Breastfeeding and perceptions of breast shape changes in Australian and Japanese women

This thesis examines infant feeding practices, including knowledge and attitudes towards breastfeeding, factors that influence the duration of breastfeeding, and breastfeeding outcomes in relation to postpartum women’s body image, particularly perceived changes of breast shape in Australian and Japanese women.From previous studies, the number of women who desire to be slim after their childbirth has been increasing in recent years, and it is hypothesised that their concerns about body image may be associated with breastfeeding outcomes. It has been found that the Asian women have more distorted body images than their Caucasian counterparts. Breastfeeding gives many benefits to health of women and child, and the benefits may be greater with longer breastfeeding duration. Nevertheless, the duration of ‘exclusive breastfeeding’ is still less than the recommendations in most countries. There have been only a limited number of studies investigating breastfeeding outcomes related to postpartum women’s body image.This thesis contains two studies. In the first study, a cross-sectional survey was conducted in 2007 at Himeji city, Japan, in order to describe infant feeding practices and to identify factors that are associated with breastfeeding duration. The survey was a self-administered questionnaire included in a letter from the Himeji City Health Department offering free health checks for infants at 18 months of age. The second study was a prospective cohort study with interviews on seven occasions (4, 10, 16, 22, 32, 40, and 52 weeks postpartum) of follow-up over a period of 12 months, the Perth Infant Feeding Study Mark II (PIFS II). This second study was undertaken in two local hospitals in Perth, Australia between 2002 and 2003. While the initial results of the PIFS II have been published elsewhere, variables related to the postpartum women’s body image had not previously been analysed. Both studies used almost the same questions on infant feeding practices and about postpartum women’s body image.Univariate analysis was first employed to describe breastfeeding practices and to assess which factors could be included in the model of breastfeeding duration. These were then incorporated into multivariate analysis to identify the contributing factors of the duration of ‘any breastfeeding’ to six months postpartum. In the second group of analysis, factors related to postpartum women’s body image, their Body Mass Index (BMI) and perceptions of changes in their weight status, body and breast shape were included. These factors were then entered into a multivariate logistics regression analysis with other contributing factors in breastfeeding duration.In the Japanese study, 2,345 women were eligible to participate and 1,623 completed the questionnaire (Response rate: 69.2%). For the final analysis, 1,612 questionnaires were used, due to missing data. The majority (72.8%) of respondents were housewives with mean age 32.2, ranging from 18 to 44. Almost half of them were primiparous (56%) and had annual family income below 4,500,000 Japanese yen (JP¥) (55.5%) (Equivalent value in Australian dollars (AU$), approximately 50000). Low birth weight infants (less than 2500g) were 8.4$ and 40,000 AU$ at 31.0%. The smoking rate reported by the women lies between 23% and 39% during the follow-up periods, and the prevalence of alcohol consumption by the women ranged from 40.2% to 48.5%. The majority had made a decision about infant feeding methods either before or early pregnancy (91.8%) and those infants were most often fed breastmilk as their first food while in hospitals (81.2%).Their husbands and own mothers positively supported breastfeeding in the decision making processes. The mean duration of ‘any breastfeeding’ and of introducing infant formula were 23.3 weeks (SD = 19.7) (approximately 5.8 months). The IIFAS also indicated that the Australian women showed positive attitudes towards breastfeeding with the mean score 64.4 (SD=8.3). About 8% of the Perth women were in the ‘underweight’ category (BMI < 18.5) before pregnancy. 