Pediatricians’ Practice Location Choice—Evaluating the Effect of Japan’s 2004 Postgraduate Training Program on the Spatial Distribution of Pediatricians

Objectives: To explore determinants of change in pediatrician supply in Japan, and examine impacts of a 2004 reform of postgraduate medical education on pediatricians’ practice location choice. Methods: Data were compiled from secondary data sources. The dependent variable was the change in the number of pediatricians at the municipality (“secondary tier of medical care” [STM]) level. To analyze the determinants of pediatrician location choices, we considered the following predictors: initial ratio of pediatricians per 1000 children under five years of age (pediatrician density) and under-5 mortality as measures of local area need, as well as measures of residential quality. Ordinary least-squares regression models were used to estimate the associations. A coefficient equality test was performed to examine differences in predictors before and after 2004. Basic comparisons of pediatrician coverage in the top and bottom 10% of STMs were conducted to assess inequality in pediatrician supply. Results: Increased supply was inversely associated with baseline pediatrician density both in the pre-period and post-period. Estimated impact of pediatrician density declined over time (P = 0.026), while opposite trends were observed for measures of residential quality. More specifically, urban centers and the SES composite index were positively associated with pediatrician supply for the post-period, but no such associations were found for the pre-period. Inequality in pediatrician distribution increased substantially after the reform, with the best-served 10% of communities benefitting from five times the pediatrician coverage compared to the least-served 10%. Conclusions: Residential quality increasingly became a function of location preference rather than public health needs after the reform. New placement schemes should be developed to achieve more equity in access to pediatric care

Low Baseline Pneumococcal Antibody Titers Predict Specific Antibody Deficiency, Increased Upper Respiratory Infections, and Allergy Sensitization.

Background:Inadequate titers of pneumococcal antibody (PA) are commonly present among patients with recurrent respiratory infections. Objective:We sought to determine the effect of the degree of inadequacy in baseline PA titers on the subsequent polysaccharide vaccine response, the incidence of sinusitis, and allergic conditions. Methods:A total of 313 patients aged 6 to 70 years with symptoms of recurrent respiratory infections were classified by baseline-pPA (percentage of protective [≥1.3 µg/mL] PA serotypes/total tested serotypes) and postvaccination pPA (post-pPA): Group A (adequate baseline-pPA), Group B (inadequate baseline-pPA, adequate post-pPA, responders), and Group C (inadequate baseline-pPA, inadequate postpPA, nonresponders, specific antibody deficiency [SAD]). Immunity against Streptococcus pneumoniae was defined as adequate when the pPA was ≥70%. Each group and combined groups, Group AB (inadequate baseline-pPA), and Group BC (adequate post-pPA) were analyzed for demographics, history of sinusitis, recurrent sinusitis in the following year, allergic conditions, and association with inadequate individual serotype titers. Results:Over 80% of patients with respiratory symptoms had inadequate baseline-pPA. Baseline-pPA and SAD prevalence are inversely related (odds ratio = 2.02, 95% CI: 1.15-3.57, P = .01). Inadequate serotype 3 antibody titer is highly associated with SAD (odds ratio = 2.02, 96% CI: 1.61-5.45, P < .01). The groups with inadequate pPA (Group B and C, or BC) had significantly higher percentage of patients with chronic rhinosinusitis (P < .001), allergic sensitization, and allergic rhinitis (P < .05). Group A contained higher percentage of patients with recurrent upper airway infections (P < .001). Conclusion:Low baseline-pPA and low antibody titers to serotype 3 are highly associated with SAD, increased incidence of respiratory infections including CRS and allergic conditions

血管内皮細胞における過酸化水素誘導のカベオリン-1リン酸化に対するケルセチンの抑制効果

Caveolin-1 is a major protein of the caveolae structure in vascular endothelial cell membrane. Phosphorylation of caveolin-1 is one of the initial events leading to exacerbation of vascular permeability caused by oxidative stress. Although quercetin is known to be an anti-atherosclerosis factor that acts as a dietary antioxidant, little is known about its role in the regulation of caveolin-1 phosphorylation. In this study, we investigated the inhibitory effect of quercetin on hydrogen peroxide-induced caveolin-1 phosphorylation in human umbilical vein endothelial cells. Quercetin inhibited caveolin-1 phosphorylation in cells pretreated with quercetin for 24 h and then exposed to hydrogen peroxide. However, quercetin 3-O-β-glucuronide, a conjugated metabolite of quercetin, did not exert this inhibitory effect. Exposure to hydrogen peroxide increased vascular permeability and reduced mRNA expression of the intercellular adhesion protein, vascular endothelial cadherin (VE-cadherin). By contrast, pretreatment with quercetin suppressed the increase in vascular permeability and decreased VE-cadherin expression. These results indicate that deconjugated quercetin can play a role in the prevention of altered vascular permeability under oxidative stress by suppressing caveolin-1 phosphorylation. Thus, dietary quercetin may be beneficial for the maintenance of endothelial cell function

