モンゴル人妊婦の受動喫煙の自覚と尿中コチニンとの関連、および受動喫煙の関連要因

学位の種別: 課程博士審査委員会委員 : （主査）東京大学教授 佐々木 敏, 東京大学准教授 瀧本 禎之, 東京大学講師 成瀬 昴, 東京大学教授 神馬 征峰, 東京大学講師 大西 弘高University of Tokyo(東京大学

Secondhand Smoke Exposure Among Pregnant Women in Mongolia

喫煙は，様々な健康被害をもたらす公衆衛生上の大きな健康問題である．毎年，世界中で800 万人がたばこを原因とする病気で命を落としており，そのうちの100 万人は受動喫煙が原因であると言われている．受動喫煙には，「安全な曝露レベルはない」と言われていることから，たばこの煙への少しの曝露であっても避ける必要がある．世界の喫煙者の80％以上が低中所得国に居住しているが，モンゴル国では43.7％の人が喫煙者で，35.7％の女性が受動喫煙をしていると報告されている．妊娠中の受動喫煙は，妊婦と胎児両方の健康に影響を及ぼし，早産や死産，先天性の異常や，胎児発育の阻害，u母体の妊娠高血圧症候群のリスクを高めるなどの影響が報告されている．モンゴル国における非喫煙妊婦の受動喫煙率は44.8％であり，年齢が若い人，学歴が低い人，家庭内全室を禁煙にしていない人が，受動喫煙のリスクが高いことが報告されている．また，妊婦とパートナー（夫）の尿中コチニンレベルが相関していることからも，妊婦はパートナーまたは同居している家族が喫煙しているたばこから受動喫煙していることが考えられる．受動喫煙予防のための対策として，法律の制定やマスメディアを使ったキャンペーン，たばこ広告の禁止，健康への害の表示，たばこ税の増税といった対策が取られている．また，医師のアドバイス，ビデオやパンフレットなどの教育媒体を用いた健康教育，喫煙するパートナーとの交渉の仕方のロールプレイ等の介入の効果が報告されている．これらの研究データは，社会全体の受動喫煙の害に対する意識を高め，妊娠中の受動喫煙の曝露を減らすことにつながると思われる．モンゴル国においても，妊婦の受動喫煙がどの程度健康に影響を及ぼしているのかを明らかにすること，また，受動喫煙を予防するための介入の効果を検証する必要がある

Physical and Mental Effects of Foot Baths Among Women in Labor: Protocol for a Pre-Post Test Experimental Design

BackgroundFoot baths are used in complementary and alternative therapy to improve the duration and quality of sleep and reduce tension, anxiety, fatigue, and confusion. They are also known to improve the frequency of labor contractions and to increase their duration in women; thus, they are commonly used by midwives in clinical settings in Japan. However, the physical and mental effects of foot baths during labor are unknown. ObjectiveThis study aims to assess the physical and mental effects of foot baths based on biomarker levels and self-administered questionnaires. MethodsA single-arm pre-post test trial design is being used in this study, and the study is being conducted at a general hospital in Tochigi Prefecture, Japan. The target study population is women in the first stage of labor, the phase when the uterus starts to contract and when the cervix dilates to 10 cm, or those undergoing labor induction. Participants who meet the eligibility criteria are recruited, and written informed consent is obtained from them. They are asked to answer the questionnaire and to collect 1.5 mL of saliva in 2 microtubes each, before and after the intervention. The intervention is foot baths for 15-20 minutes using a foot bath device. Data on delivery, such as gestational age, gravidity, parity, diagnosis following the last vaginal examination, and presence or absence of membrane rupture, are retrieved from the medical records. The primary outcomes are salivary cortisol levels before and after the foot baths. The secondary outcomes are levels of relaxation and comfort, labor pain, body warmth, vital signs, and interval of labor pain before and after the foot baths, which are assessed using a numerical rating scale. A paired t test or Wilcoxon signed-rank test will be performed to compare the data for salivary cortisol levels and numerical rating scale scores. ResultsData collection started on April 1, 2022. As of October 2022, we had enrolled 10 participants. Because of the COVID-19 pandemic in Japan, it is difficult for medical personnel to freely interact with women in labor until the results of the COVID-19 polymerase chain reaction test are available in the research facility, complicating the recruitment process. ConclusionsThis is the first prospective study to assess the effects of foot baths using a biomarker during the first stage of labor. The findings on the effects of foot baths on women in labor will provide novel insights that may improve the outcomes of delivery. A randomized controlled trial to investigate the effects of foot baths to obtain robust evidence should be conducted in the future. Trial RegistrationUniversity Hospital Medical Information Network-Clinical Trial Registry UMIN000046539; https://tinyurl.com/2wwj7dns International Registered Report Identifier (IRRID)DERR1-10.2196/3998