51% noticed changes in their breast shape within four weeks of birth and this increased to 60% at 52 weeks postpartum. The most common changes perceived between four and 52 weeks postpartum were ‘sagging’ following ‘changes in size’. The factors that influenced breastfeeding duration in Australia were similar to the Japanese women with the exception of alcohol consumption. A multiple logistic regression showed that the women who had longer breastfeeding duration were more likely to perceive changes of their breast shape at week 52. For a one week increase in the duration of ‘exclusive breastfeeding’ up to six months, the average risk of perceived changes in breast shape at week 52 increased by 3.5% (95% CI = 1.00 to 1.07), by 3.8% (95% CI = 1.01 to 1.07) with ‘any breastfeeding’ duration up to six months, and by 2.9% (95% CI = 1.00 to 1.06) with ‘full breastfeeding’ up to six months, respectively. Moreover, the average risk of perceived changes in breast shape at week 52 increased by 0.8% (95% CI = 1.00 to 1.02), whenever women increase ‘any breastfeeding’ duration up to 12 months with each additional week.Cox logistic regression was also used to explore breastfeeding by type for six months or 12 months given their perceptions of breast shape at four weeks postpartum. However, no significant associations were found after adjustment of the model. The results indicated that the Australian women perceived changes to their body weight and breast shape in the postpartum period, but Japanese women were significantly more conscious about these aspects than their Australian counterparts. The cultural backgrounds of the women affected the associations between body image and breastfeeding outcomes. It is important to acknowledge this factor when providing education programs in breastfeeding.Breastfeeding outcomes were different between studies, particularly with regard to supplemental feeding, family involvement in decisions about infant feeding methods, and opinions on alcohol intake during breastfeeding. In addition, the prevalence of women with ‘underweight’ BMI is different between the two countries. These two studies suggest that cultural beliefs about women’s body image were associated with breastfeeding duration. The Japanese women were more conscious about their body and breast shape, which was significantly associated with breastfeeding duration, compared with their Australian counterparts. Women’s knowledge and attitudes towards breastfeeding reflected this and was at a lower level in Japan than in Australia. Several issues including media exposure, social expectations about women’s body shape and gestational weight control that are potentially related to women’s body image are discussed below.There are some limitations that needed to be considered when interpreting and assessing the applicability of the results. Through these two studies, changes of body weight, breast in shape were not assessed by any objective measure and were based on the participants’ perceptions. In addition, as the first study was cross-sectional and based on self-reported data at 18 months postpartum in Japan, there is a possibility of some recall bias about breastfeeding practices. In the second study, the PIFS II, a limitation was that the sample was recruited from two public hospitals and probably reflected a selection bias towards lower socio-economic status.It is recommended further studies using a cohort method with a large sample size and a qualitative approach be undertaken to enrich and verify the results of the study. These will enable a more accurate estimate of the prevalence of breastfeeding, factors that predict breastfeeding duration and postpartum women’s perceptions of changes in breast shape during breastfeeding. Breastfeeding education programs should be based on accurate studies of maternal knowledge and attitudes towards infant feeding methods, benefits of breastfeeding in the short and long term, and attitudes to body image in postpartum. These education programs need to acknowledge cultural perspectives in breastfeeding and women’s body image. Further improvements in working environments of postpartum women allowing them to continue breastfeeding are also suggested. It is important for public health that relevant interventions should be developed to improve breastfeeding rates and duration, in Australia and Japan