The Impact of Japan's 2004 Postgraduate Training Program on Intra-Prefectural Distribution of Pediatricians in Japan

Objective: Inequity in physician distribution poses a challenge to many health systems. In Japan, a new postgraduate training program for all new medical graduates was introduced in 2004, and researchers have argued that this program has increased inequalities in physician distribution. We examined the trends in the geographic distribution of pediatricians as well as all physicians from 1996 to 2010 to identify the impact of the launch of the new training program. Methods: The Gini coefficient was calculated using municipalities as the study unit within each prefecture to assess whether there were significant changes in the intra-prefectural distribution of all physicians and pediatricians before and after the launch of the new training program. The effect of the new program was quantified by estimating the difference in the slope in the time trend of the Gini coefficients before and after 2004 using a linear change-point regression design. We categorized 47 prefectures in Japan into two groups: 1) predominantly urban and 2) others by the definition from OECD to conduct stratified analyses by urban-rural status. Results: The trends in physician distribution worsened after 2004 for all physicians (p value<.0001) and pediatricians (p value = 0.0057). For all physicians, the trends worsened after 2004 both in predominantly urban prefectures (p value = 0.0012) and others (p value<0.0001), whereas, for pediatricians, the distribution worsened in others (p value = 0.0343), but not in predominantly urban prefectures (p value = 0.0584). Conclusion: The intra-prefectural distribution of physicians worsened after the launch of the new training program, which may reflect the impact of the new postgraduate program. In pediatrics, changes in the Gini trend differed significantly before and after the launch of the new training program in others, but not in predominantly urban prefectures. Further observation is needed to explore how this difference in trends affects the health status of the child population

An Overview of the Scholarly Literature Regarding the Mental Burden Perceived by the Mothers of Children with Autism

本研究は、自閉症児の母親の心的負担に関する先行研究を概観し、得られた知見を整理することを目的としている。分析視点は、①障害のある子どもの母親の心的負担を測定するための心理尺度はどのような尺度が開発されてきたか、②それらの尺度によって自閉症児の母親の心的負担について、どのようなことが明らかになったか、③自閉症児の母親の心的負担を軽減するための有効な支援としてどのような支援が指摘されているかとした。①について、障害のある子どもの母親全般を対象とした尺度開発は盛んに行われていた。しかし、自閉症に特化した尺度はあまりなかった。②について、自閉症児の母親の心的負担の特色として、「他の障害種の子どもの母親に比べて、相対的に高いこと」、「子どもの幼児期に高いこと」、「子どもの問題行動に由来する心的負担があること」、そして「子どもとの愛着形成の困難さに由来する心的負担があること」が明らかになった。③について、自閉症児の母親にとって「診断告知における配慮」や「同じ立場にある母親とのつながり」が有効な支援であった。This study aims to provide an overview of studies relating to the mental burden borne by the mothers of children with autism and to summarize the findings. To this end, three analytical perspectives are employed, namely（ 1） what kinds of psychological scales have been developed to measure the mental burden borne by mothers of children with disabilities;（ 2） what have these scales revealed about the mental burden borne by mothers of children with autism; and（ 3） what kinds of supports have been found to be effective in reducing the mental burden borne by mothers of children with autism. Regarding the first point, such scales have been actively developed; however, few of these scales have specifically targeted autism. Regarding the second point, which addresses the mental burden born specifically by mothers of children with autism, it was revealed that their burden“ is relatively high in comparison with the mothers of children with other types of disability,” that it“ is particularly high in early childhood,”“ that some mental burdens derive from problem behaviors,” and “that some mental burdens derive from the difficulty of forming attachments.” Finally, regarding the third point,“ consideration in the context of diagnostic notification” and“ connection with other mothers in a similar position” have proven to be effective supports for the mothers of children with autism

Heritability and Environmental Correlation of Phase Angle with Anthropometric Measurements: A Twin Study

Bioelectrical impedance analysis (BIA)-derived phase angle (PhA) is a valuable parameter to assess physical health. However, the genetic and environmental aspects of PhA are not yet well understood. The present study aimed to estimate the heritability of PhA and investigate the relationships between PhA and anthropometric measurements. PhA and skeletal muscle mass index (SMI) were examined using multi-frequency BIA in 168 Japanese twin volunteers (54 males and 114 females; mean age = 61.0 ± 16.5 years). We estimated the narrow-sense heritability of these parameters and the genetic and environmental relationships between them using a genetic twin modeling. For the PhA, 51% (95% confidence interval: 0.33, 0.64) of the variance was explained by additive genetic effects, and 49% (95% confidence interval: 0.36, 0.67) was explained by unique environmental effects. The heritability of PhA was lower than the height, body weight, and body mass index. PhA shared almost no genetic variation with anthropometric measurements and SMI but shared an environmental variation (14%) with SMI. These findings suggest that the genes affecting PhA are different than those affecting anthropometric measurements and SMI. The correlation between PhA and SMI is caused by common environmental factors

