Factors Associated With Intention of Future Pregnancy Among Women Affected by the Fukushima Nuclear Accident: Analysis of Fukushima Health Management Survey Data From 2012 to 2014.

BackgroundLittle is known about the association between the anxiety toward the effects of radiation on reproduction caused by the Fukushima nuclear accident and the birth rate of people in Fukushima. Therefore, we examined changes and associated factors of future pregnancy intention among mothers in Fukushima Prefecture.MethodsUsing data from three postal surveys among women who registered their pregnancies in the prefecture (N = 6,751 in 2012, N = 6,871 in 2013, and N = 6,725 in 2014), we analyzed the factors associated with women's intention of future pregnancy using multivariable logistic regression models.ResultsThe proportion of mothers with pregnancy intention increased from 53.5% in 2012 to 57.9% in 2014, especially among multiparas (P for trend <0.001). Factors inversely associated with pregnancy intention of both groups were older maternal age (adjusted odds ratio [aOR] 0.92 for primipara and 0.87 for multipara), poor subjective health (aOR 0.75 and 0.81, respectively), and presence of depressive symptoms (aOR 0.71 and 0.79, respectively) (P < 0.01 for all items). In addition, not living with husband (aOR 0.24), dissatisfaction with obstetrical care (aOR 0.89) and child abnormalities (aOR 0.72) were inversely associated with pregnancy intention among primiparas, while receiving infertility treatment (aOR 2.05) was positively associated among multiparas (P < 0.01 for all items). A separate analysis of 2012 and 2013 data showed that concern about radiation contamination of breast milk was associated with pregnancy intention among primiparas (aOR 0.61, P < 0.001).ConclusionsMothers' concern about radiation was associated with lower pregnancy intention, especially among primiparas. Providing quality obstetrical and mental health care and parenting support may be the keys to maintaining the temporal increase in fertility

Association between physician characteristics and payments from industry in 2015-2017: observational study.

OBJECTIVE:To investigate the association between physician characteristics and the value of industry payments. DESIGN:Observational study. SETTING AND PARTICIPANTS:Using the 2015-2017 Open Payments reports of industry payments linked to the Physician Compare database, we examined the association between physician characteristics (physician sex, years in practice, medical school attended and specialty) and the industry payment value, adjusting for other physician characteristic and institution fixed effects (effectively comparing physicians practicing at the same institution). MAIN OUTCOME MEASURES:Our primary outcome was the value of total industry payments to physicians including (1) general payments (all forms of payments other than those classified for research purpose, eg, consulting fees, food, beverage), (2) research payments (payments for research endeavours under a written contract or protocol) and (3) ownership interests (eg, stock or stock options, bonds). We also investigated each category of payment separately. RESULTS:Of 544 264 physicians treating Medicare beneficiaries, a total of $5.8 billion in industry payments were made to 365 801 physicians during 2015-2017. The top 5% of physicians, by cumulative payments, accounted for 91% of industry payments. Within the same institution, male physicians, physicians with 21-30 years in practice and physicians who attended top 50 US medical schools (based on the research ranking) received higher industry payments. Across specialties, orthopaedic surgeons, neurosurgeons and endocrinologists received the highest payments. When we investigated individual types of payment, we found that orthopaedic surgeons received the highest general payments; haematologists/oncologists were the most likely to receive research payments and surgeons were the most likely to receive ownership interests compared with other types of physicians. CONCLUSIONS:Industry payments to physicians were highly concentrated among a small number of physicians. Male sex, longer length of time in clinical practice, graduated from a top-ranked US medical school and practicing certain specialties, were independently associated with higher industry payments

Challenging cases of professionalism in Japan: improvement in understanding of professional behaviors among Japanese residents between 2005 and 2013.

BackgroundProfessionalism is deemed as the basis of physicians' contract with society in Japan. Our study in 2005, using a questionnaire with scenarios to professionalism, suggested that many physicians at various levels of training in Japan encounter challenges when responding to these common scenarios related to professionalism. It is unclear how medical professionalism has changed among Japanese residents in over time.MethodsWe conducted a follow-up survey about challenges to professionalism for Japanese residents using the same Barry Questionnaire after a seven-year interval from the prior survey. The survey uses six clinical scenarios with multiple choice responses. The six cases include the following challenges: acceptance of gifts; conflict of interest; confidentiality; physician impairment; sexual harassment; and honesty in documentation. Each scenario is followed by 4 or 5 possible responses, including the "best" and the "second best" responses. The survey was conducted as a part of nationwide general medicine in-training examination.ResultsWe collected data from 1,049 participants (290 women, 28%; 431 PGY-1 and 618 PGY-2 residents). Overall, the current residents performed better than their colleagues in the earlier survey for five scenarios (gifts, conflict of interest, confidentiality, impairment, and honesty) but not for the harassment scenario. PGY-2 residents were more likely to select either the best or 2nd best choices to gifts (p = 0.002) and harassment (p = 0.031) scenarios than PGY-1 residents. Residents in the current study chose either the best or 2nd best choices to the gifts (p < 0.001) and honesty (p < 0.001) scenarios than those of the previous study conducted seven years ago, but not for the harassment scenario (p = 0.004).ConclusionsOur study suggests that there is improvement of medical professionalism with respect to some ethical challenges among the Japanese residents in the current study compared to those in our previous study

Out-of-pocket spending and financial burden among low income adults after Medicaid expansions in the United States: quasi-experimental difference-in-difference study.