THE STEREOSCOPIC EFFECT OF A SPINNING BATON FLIGHT

INTRODUCTION: In baton twirling, catching a spinning baton is one of fundamental skills. For successful baton-catching, baton twirlers acquire the efficient visual search behavior setting their gaze not only to parabolic flight but spin of baton (Takahashi et al., 2007). Mazyn et al. (2007) reported that the learning to catch a ball is affected by stereo vision providing accurate depth perception of the ball’s movement. We consider a CAVE Automatic Virtual Environment system, 3D virtual reality display with stereoscopic effect, may be used as a training tool for baton-catching. This preliminary study aimed to examine the stereoscopic effect on the virtual reality simulation of baton-catching in a CAVE system. We reconstructed stereo- and monoscopic stimuli of spinning baton flight simulated by 3D motion capture data and assessed observer’s impression of them

ユートピアがディストピアになるとき―ソルジェニーツィンのロシア論における悪の不在―

　本稿では、ソルジェニーツィンのロシア/ロシア人論を検討することにより、その表象世界においては、その内部に悪や悪意が存在しないことを明らかにする。今日のソルジェニーツィンに対する評価は、完全に二分されている。とりわけ彼のロシア/ロシア人論について、リベラルな人々は民族主義的あるいは反ユダヤ主義的であると批判して、もはや考察の対象としない一方で、政治家や本質主義的なロシア論を展開する人々においては根強く支持されている。両者の間に大きな懸隔が存在する。本稿では、ソルジェニーツィンのロシア表象における悪の不在を明らかにすることによって、その両者の対話の糸口とすることを目的とする。　検討の対象となるのは、ソルジェニーツィンの主に60―70年代と90年代の作品である。60年代の作品の中から主に短編文芸作品、90年代の作品の中からロシア/ロシア人論が展開される2つの論文をとりあげる。　第1節は、「善き民衆（ナロード）～智慧としての正教」と題し、60年代の作品では農民や労働者に見出される人間的美徳が、90年代においてはロシア人一般に投影され、正教によって培われる美徳とみなされるようになることを明らかにする。第2節は、「善き大統領とともに～ロシア型民主主義」と題し、90年代のロシア論をとりあげ、「小空間の民主主義」とソルジェニーツィンが呼ぶところのロシア型民主主義について考察する。第3節は、「ロシア人論と民族概念」と題し、1990年代の作品におけるロシア人像をソ連時代の民族概念・民族行政との関連において考察する。最後に、ソルジェニーツィンのロシア表象における悪の不在とその意味について検討を行なう。This paper discusses the absence of evil in the 60s and 90s works of A. Solzhenitsyn. When he talks about what Russians should be, or how Russia can reborn after the collapse of USSR, he imagines a world of harmony with people of good faith. In his 60s literary works, Solzhenitsyn portrays Russian peasants as people endowed with the virtues of modesty, unselfishness and patience. In his 90s works, he reflects on the goodness of Russian peasants among all the Russian people, who follow the faith of the Orthodox Church. Moreover, when he argues about the Russian type of democracy, he claims that a cooperative relationship could emerge between an ethical and moral president and a Russian people who can both listen to each other. In his consideration, ethnic Russians who have been forced to scatter throughout the Russian Federation, have a mission to become a warp thread in a tapestry woven by various ethnic groups in Russia. Addition to discussing these analyses, this paper clarifies the fact that evils are absent from the world which Solzhenitsyn depicts; that is, his world is full of people of good will. In such a situation, what seems to be utopia takes on a new complexion as dystopia. This is because the violence of compulsive agreement might be forced on people. Solzhenitsyn has sometimes been called a Russian chauvinist or nationalist; however, it is insufficient and meaningless to label him as such. If we are to face the gulf or lack of dialogue between liberal intellectuals and people who sympathize with the Russian image of Solzhenitsyn, further considerations on the absence of evil in his world might provide a clue to initiating dialogues

Stepwise discriminant function analysis for differentiation of idiopathic cytopenia of undetermined significance from myelodysplastic syndrome or aplastic anemia using Sysmex XE-5000™ parameters

学位記番号：保博甲141

Infant feeding practices and breastfeeding duration in Japan: A review

The Japanese health system places great emphasis on healthy development. However, the prevalence of Exclusive Breastfeeding at one month postpartum between 1980 and 2005 has remained unchanged, fluctuating between 42% and 49%. At the same time, the Any Breastfeeding prevalence has gradually increased from about 80% to 95%. In 2010, the latest national breastfeeding report showed that ‘exclusive’ and ‘any’ breastfeeding rates have improved. However, as the World Health Organization (WHO) definition of breastfeeding practices was not used in this study or in other national surveys, it is difficult to interpret these latest results. While the Japanese government has launched several promotion projects, there have been few studies and reviews of risk factors that influence breastfeeding duration. The objectives of this review were to summarise the factors that have influenced the duration of breastfeeding in Japan to provide information relevant to breastfeeding promotion programs. A search of electronic databases in Japanese and English was undertaken up to 2011. The inclusion criteria for this review were studies that focused on infant feeding practices and targeted Japanese mothers, fathers, or health professionals, but excluded mothers’ friends and peer groups.In total, 12 articles were selected for the final analysis. Smoking status, low birth weight of infants and maternal perceptions of insufficient breast milk supply were negative influences on breastfeeding duration, while support from husbands/partners is associated with continued breastfeeding. Some factors that have been found to be associated with breastfeeding in other countries, including maternal age, family income, maternal educational levels, and living with grandparents of infants have not been confirmed in Japan. While the national breastfeeding rates were higher than other countries of similar health status, inconsistent knowledge of breastfeeding benefits and inappropriate hospital practices remain in Japan may be associated with increased the use of infant formula and reduced breastfeeding duration. Most of the studies reviewed were cross-sectional in design, with only a limited number of cohort studies. Also many published studies used small sample sizes. Cohort studies of infant feeding practices with larger sample sizes are required to monitor trends in rates and risk factors for breastfeeding outcomes

Association between Immediate Postoperative Radiographic Findings and Failed Internal Fixation for Trochanteric Fractures: Systematic Review and Meta-Analysis