Heritability and Environmental Correlation of Phase Angle with Anthropometric Measurements: A Twin Study

Bioelectrical impedance analysis (BIA)-derived phase angle (PhA) is a valuable parameter to assess physical health. However, the genetic and environmental aspects of PhA are not yet well understood. The present study aimed to estimate the heritability of PhA and investigate the relationships between PhA and anthropometric measurements. PhA and skeletal muscle mass index (SMI) were examined using multi-frequency BIA in 168 Japanese twin volunteers (54 males and 114 females; mean age = 61.0 ± 16.5 years). We estimated the narrow-sense heritability of these parameters and the genetic and environmental relationships between them using a genetic twin modeling. For the PhA, 51% (95% confidence interval: 0.33, 0.64) of the variance was explained by additive genetic effects, and 49% (95% confidence interval: 0.36, 0.67) was explained by unique environmental effects. The heritability of PhA was lower than the height, body weight, and body mass index. PhA shared almost no genetic variation with anthropometric measurements and SMI but shared an environmental variation (14%) with SMI. These findings suggest that the genes affecting PhA are different than those affecting anthropometric measurements and SMI. The correlation between PhA and SMI is caused by common environmental factors

Correlation Between Pediatrician Supply and Public Health in Japan as Evidenced by Vaccination Coverage in 2010: Secondary Data Analysis

Background: In industrialized countries, assessment of the causal effect of physician supply on population health has yielded mixed results. Since the scope of child vaccination is an indicator of preventive health service utilization, this study investigates the correlation between vaccination coverage and pediatrician supply as a reflection of overall pediatric health during a time of increasing pediatrician numbers in Japan. Methods: Cross-sectional data were collected from publicly available sources for 2010. Dependent variables were vaccination coverage for measles and diphtheria, pertussis, and tetanus (DPT) by region. The primary predictor of interest was number of pediatricians per 10 000-child population (pediatrician density) at the municipality level. Multivariate logistic regression models were used to estimate associations of interest, conditional on a large range of demographic and infrastructure-related factors as covariates, including non-pediatric physician density, total population, per capita income, occupation, unemployment rate, prevalence of single motherhood, number of hospital beds per capita, length of roads, crime rate, accident rate, and metropolitan area code as urban/rural status. The percentage of the population who completed college-level education or higher in 2010 was included in the model as a proxy for education level. Results: Pediatrician density was positively and significantly associated with vaccination coverage for both vaccine series. On average, each unit of pediatrician density increased odds by 1.012 for measles (95% confidence interval, 1.010–1.015) and 1.019 for DPT (95% confidence interval, 1.016–1.022). Conclusions: Policies increasing pediatrician supply contribute to improved preventive healthcare services utilization, such as immunizations, and presumably improved child health status in Japan

Relationship between Visual Acuity and Lifestyle: A Cross-Sectional Study in Japanese Children

Purpose: To evaluate poor visual acuity (PVA) prevalence and factors related to PVA, including parental myopia status and lifestyle, in primary school children. Methods: Of total 220 primary school children from grades 4–6 in Hiroshima, 184 (83.6%) were enrolled in the study. They were divided into non-PVA (both eyes’ acuities ≥ 1.0) and PVA (one or both eyes’ acuity < 1.0 and/or wearing spectacles) groups. Data on lifestyle activities were obtained using self-reported questionnaires regarding daily lifestyle, including the duration of watching TV, playing games, using a computer, studying, number of books read per month, and outdoor activities. Results: The total prevalence of PVA was 66.8%: 50.0% for grade 4, 71.4% for grade 5, and 74.6% for grade 6. In binary logistic regression models, children who had at least one parent with myopia showed greater PVA than those with parents without myopia (OR = 1.89; 95% CI, 1.14 to 3.15). In addition, weekend studying was significantly associated with PVA (OR = 1.48; 95% CI, 1.03 to 2.12), and the number of books read per month was associated with PVA (OR = 1.26, 95% CI, 1.05 to 1.51). Conclusions: This study confirmed a high PVA prevalence in primary school children, and that the rate of PVA increased with advancing grade. Parental myopia was associated with PVA, as were long studying time and a high number of books read per month