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)

Residential proximity to major roads and adverse birth outcomes: a hospital-based study

Background: Exposure to air pollution has been demonstrated to increase the risk of preterm birth and low birth weight (LBW). Although evidence has accumulated on characteristics associated with increased risk of air pollution-related health effects, most studies have been conducted in the adult population and evidence on reproductive outcomes is limited. We examined whether socio-economic position (SEP) and parental characteristics (parental behavior and co-morbidity) modified the relationship between air pollution and adverse birth outcomes. Methods: Data were extracted from a perinatal hospital database based in Shizuoka, Japan. We restricted the analysis to mothers who delivered live-born single births from January 1997 to December 2010 (n = 16,615). Each birth was assigned proximity to major roads. Multivariate adjusted odds ratios (ORs) and their 95% confidence intervals (CIs) were estimated for the outcomes of preterm birth and term LBW. We stratified subjects by individual/area-level SEP and parental characteristics. We then measured interactions on the additive scale between the respective factors and exposure. Results: Lower SEP at both individual and area levels was associated with the increased occurrence of adverse birth outcomes. Living within 200 m from a major road increased the risk of preterm birth by 1.5 times (95% CI: 1.3-1.9) and LBW by 1.2 times (95% CI: 0.9-1.6). Mothers with lower individual SEP defined by household occupation experienced higher ORs for term LBW (OR = 3.1, 95% CI: 1.2-8.2) compared with those with higher individual SEP. In contrast, mothers who lived in the highest area-level SEP region (i.e., affluent areas) showed slightly higher point estimates compared with those who lived in middle or poor areas. In addition, maternal diabetic and hypertensive status modified the association between proximity and preterm birth, while maternal smoking status modified the association between proximity and term LBW. Conclusions: The present study demonstrated that air pollution is an independent risk factor for adverse birth outcomes. Mothers with lower individual SEP and mothers living in higher SEP region may be susceptible to the adverse effect of air pollution. Maternal diabetic, hypertensive, and smoking status may also increase susceptibility to this air pollution-related health effect

Trends of preterm birth and low birth weight in Japan: a one hospital-based study

Background: The proportions of preterm birth (PTB, ie., delivered before 37 gestational weeks) and low birth weight (LBW, ie., birth weight less than 2500 g at delivery) have been rising in developed countries. We sought to examine the factors contributing to the rise in Japan, with particular focus on the effects of obstetric interventions. Methods: We used a database maintained by one large regional hospital in Shizuoka, Japan. We restricted the analysis to mothers who delivered live singleton births from 1997 to 2010 (n = 19,221). We assessed the temporal trends in PTB and LBW, then divided the study period into four intervals and compared the proportions of PTB and LBW. We also compared the newborns’ outcomes between the intervals. Results: PTB, in particular medically indicated PTB, increased considerably. The increase was largely explained by changes in caesarean sections. The neonatal outcomes did not worsen, and instead the Apgar scores and proportions requiring neonatal intensive care unit (NICU) admission improved. In particular, the risks of NICU admission in the interval from 2007 to 2010 were decreased among all births [odds ratio (OR): 0.84; 95% confidence interval (CI): 0.75, 0.95] and medically indicated births (OR: 0.44; 95% CI: 0.29, 0.68) compared with the interval from 1997 to 2000. Conclusions: Despite the increases in PTB as well as LBW, the present study suggests benefits of obstetric interventions. Rather than simple categorization of PTB or LBW, indicators such as perinatal mortality or other outcomes may be more appropriate for evaluation of perinatal health in developed countries

Adhesion characteristics of geopolymer mortar to concrete and rebars

In recent years, geopolymers have gained a wide attention as highly ecological-friendly building materials, having a capability to cut down 70% of CO2 emissions in comparison to the ordinary cement concrete. In this study, geopolymer mortars are proposed as repair materials for reinforced concrete structures, due to their superior acid resistance, heat resistance and high strength in comparison to the existing repair materials. The objective of this study is to investigate the adhesion properties of geopolymer mortars to concrete substrates with different surface treatments, steel plates and rebars. As a result, the geopolymer mortars are found to have excellent adhesion properties to dry concrete substrates, steel plates and rebars. Concrete substrates treated with grinder, further enhanced the adhesion properties of geopolymer mortars. On the other hand, poor adhesion of geopolymer mortars to wet concrete substrates was observed due to the presence of water on the interfacial zone, which decreased the alkali concentration of the geopolymer, resulting in lower adhesion strength. In general, geopolymer mortars are found to have suitable adhesion properties to the concrete substrates, steel plates and rebars and can be applied as repair materials for reinforced concrete structures

Adhesion characteristics of geopolymer mortar to concrete and rebars

In recent years, geopolymers have gained a wide attention as highly ecological-friendly building materials, having a capability to cut down 70% of CO2 emissions in comparison to the ordinary cement concrete. In this study, geopolymer mortars are proposed as repair materials for reinforced concrete structures, due to their superior acid resistance, heat resistance and high strength in comparison to the existing repair materials. The objective of this study is to investigate the adhesion properties of geopolymer mortars to concrete substrates with different surface treatments, steel plates and rebars. As a result, the geopolymer mortars are found to have excellent adhesion properties to dry concrete substrates, steel plates and rebars. Concrete substrates treated with grinder, further enhanced the adhesion properties of geopolymer mortars. On the other hand, poor adhesion of geopolymer mortars to wet concrete substrates was observed due to the presence of water on the interfacial zone, which decreased the alkali concentration of the geopolymer, resulting in lower adhesion strength. In general, geopolymer mortars are found to have suitable adhesion properties to the concrete substrates, steel plates and rebars and can be applied as repair materials for reinforced concrete structures

Trends of preterm birth and low birth weight in Japan: a one hospital-based study

Abstract Background The proportions of preterm birth (PTB, ie., delivered before 37 gestational weeks) and low birth weight (LBW, ie., birth weight less than 2500 g at delivery) have been rising in developed countries. We sought to examine the factors contributing to the rise in Japan, with particular focus on the effects of obstetric interventions. Methods We used a database maintained by one large regional hospital in Shizuoka, Japan. We restricted the analysis to mothers who delivered live singleton births from 1997 to 2010 (n = 19,221). We assessed the temporal trends in PTB and LBW, then divided the study period into four intervals and compared the proportions of PTB and LBW. We also compared the newborns’ outcomes between the intervals. Results PTB, in particular medically indicated PTB, increased considerably. The increase was largely explained by changes in caesarean sections. The neonatal outcomes did not worsen, and instead the Apgar scores and proportions requiring neonatal intensive care unit (NICU) admission improved. In particular, the risks of NICU admission in the interval from 2007 to 2010 were decreased among all births [odds ratio (OR): 0.84; 95% confidence interval (CI): 0.75, 0.95] and medically indicated births (OR: 0.44; 95% CI: 0.29, 0.68) compared with the interval from 1997 to 2000. Conclusions Despite the increases in PTB as well as LBW, the present study suggests benefits of obstetric interventions. Rather than simple categorization of PTB or LBW, indicators such as perinatal mortality or other outcomes may be more appropriate for evaluation of perinatal health in developed countries.</p