Comparison of knowledge about smoking and passive smoking and urinary cotinine levels in pregnant women and their partners in Mongolia: A cross-sectional study

This study aimed to compare knowledge about smoking, including passive smoking, and urinary cotinine (UC) levels in pregnant women and their partners in Mongolia. The study was conducted between November 2015 and January 2016 in Darkhan-Uul Province, Mongolia. Pregnant women with less than 20 weeks’ gestation were recruited, and their partners were also invited to participate. Self-administered questionnaires and urine samples were used to collect data. Knowledge about smoking including passive smoking was measured using 14 questions. Data were analyzed using a Student’s t-test, a chi-squared test, a one-way analysis of variance, and the Tukey–Kramer method for post-hoc analysis. Correlations were measured by computing Pearson’s r or Spearman’s ρ. A total of 508 pregnant women and 227 partners participated in this study; of these, 221 couples’ data were analyzed. Pregnant women’s scores on knowledge about smoking and passive smoking were significantly higher than those of their partners (9.4 ± 2.9 and 8.7 ± 3.1, respectively; p = 0.017). Pregnant women’s and their partners’ scores were slightly correlated (r = 0.163, p = 0.015). Pregnant women’s and their partners’ UC levels were significantly correlated (ρ = 0.250, p < 0.001). This study is the first to examine knowledge about smoking and passive smoking and UC levels among pregnant women and their partners in Mongolia. Because pregnant women’s and their partners’ scores and UC levels were positively correlated, health education on the harm caused by smoking and passive smoking should be provided to both pregnant women and their partners

Prevalence and risk factors of secondhand smoke (SHS) exposure among pregnant women in Mongolia

Abstract This cross-sectional study investigated the prevalence of smoking and secondhand smoking (SHS) among pregnant women in Darkhan-Uul Province, Mongolia, using urinary cotinine (UC) levels, and clarified the factors related to SHS exposure. It targeted pregnant women who underwent antenatal health check-ups from November 2015 to January 2016. Self-administered questionnaires and urine samples were used to collect data. Using UC levels as the criterion, it was found that the prevalence of smokers (>100 ng/ml) among 493 pregnant women was 11.8%, while SHS exposure (≥5 ng/ml) among nonsmokers was 44.8%. Older and highly educated women had lower odds of SHS exposure (p = 0.006 and 0.002, respectively). Furthermore, nonsmoking pregnant women from homes where smoking was permitted had higher odds of SHS exposure compared to women from homes where smoking was not permitted. These results suggest that community guidance programs, such as home smoking cessation that include families, are necessary

Growth Factors Released from Gelatin Hydrogel Microspheres Increase New Neurons in the Adult Mouse Brain

Recent studies have shown that new neurons are continuously generated by endogenous neural stem cells in the subventricular zone (SVZ) of the adult mammalian brain. Some of these new neurons migrate to injured brain tissues and differentiate into mature neurons, suggesting that such new neurons may be able to replace neurons lost to degenerative disease or injury and improve or repair neurological deficits. Here, we tested whether delivering growth factors via gelatin hydrogel microspheres would support neurogenesis in the SVZ. Insulin-like growth factor-1 (IGF-1)-containing microspheres increased the number of new neurons in the SVZ. Hepatocyte growth factor (HGF)-containing microspheres increased the number of new neurons migrating from the SVZ towards the injured striatum in a stroke model in mouse. These results suggest that the strategy of using gelatin hydrogel microspheres to achieve the sustained release of growth factors holds promise for the clinical regeneration of damaged brain tissues from endogenous neural stem cells in the adult SVZ

Hospitalization risk factors for children's lower respiratory tract infection: A population-based, cross-sectional study in Mongolia.

This study aimed to assess the potential risk factors for lower respiratory tract infection (LRTI)-related hospital admissions in Mongolian children. A population-based cross-sectional study was conducted in rural Mongolia in 2013, and 1, 013 mother–child pairs were included. Of the participating children, 38. 9% were admitted to hospital with LRTIs. Home smoking, low birthweight, being a male child, exclusive breastfeeding and healthcare-seeking behaviour showed substantial association with LRTI-related hospital admissions. Number of cigarettes smoked by family members showed a dose-response relationship and increased hospital admissions. Strategies to prevent second-hand-smoke exposure from adult smokers, especially inside the home, are crucial to preventing LRTI-related hospital admissions for children in Mongolia. Improving rates of exclusive breastfeeding and increasing birthweight have great potential to decrease the likelihood of children acquiring a LRTI. Educational initiatives are also necessary for women who are less likely to seek out care for their children's symptoms