Failed internal fixations for trochanteric fractures have a strong negative impact owing to increased postoperative mortality and high medical costs. However, evidence on the prognostic value of postoperative radiographic findings for failed internal fixations is limited. We aimed to clarify the association between comprehensive immediate postoperative radiographic findings and failed internal fixation using relative and absolute risk measures. We followed the meta-analysis of observational studies in epidemiology guidelines and the Cochrane handbook. We searched specific databases in November 2021. The outcomes of interest were failed internal fixation and cut-out. We pooled the odds ratios and 95% confidence intervals using a random-effects model and calculated the number needed to harm for each outcome. Thirty-six studies involving 8938 patients were included. The certainty of evidence in the association between postoperative radiographic findings and failed internal fixation or cut-out was mainly low or very low except for the association between intramedullary malreduction on the anteromedial cortex and failed internal fixation. Moderate certainty of evidence supported that intramedullary malreduction on the anteromedial cortex was associated with failed internal fixation. Most postoperative radiographic findings on immediate postoperative radiographs for trochanteric fractures were uncertain as prognostic factors for failed internal fixations

Hard X-ray Properties of the Merging Cluster Abell 3667 as Observed with Suzaku

Wide-band Suzaku data on the merging cluster Abell 3667 were examined for hard X-ray emission in excess to the known thermal component. Suzaku detected X-ray signals in the wide energy band from 0.5 to 40 keV. The hard X-ray (> 10 keV) flux observed by the HXD around the cluster center cannot be explained by a simple extension of the thermal emission with average temperature of ~7 keV. The emission is most likely an emission from a very hot (kT > 13.2 keV) thermal component around the cluster center, produced via a strong heating process in the merger. In the north-west radio relic, no signature of non-thermal emission was observed. Using the HXD, the overall upper-limit flux within a 34'x34' field-of-view around the relic is derived to be 5.3e-12 erg s-1 cm-2 in the 10-40 keV band, after subtracting the ICM contribution estimated using the XIS or the XMM-Newton spectra. Directly on the relic region, the upper limit is further tightened by the XIS data to be less than 7.3e-13 erg s-1 cm-2, when converted into the 10--40 keV band. The latter value suggest that the average magnetic field within the relic is higher than 1.6 uG. The non-thermal pressure due to magnetic fields and relativistic electrons may be as large as ~20% of the thermal pressure in the region.Comment: 18 pages, 13 figures, to be appeared in PASJ 200

Osteosynthesis for Geriatric Acetabular Fractures: An Epidemiological and Clinico-Radiological Study Related to Marginal or Roof Impaction

This retrospective study sought to elucidate the incidence rates of roof impaction (RI) and marginal impaction (MI) and radiological and clinical outcomes of open reduction and internal fixation (ORIF) for RI and MI in geriatric acetabular fractures. The cases of 68 patients aged ≥ 65 years (mean 71 years) treated with ORIF were analyzed. MI was present in 12 fractures (67%) and an RI of the weight-bearing surface was present in 24 (46%) of the potential fracture types. Regarding the reduction quality, 54% of the reductions were graded as anatomical, 37% as imperfect, and 9% as poor. In the clinical evaluations of the 45 patients who had > 1-year follow-up (follow-up rate: 66.2%), 18% were graded as excellent, 53% as good, 16% as fair, and 13% as poor. An anatomic reduction was strongly associated with good or excellent clinical and radiological outcomes. CT was superior to radiographs for detecting the residual displacement postoperatively. Postoperative deep infection occurred in four patients. Three patients (6.7%) underwent a total hip arthroplasty conversion due to secondary osteoarthritis of the hip. We recommend ORIF as the preferred surgical treatment option for displaced acetabular fractures in elderly patients

Introducing Solid Foods to Infants in the Asia Pacific Region

For infants’ optimal growth and development, the introduction of nutritionally suitable solid foods at the appropriate time is essential. However, less attention has been paid to this stage of infant life when compared with studies on breastfeeding initiation and duration. The practice of introducing solid foods, including the types of foods given to infants, in the Asia Pacific region was reviewed. In total nine studies using the same questionnaire on infant feeding practices were analysed to gain a better understanding of trends in the introduction of solid foods in this region. All studies showed less than optimal duration of exclusive breastfeeding indicating an earlier time of introduction of solid foods than recommended by the WHO. Most mothers commonly used rice or rice products as the first feed. In many studies, the timing of introducing solid foods was associated with breastfeeding duration. Compared with the Recommended Nutrient Intakes for infants aged above six months, rice/rice products are of lower energy density and have insufficient micronutrients unless they have been fortified. Although the timing of introducing solid foods to infants is important in terms of preventing later health problems, the quality of the foods should also be considered. Recommendations to improve the introduction of solid foods include measures to discourage prelacteal feeding, facilitating breastfeeding education and providing better information on healthier food choices for infants