OBJECTIVE:To examine the association between expansion of the Medicaid program under the Affordable Care Act and changes in healthcare spending among low income adults during the first four years of the policy implementation (2014-17). DESIGN:Quasi-experimental difference-in-difference analysis to examine out-of-pocket spending and financial burden among low income adults after Medicaid expansions. SETTING:United States. PARTICIPANTS:A nationally representative sample of individuals aged 19-64 years, with family incomes below 138% of the federal poverty level, from the 2010-17 Medical Expenditure Panel Survey. MAIN OUTCOMES AND MEASURES:Four annual healthcare spending outcomes: out-of-pocket spending; premium contributions; out-of-pocket plus premium spending; and catastrophic financial burden (defined as out-of-pocket plus premium spending exceeding 40% of post-subsistence income). P values were adjusted for multiple comparisons. RESULTS:37 819 adults were included in the study. Healthcare spending did not change in the first two years, but Medicaid expansions were associated with lower out-of-pocket spending (adjusted percentage change -28.0% (95% confidence interval -38.4% to -15.8%); adjusted absolute change -122 (£93; €110); adjusted P<0.001), lower out-of-pocket plus premium spending (-29.0% (-40.5% to -15.3%); -442; adjusted P&lt;0.001), and lower probability of experiencing a catastrophic financial burden (adjusted percentage point change -4.7 (-7.9 to -1.4); adjusted P=0.01) in years three to four. No evidence was found to indicate that premium contributions changed after the Medicaid expansions. CONCLUSION:Medicaid expansions under the Affordable Care Act were associated with lower out-of-pocket spending and a lower likelihood of catastrophic financial burden for low income adults in the third and fourth years of the act's implementation. These findings suggest that the act has been successful nationally in improving financial risk protection against medical bills among low income adults

Machine-learning-based high-benefit approach versus conventional high-risk approach in blood pressure management

高血圧診療における次世代の個別化医療戦略を提唱 --機械学習により個人の治療効果を予測する時代へ--. 京都大学プレスリリース. 2023-04-05.[Background] In medicine, clinicians treat individuals under an implicit assumption that high-risk patients would benefit most from the treatment (‘high-risk approach’). However, treating individuals with the highest estimated benefit using a novel machine-learning method (‘high-benefit approach’) may improve population health outcomes. [Methods] This study included 10 672 participants who were randomized to systolic blood pressure (SBP) target of either 0) versus the high-risk approach (treating individuals with SBP ≥130 mmHg). Using transportability formula, we also estimated the effect of these approaches among 14 575 US adults from National Health and Nutrition Examination Surveys (NHANES) 1999–2018. [Results] We found that 78.9% of individuals with SBP ≥130 mmHg benefited from the intensive SBP control. The high-benefit approach outperformed the high-risk approach [average treatment effect (95% CI), +9.36 (8.33–10.44) vs +1.65 (0.36–2.84) percentage point; difference between these two approaches, +7.71 (6.79–8.67) percentage points, P-value <0.001]. The results were consistent when we transported the results to the NHANES data. [Conclusions] The machine-learning-based high-benefit approach outperformed the high-risk approach with a larger treatment effect. These findings indicate that the high-benefit approach has the potential to maximize the effectiveness of treatment rather than the conventional high-risk approach, which needs to be validated in future research

Association of the National Health Guidance Intervention for Obesity and Cardiovascular Risks With Health Outcomes Among Japanese Men

メタボ健診・特定保健指導制度の課題を提言 --エビデンスに基づく制度改善に期待--. 京都大学プレスリリース. 2020-10-09.Importance: Obesity and cardiovascular risks have become major public health problems. However, evidence is limited as to whether population-level lifestyle interventions for obesity and cardiovascular risk factors are associated with improved population health outcomes. Objective: To investigate the association of the national health guidance intervention in Japan with population health outcomes. Design, Setting, and Participants: This cohort study used a regression discontinuity design that included men aged 40 to 74 years who participated in the national health screening program in Japan from April 2013 to March 2018. Exposures: Assignment to the national health guidance intervention (counseling on healthy lifestyle and appropriate clinical follow-up for individuals found to have waist circumference of 85 cm or greater with 1 or more cardiovascular risk factors during annual national health screening program). Main Outcomes and Measures: Changes in obesity status (body weight, body mass index, waist circumference), and cardiovascular risk factors (blood pressure, hemoglobin A1c level, and low-density lipoprotein cholesterol level) 1 to 4 years after screening. Results: Of 74 693 men (mean [SD] age, 52.1 [7.8] years; mean [SD] baseline waist circumference, 86.3 [9.0] cm), the assignment to the health guidance intervention was associated with lower weight (adjusted difference, −0.29 kg; 95% CI, −0.50 to −0.08; P = .005), body mass index (−0.10; 95% CI, −0.17 to −0.03; P = .008), and waist circumference (−0.34 cm; 95% CI, −0.59 to −0.04; P = .02) 1 year after screening. The observed association of the guidance assignment attenuated over time and was no longer significant by years 3 to 4. No evidence was found that the health guidance intervention was associated with changes in participants’ systolic blood pressure, diastolic blood pressure, hemoglobin A1c level, or low-density lipoprotein cholesterol level in years 1 to 4. Conclusions and Relevance: Among working-age men in Japan, the national health guidance intervention was not associated with clinically meaningful weight loss or other cardiovascular risk factor reduction. Further research is warranted to understand the specific design of lifestyle interventions that are effective in improving obesity and cardiovascular risk factors

