryonic hematopoietic marker. Furthermore, developing HSCs in the intraembryonic aorta-gonad-mesonephros (AGM) region were highly enriched in the CD45−CD41+Endomucin+ fraction at day 10.5 of gestation (E10.5) and in the CD45+CD41+Endomucin+ fraction at E11.5. Detailed analyses of these fractions uncovered drastic changes in their BM repopulating capacities as well as in vitro cytokine responsiveness within this narrow time frame. Our findings establish Endomucin as a novel cell-surface marker for LTR-HSCs throughout development and provide a powerful tool in understanding HSC ontogeny

Genomic regions involved in yield potential detected by genome-wide association analysis in Japanese high-yielding rice cultivars

BACKGROUND: High-yielding cultivars of rice (Oryza sativa L.) have been developed in Japan from crosses between overseas indica and domestic japonica cultivars. Recently, next-generation sequencing technology and high-throughput genotyping systems have shown many single-nucleotide polymorphisms (SNPs) that are proving useful for detailed analysis of genome composition. These SNPs can be used in genome-wide association studies to detect candidate genome regions associated with economically important traits. In this study, we used a custom SNP set to identify introgressed chromosomal regions in a set of high-yielding Japanese rice cultivars, and we performed an association study to identify genome regions associated with yield. RESULTS: An informative set of 1152 SNPs was established by screening 14 high-yielding or primary ancestral cultivars for 5760 validated SNPs. Analysis of the population structure of high-yielding cultivars showed three genome types: japonica-type, indica-type and a mixture of the two. SNP allele frequencies showed several regions derived predominantly from one of the two parental genome types. Distinct regions skewed for the presence of parental alleles were observed on chromosomes 1, 2, 7, 8, 11 and 12 (indica) and on chromosomes 1, 2 and 6 (japonica). A possible relationship between these introgressed regions and six yield traits (blast susceptibility, heading date, length of unhusked seeds, number of panicles, surface area of unhusked seeds and 1000-grain weight) was detected in eight genome regions dominated by alleles of one parental origin. Two of these regions were near Ghd7, a heading date locus, and Pi-ta, a blast resistance locus. The allele types (i.e., japonica or indica) of significant SNPs coincided with those previously reported for candidate genes Ghd7 and Pi-ta. CONCLUSIONS: Introgression breeding is an established strategy for the accumulation of QTLs and genes controlling high yield. Our custom SNP set is an effective tool for the identification of introgressed genome regions from a particular genetic background. This study demonstrates that changes in genome structure occurred during artificial selection for high yield, and provides information on several genomic regions associated with yield performance. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/1471-2164-15-346) contains supplementary material, which is available to authorized users

Pharmacist-physician collaborative care for outpatients with left ventricular assist devices using a cloud-based home medical management information-sharing system: a case report

[Background] The standard anticoagulation therapy for patients implanted with left ventricular assist devices (LVADs) includes warfarin therapy. We developed a cloud-based home medical management information-sharing system named as LVAD@home. The LVAD@home system is an application designed to be used on iPad tablet computers. This system enables the sharing of daily information between a patient and care providers in real time. In this study, we reported cases of outpatients with LVADs using this system to manage anticoagulation therapy. [Case presentation] The patient, a man in his 40s with end-stage heart failure owing to non-ischemic dilated cardiomyopathy, underwent LVAD implantation and warfarin was started on postoperative day 1. He started to use LVAD@home to manage warfarin therapy after discharge (postoperative day 47). He sent his data to care providers daily. By using this system, the pharmacist observed his signs of reduced dietary intake 179 days after discharge, and after consulting the physician, told the patient to change the timing of the next measurement earlier than usual. On the next day, the prothrombin time-international normalized ratio increased from 2.0 to 3.0, and thus the dose was decreased by 0.5 mg. Four patients used this system to monitor warfarin therapy from October 2015 to March 2018. In these patients, the time in therapeutic range was 90.1 ± 1.3, which was higher than that observed in previous studies. Additionally, there were no thromboembolic events or bleeding events. [Conclusions] The cloud-based home management system can be applied to share real-time patient information of factors, including dietary intake that interact with warfarin. It can help to improve long-term anticoagulation outcomes in patients implanted with LVAD

Changes of behavior and consciousness in COVID-19

新型コロナウイルスの感染症の拡大と長期化に伴い，世の中はパンデミック状態にある一方でテレワークの普及によって，個人生活にとってはメリットもあると考えられる．そこで現在の行動やコミュニケーション等の意識の変化，さらにフレイルなど健康面の課題について①生活，行動と意識に関するアンケート，②通勤，勤務と行動と意識に関するアンケート2種類のWeb調査により実態を明らかにした．その結果，未知のウイルスに対する脅威感から，人々の意識やライフスタイルも大きく変容していて，在宅時間の増加によりメリットもある一方で，時間の使い方は自己への投資などには回っておらず，健康面では不安を抱えていることが明らかになり，フレイル等により健康寿命の短縮が危惧されるなど，新たな日常スタイルに向けての課題があることが明らかになった．With the spread and prolongation of the new coronavirus infection, the world is in a pandemic state, but the spread of telework is thought to have benefits for personal life. Therefore, awareness of current behavior and communication, etc. Regarding changes and health issues such as frailty, (1) questionnaires on life, behavior and consciousness, and (2) questionnaires on commuting work and behavior and consciousness, the actual situation was clarified by two types of Web surveys. As a result, people's consciousness and lifestyle have changed significantly due to the threat of unknown viruses, and while there are benefits to increasing the time spent at home, spending time is not used for self-investment. However, it became clear that he was worried about his health, and that there were issues for a new daily style, such as fear of shortening healthy life expectancy due to frailty syndrome

高校生の生徒文化と学校経営(I)

日本教育社会学会第32回大会, 1980年9月(東北大学), 一般研究Ⅲ-3部会 高校教