乳幼児育児世代の女性の子宮頸がん検診受診に関連する要因 : 日本の国民を代表するサンプルによる横断研究

京都大学0048新制・課程博士博士(社会健康医学)甲第22043号社医博第96号新制||社医||10(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 万代 昌紀, 教授 福原 俊一, 教授 戸井 雅和学位規則第4条第1項該当Doctor of Public HealthKyoto UniversityDFA

Updating quality indicators for low-risk labour care in Japan using current clinical practice guidelines: a modified Delphi method

Objectives: Quality indicators are measurable elements widely used to assess the quality of care. They are often developed from the results of systematic reviews or clinical practice guidelines. These sources are regularly updated in line with new clinical evidence, but there are few articles on updating quality indicators based on clinical practice guidelines. This study aimed to update the quality indicators developed for low-risk labour care in Japan in 2012, mainly drawing on new or updated clinical practice guidelines, and making the process clearly visible and assessable. Design and setting: We used a modified Delphi method for the update. The procedure included four steps: (1) updating the definition of low-risk labour; (2) reviewing the literature published between June 2012 and December 2015 using five guidelines and two quality indicator databases to extract potential candidate indicators; (3) formation of a multidisciplinary panel including mothers and (4) panel ratings (two rounds between February and April 2016) on the validity of the candidate indicators, and judging the validity of the previous quality indicators drawing on the new evidence. Participants: A multidisciplinary panel of 13 clinicians, including obstetricians, paediatricians and midwives, plus 3 non-clinician mothers. Results: The literature review identified 276 new recommendations from 27 clinical practice guidelines including 2 published in Japan and 21 quality indicators. We developed 13 new candidate indicators from these sources and panel recommendations, 12 of which were approved by the multidisciplinary panel. The panel also accepted all 23 existing quality indicators as still valid, resulting in a total of 35 quality indicators for low-risk labour. Conclusions: We successfully updated the quality indicators for low-risk labour care in Japan. The procedure developed may be useful for updating other quality indicators based on new clinical practice guidelines

Breastfeeding information in midwifery textbooks in Japan: content analysis with evaluation standards based on Delphi method.

The purpose of this study was to evaluate breastfeeding information in midwifery textbooks. Evaluation standards were developed in order to perform content analysis. A 3-round Delphi method using a panel of 32 midwives resulted in 36 evaluation items from the original 38 draft items based on 4 major international guidelines and statements on breastfeeding. Subsequently, breastfeeding descriptions in 4 midwifery textbooks most frequently used in Japan were examined using a 4-point scale (A, accurate and sufficient description; B, accurate but insufficient description; C, no description; and D, inaccurate or inconsistent description). Among the evaluation items, 40% were rated as A, 25% as C, 21% as B, and 15% as D across the 4 textbooks. In conclusion, a substantial proportion of breastfeeding information in these textbooks was found to be inaccurate, inconsistent, or insufficient in content

Development of quality indicators for low-risk labor care provided by midwives using a RAND-modified Delphi method

Abstract Background In childbirth, most deliveries are low-risk, defined as spontaneous labor at full term without special high-risk facts or complications, especially in high-resource countries where maternal and perinatal mortality rates are very low. Indeed, the majority of mothers and infants have no serious conditions during labor. However, the quality of care provided is not assured, and performance may vary by birthing facility and provider. The overuse of technology in childbirth in some parts of the world is almost certainly based on assumptions like, “something can go wrong at any minute.” There is a need to assess the quality of care provided for mothers and infants in low-risk labor. We aimed to develop specific quality indicators for low-risk labor care provided primarily by midwives in Japan. Methods We used a RAND-modified Delphi method, which integrates evidence review with expert consensus development. The procedure comprises five steps: (1) literature review, including clinical practice guidelines, to extract and develop quality indicator candidates; (2) formation of a multidisciplinary panel; (3) independent panel ratings (Round 1); (4) panel meeting and independent panel ratings (Round 2); and (5) independent panel ratings (Round 3). The three independent panel ratings (Rounds 1–3) were held between July and December 2012. Results The assembled multidisciplinary panel comprised eight clinicians (two pediatricians, three obstetricians, and three midwives) and three mothers who were nonclinicians. Evidentiary review extracted 166 key recommendations from 32 clinical practice guidelines, and 31 existing quality indicators were added. After excluding duplicate recommendations and quality indicators, the panel discussed 25 candidate indicators. Of these, 18 were adopted, one was modified, six were not adopted, and four were added during the meeting, respectively. Conclusions We established 23 quality indicators for low-risk labor care provided by midwives in labor units in Japan

Loneliness among mothers raising children under the age of 3 years and predictors with special reference to the use of SNS: a community-based cross-sectional study

SNS使用と育児中のお母さんの孤独感との関連を見出しました. 京都大学プレスリリース. 2018-08-24.Background: Loneliness in mothers raising children can adversely impact the health of their children and lead to child abuse, depression, and deterioration of mothers’ health. Few studies to date have specifically assessed the association between loneliness and social factors, including the use of social network sites (SNSs), and personal factors. This study aimed to identify predictors of loneliness in mothers raising children, with special reference to SNS use. Methods: This cross-sectional study involved an anonymous self-reported questionnaire survey of mothers participating in the health check-ups for their children in Nagahama City, Japan, from July 28 to September 29, 2014. The following items were assessed: revised UCLA Loneliness Scale, “Secure” subscale of the Internal Working Model Scale (IWMS-S), psychological distress scale (K6), abbreviated Lubben Social Network Scale (LSNS-6), and types of communication devices and information sources. Multiple regression analysis was performed using the Loneliness Scale score as the dependent variable. Results: Among 763 mothers attending health check-ups for children in Nagahama City, 715 were available for the survey. Among a total of 638 respondents, data from 523 mothers were analyzed (valid response rate: 73.1%). The mean Loneliness Scale score ± standard deviation was 36.1 ± 9.7. The multiple regression analysis revealed that loneliness was significantly associated with being financially worse-off (β = − 3.35, p = 0.004) and struggling (β = − 2.47, p = 0.047); having a smaller family social network (β = − 0.32, p = 0.032), having fewer friends (β = − 0.49, p = 0.001), and having a smaller SNS network (β = − 0.21, p = 0.018); a lower secure subscale score on the IWMS-S (β = − 0.56, p < 0.001); and a K6 score of ≥5 (β = 4.24, p < 0.001). Conclusion: The degree of loneliness in mothers raising children was associated with a smaller social network, lower secure attachment style, and a higher possibility of psychological distress. These factors should be considered when developing effective interventions against loneliness in mothers raising children

Additional file 1: of A qualitative study on coping behaviors and influencing factors among mothers in Japan raising children under three years old while experiencing physical and mental subjective symptoms

Consolidated criteria for reporting qualitative studies (COREQ): 32-item checklist [22]. This data is to ensure our manuscript adheres to COREQ guidelines for reporting qualitative studies. (DOCX 128 kb