Changes in industry marketing payments to physicians during the covid-19 pandemic: quasi experimental, difference-in-difference study

[Objective] To determine changes in industry marketing payments to physicians due to the covid-19 pandemic. [Design] Quasi experimental, difference-in-difference study. [Data source] US nationwide database of licensed physicians, the National Plan and Provider Enumeration System, which was linked to a database of industry marketing payments made to physicians, Open Payments. [Population] All licensed US physicians from 2018 to 2020 and those who received payments from industry. [Main outcome measures] Changes in the value and the number of monthly industry payments physician received before (January-February 2020) and during the pandemic (April-December 2020) were assessed, adjusting for physicians’ characteristics (gender and specialty). As the control, data for the same months in 2019 were used. Industry payments by type of payments (eg, meals, travel, consulting fees, speaker compensation, honorariums), were also examined. [Results] Among 880 589 US physicians included in this study, 267 463 (30.4%) physicians received a total of 4 117 482 non-research payments with $626 million ($710 per physician; £610; €708) in 2020 (40-44% decrease from $1047m in 2018 and$1115m in 2019). Industry payments decreased significantly in the months of the covid-19 pandemic (adjusted change in the value of −48.4%; 95% confidence interval −50.6 to −46.2; P<0.001; and adjusted change in the number of −47.4%, 95% confidence interval −47.7 to −47.1; P<0.001), particularly for meals and travel fees. No evidence was seen of a decrease in the number of industry payments for consulting and honorariums. A similar pattern was observed across physicians’ gender and specialty. [Conclusions] Industry payments to physicians, particularly those involving physical interactions such as meals and travel, substantially decreased during the pandemic. How such changes affect prescription practices and the quality of clinical practice in the long term should be investigated

Association of Daily Step Patterns With Mortality in US Adults

1週間の歩行パターンと死亡リスクの関連を明らかに --週2回しっかり歩くことで健康は維持できるか？--. 京都大学プレスリリース. 2023-03-30.[Importance] Previous studies have shown that individuals who regularly walk, particularly 8000 daily steps or more, experience lower mortality. However, little is known about the health benefits of walking intensively only a few days a week. [Objective] To evaluate the dose-response association between the number of days an individual takes 8000 steps or more and mortality among US adults. [Design, Setting, and Participants] This cohort study evaluated a representative sample of participants aged 20 years or older in the National Health and Nutrition Examination Surveys 2005-2006 who wore an accelerometer for 1 week and their mortality data through December 31, 2019. Data were analyzed from April 1, 2022, to January 31, 2023. [Exposures] Participants were grouped by the number of days per week they took 8000 steps or more (0 days, 1-2 days, and 3-7 days). [Main Outcomes and Measures] Multivariable ordinary least squares regression models were used to estimate adjusted risk differences (aRDs) for all-cause and cardiovascular mortality during the 10-year follow-up, adjusting for potential confounders (eg, age, sex, race and ethnicity, insurance status, marital status, smoking, comorbidities, and average daily step counts). [Results] Among 3101 participants (mean [SD] age, 50.5 [18.4] years; 1583 [51.0%] women and 1518 [49.0%] men; 666 [21.5%] Black, 734 [23.7%] Hispanic, 1579 [50.9%] White, and 122 [3.9%] other race and ethnicity), 632 (20.4%) did not take 8000 steps or more any day of the week, 532 (17.2%) took 8000 steps or more 1 to 2 days per week, and 1937 (62.5%) took 8000 steps or more 3 to 7 days per week. Over the 10-year follow-up, all-cause and cardiovascular deaths occurred in 439 (14.2%) and 148 (5.3%) participants, respectively. Compared with participants who walked 8000 steps or more 0 days per week, all-cause mortality risk was lower among those who took 8000 steps or more 1 to 2 days per week (aRD, −14.9%; 95% CI −18.8% to −10.9%) and 3 to 7 days per week (aRD, −16.5%; 95% CI, −20.4% to −12.5%). The dose-response association for both all-cause and cardiovascular mortality risk was curvilinear; the protective association plateaued at 3 days per week. Different thresholds for the number of daily steps between 6000 and 10 000 yielded similar results. [Conclusions and Relevance] In this cohort study of US adults, the number of days per week taking 8000 steps or more was associated with a lower risk of all-cause and cardiovascular mortality in a curvilinear fashion. These findings suggest that individuals may receive substantial health benefits by walking just a couple days a week