病院で出産予定の低リスク妊婦への医療の質指標の適用可能性：既存の診療記録による検証

京都大学新制・課程博士博士(社会健康医学)甲第23384号社医博第117号新制||社医||11(附属図書館)京都大学大学院医学研究科社会健康医学系専攻(主査)教授 佐藤 俊哉, 教授 滝田 順子, 教授 万代 昌紀学位規則第4条第1項該当Doctor of Public HealthKyoto UniversityDFA

Applicability of care quality indicators for women with low-risk pregnancies planning hospital birth: a retrospective study of medical records

Practices for planned birth among women with low-risk pregnancies vary by birth setting, medical professional, and organizational system. Appropriate monitoring is essential for quality improvement. Although sets of quality indicators have been developed, their applicability has not been tested. To improve the quality of childbirth care for low-risk mothers and infants in Japanese hospitals, we developed 35 quality indicators using existing clinical guidelines and quality indicators. We retrospectively analysed data for 347 women in Japan diagnosed with low-risk pregnancy in the second trimester, admitted between April 2015 and March 2016. We obtained scores for 35 quality indicators and evaluated their applicability, i.e., feasibility, improvement potential, and reliability (intra- and inter-rater reliability: kappa score, positive and negative agreement). The range of adherence to each indicator was 0–95.7%. We identified feasibility concerns for six indicators with over 25% missing data. Two indicators with over 90% adherence showed limited potential for improvement. Three indicators had poor kappa scores for intra-rater reliability, with positive/negative agreement scores 0.94/0.33, 0.33/0.95, and 0.00/0.97, respectively. Two indicators had poor kappa scores for inter-rater reliability, with positive/negative agreement scores 0.25/0.92 and 0.68/0.61, respectively. The findings indicated that these 35 care quality indicators for low-risk pregnant women may be applicable to real-world practice, with some caveats

Effect modification by temperature on the association between O3 and emergency ambulance dispatches in Japan: A multi-city study

Numerous epidemiological studies have reported that ozone (O₃) and temperature are independently associated with health outcomes, but modification of the effects of O₃ on health outcomes by temperature, and vice versa, has not been fully described. This study aimed to investigate effect modification by temperature on the association between O₃ and emergency ambulance dispatches (EADs) in Japan. Data on daily air pollutants, ambient temperature, and EADs were obtained from eight Japanese cities from 2007 to 2015. A distributed lag non-linear model combined with Poisson regression was performed with temperature as a confounding factor and effect modifier to estimate the effects of O₃ on EADs at low (75th percentile) temperature for each city. The estimates obtained from each city were pooled by random-effects meta-analysis. When temperature was entered as a confounder, the estimated effects of O₃ on EADs for all acute, cardiovascular, and respiratory illnesses were largest at lag 0 (current-day lag). Therefore, this lag was used to further estimate the effects of O₃ on EADs in each temperature category. The estimated effects of O₃ on EADs for all acute, cardiovascular, and respiratory illnesses in all eight Japanese cities increased with increasing temperature. Specifically, a 10 ppb increase in O₃ was associated with 0.80 % (95 % CI: 0.25 to 1.35), 0.19 % (95 % CI: -0.85 to 1.25), and 1.14 % (95 % CI: -0.01 to 2.31) increases in the risk of EADs for all acute, cardiovascular, and respiratory illnesses, respectively, when city-specific daily temperature exceeded the 75th percentile. Our findings suggest that the association between O₃ and EADs for all acute, cardiovascular, and respiratory illnesses is the highest during high temperature. Finding of this study can be used to develop potential mitigation measures against O₃ exposure in high temperature environment to reduce its associated adverse health effects

Deep Collaborative Filtering Approaches for Context-Aware Venue Recommendation

In recent years, vast amounts of user-generated data have being created on Location-Based Social Networks (LBSNs) such as Yelp and Foursquare. Making effective personalised venue suggestions to users based on their preferences and surrounding context is a challenging task. Context-Aware Venue Recommendation (CAVR) is an emerging topic that has gained a lot of attention from researchers, where context can be the user's current location for example. Matrix Factorisation (MF) is one of the most popular collaborative filtering-based techniques, which can be used to predict a user's rating on venues by exploiting explicit feedback (e.g. users' ratings on venues). However, such explicit feedback may not be available, particularly for inactive users, while implicit feedback is easier to obtain from LBSNs as it does not require the users to explicitly express their satisfaction with the venues. In addition, the MF-based approaches usually suffer from the sparsity problem where users/venues have very few rating, hindering the prediction accuracy. Although previous works on user-venue rating prediction have proposed to alleviate the sparsity problem by leveraging user-generated data such as social information from LBSNs, research that investigates the usefulness of Deep Neural Network algorithms (DNN) in alleviating the sparsity problem for CAVR remains untouched or partially studied

Effect of optical correction on choroidal structure

The aim of this study was to assess the effect of wearing optical correction on the choroidal structure in eyes of children with anisohypermetropic amblyopia. This study was conducted at the Nara Medical University Hospital and at the Tokushima University Hospital. Twenty-nine anisohypermetropic amblyopic eyes and their fellow eyes of 29 amblyopic patients (mean age, 5.7 ± 1.7 years, range 3- to 8-years) and twenty eyes of 20 age-similar control children (4.9 ± 0.8 years, range 4- to 6-years) were studied. All patients wore optical correction and 15 patients had both optical correction and patching. The values at the baseline were compared to that at one year later. The binarization method was used to determine the total, luminal, and stromal areas of the choroid in the enhanced depth imaging optical coherence tomographic images. The best-corrected visual acuity (BCVA) of the amblyopic eyes was significantly improved after the one-year period. A large luminal area was characteristic of the amblyopic eye at the baseline, and it was significantly reduced after the optical treatment. The stromal area widened significantly in the amblyopic and fellow eyes after one year whereas there were no significant changes in the choroid of the control eyes after one year. After one-year of optical correction, the luminal/stromal ratios in the amblyopic and fellow eyes were decreased and were then not significantly different from that of the normal control eyes. There was a significant and positive correlation between the improvement of the BCVA and the stromal area at the baseline (r = 0.64, P = 0.001). Wearing corrective lenses on the amblyopic eyes improves the BCVA, and the choroidal structure of the amblyopic eye becomes closer to that of the control eyes. The narrowed luminal area is a specific response of the amblyopic eye associated with the correction of the refractive error. The larger stromal area in the amblyopic eyes at the baseline is a predictive factor for improvements of the BCVA

Health impact assessment of PM2.5-related mitigation scenarios using local risk coefficient estimates in 9 Japanese cities

Previous studies have highlighted the negative effects of PM2.5 on mortality, expressed in terms of attributable deaths and life years lost. However, there are very few studies assessing the health impacts of air pollution in terms of economic burden/benefits. This study assessed the health impact of two hypothetical interventions among sex- and age-specific risk populations using a robust risk estimation and economic valuation process. We utilized the sex- and age-stratified daily all-cause mortality together with the daily PM2.5 of the 9 Japanese cities from 2002 to 2008 in estimating the relative risks. The estimated risks were then utilized for the economic valuation of co-benefits/burden with respect to the two hypothetical PM2.5-related mitigation scenarios, in comparison to status quo, namely: i) decrease to Japanese standards, and ii) decrease to WHO standards. Impact of these interventions on health were assessed using the following HIA metrics: attributable mortality, attributable years life lost, and environmental health impact. A 10-μg/m3 increase in PM2.5 would increase the risk by 0.52% (95% CI: −0.91% to 1.99%) for all-cause mortality, with varying risk estimates per subgroup. High economic burdens were estimated at status quo, with particularly distinct burden difference for age-specific mortality; 0.40 trillion yen (0–64 y.o.) and 1.50 trillion yen (>64 y.o.). If stricter standards, relative to status quo, were to be enforced, i.e. WHO standard, there is a potential to yield economic benefits in the same risk population; 0.26 trillion yen (0–64 y.o.) and 0.98 trillion yen (>64 y.o.). We did not observe any substantial difference with the burden and benefit related to sex-specific mortality. Using the estimated local risk coefficients complemented with the valuation of the risks, policymaking entities will have the opportunity to operate their own HIA to assess the relevant air pollution-related health impacts

Ultraviolet Action Spectrum and Effect of EPC-K1 on Ultraviolet Radiation-induced Injury in Cultured Normal Human Epidermal Keratinocytes

This study was aimed to determine the ultraviolet (UV: 235-310nm) action spectrum for killing normal human epidermal keratinocytes (NHEK) and to investigate the preventive effect of EPC-K1, a phosphate diester of vitamin C and vitamin E on UV radiation-induced NHEK injury. NHEK were cultured in EpiLife medium supplemented with Human Keratinocyte Growth Supplement Kit. NHEK viability was determined by crystal violet (CV) staining 48 h after the UV irradiation. The mRNA expressions of the C/EBP homologous protein (Chop) transcription factor and endoplasmic reticulum-resident molecular chaperone, Bip, were determined by RT-PCR analyses. UV was especially effective in killing NHEK when applied in the wavelength region of 250-280nm. The minimum exposure dose required to kill 50% of cells (LD50) was 1.64mJ/cm2 at 269nm. At 235 and 310nm, the LD50 for NHEK was 6.62 and 293mJ/cm2, respectively. Irradiation of 660-mJ/cm2 at 310nm significantly decreased the cell viability to 30% of control (without irradiation). The addition of 0.1mM EPC-K1 after irradiation returned the cell viability to 118%. Six hours after the 660-mJ/cm2 irradiation at 310nm, Chop and Bip mRNA levels in NHEK were increased to 487% and 283%, respectively, and were not significantly affected by EPC-K1. Chop and Bip are responsive to ER stress. These results suggested that EPC-K1 exerts a protective effect against UV-induced NHEK injury, and further studies should investigate the molecular mechanism underlying this effect

Probability Distribution Function of Cosmological Density Fluctuations from Gaussian Initial Condition: Comparison of One- and Two-point Log-normal Model Predictions with N-body Simulations

We quantitatively study the probability distribution function (PDF) of cosmological nonlinear density fluctuations from N-body simulations with Gaussian initial condition. In particular, we examine the validity and limitations of one-point and two-point log-normal PDF models against those directly estimated from the simulations. We find that the one-point log-normal PDF describes very accurately the cosmological density distribution even in the nonlinear regime (the rms variance \sigma_{nl} \simlt 4 and the over-density \delta \simlt 100). Furthermore the two-point log-normal PDFs are also in good agreement with the simulation data from linear to fairly nonlinear regime, while slightly deviate from them for \delta \simlt -0.5. Thus the log-normal PDF can be used as a useful empirical model for the cosmological density fluctuations. While this conclusion is fairly insensitive to the shape of the underlying power spectrum of density fluctuations P(k), models with substantial power on large scales, i.e., n\equiv d\ln P(k)/d \ln k \simlt -1, are better described by the log-normal PDF. On the other hand, we note that the one-to-one mapping of the initial and the evolved density fields consistent with the log-normal model does not approximate the broad distribution of their mutual correlation even on average. Thus the origin of the phenomenological log-normal PDF approximation still remains to be understood.Comment: 25 pages, 8 figures, Accepted for publication in Ap