Preconception underweight impact on postnatal osteoporotic fracture: a retrospective cohort study using Japanese claims data.

BACKGROUND: Undernutrition and underweight are osteoporosis risk factors. Therefore, improving the health of underweight young women in Japan is an important medical issue. However, few studies have evaluated the association between being preconception underweight and postnatal osteoporotic fractures in young women. METHODS: This retrospective cohort study used a Japanese nationwide claims database (JMDC Inc.) to evaluate the effect of preconception underweight on the incidence of osteoporotic fracture within two years after delivery. Data from 16,684 mothers who delivered their first singleton babies between January 2006 and December 2020 were analysed. The combination of disease codes of fractures at sites associated with osteoporosis and medical procedures for fractures was defined as the incidence of osteoporotic fractures, whereas the body mass index (BMI) recorded 12-36 months before delivery was used as the exposure. We estimated the incidence of osteoporotic fractures by BMI category using a Kaplan-Meier curve and examined the fracture risk using Cox hazard regression analyses. RESULTS: Fifty-one women (0.31%) were affected by osteoporotic fractures within two years of delivery. More than 80% of these were rib fractures, and approximately 65% of fractures occurred after the first year postpartum. Preconception underweight (BMI < 18.5 kg/m2) was significantly associated with the incidence of postpartum osteoporotic fractures. There was no significant association between low BMI and postnatal fractures, as analysed via multiple categorical logistic regression analysis. CONCLUSION: Appropriate control of preconception weight might be critical to improving the postpartum quality of life, subsequent bone health, and neonatal care environment.

Literature Review of Studies Using the National Database of the Health Insurance Claims of Japan (NDB): Limitations and Strategies in Using the NDB for Research.

The use of the National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB) for research has increased over time. Researchers need to understand the characteristics of the data to generate quality-assured evidence from the NDB. In this review, we mapped and characterized the limitations and related strategies using the NDB for research based on the descriptions of published NDB studies. To find studies that used Japanese healthcare claims data, we searched MEDLINE, EMBASE, and Ichushi-Web up to June 2023. Additionally, we hand-searched the NDB data publication list from the Ministry of Health, Labour and Welfare (2017-2023). We abstracted data based on the NDB data type, research themes, age of the study sample or population, targeted disease, and the limitations and strategies in the NDB studies. Ultimately, 267 studies were included. Overall, the most common research theme was describing and estimating the prescriptions and treatment patterns (125 studies, 46.8%). There was a variation in the frequency of themes according to the type of NDB data. We identified the following categories of limitations: (1) lack of information on confounders/covariates, outcomes, and other clinical content, (2) limitations regarding patients not included in the NDB, (3) misclassification of data, (4) lack of unique identifiers and register of beneficiaries, and (5) others. Although the included studies noted several limitations of using the NDB for research, they also provided some strategies to address them. Organizing the limitations of NDB in research and the related strategies across research fields can help support high-quality NDB studies.

Annual numbers of diagnoses and medical expenses for obstetric diseases in Japan: A report from the National Database of Health Insurance Claims.

AIM: The present study aimed to estimate the total numbers of obstetric diseases diagnosed, total amounts of medical expenses claimed for obstetric diseases, their averages per livebirth, and yearly trends in Japan. METHODS: This is a secondary analysis of the National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB) (data from 2015 to 2019). The target population was women of reproductive age (15-49 years old) with diseases in pregnancy, childbirth, and the puerperium, defined by having O codes according to the International Classification of Diseases 10th Revision. We calculated the numbers of obstetric diseases diagnosed, amounts of medical expenses claimed for obstetric diseases marked with the "main injury/disease decision flag," and the totals divided by the annual numbers of livebirths, by year and women's age group. RESULTS: From 2015 to 2019, both the numbers of obstetric diseases diagnosed and amounts of medical expenses claimed for obstetric diseases per livebirth were on an upward trend, whereas the total numbers of obstetric diseases diagnosed were decreased. Women in advanced age groups had a higher number of diagnoses and a higher amount of medical expenses for obstetric diseases per livebirth. "Preterm labour without delivery" had the highest amounts of medical expenses claimed for and the second highest numbers of diagnoses throughout the study period. CONCLUSIONS: This study suggests that pregnant women in Japan would have an increasing number of obstetric complications and necessary medical expenses year by year. Further study is warranted to elucidate these trends and identify possible mitigation measures.

Disease Trends in Children and Adolescents in Japan: A Retrospective Observational Study Using the Nationwide Claims Data for 2012-2016.

This study aimed to clarify diseases that occur more frequently by age and identify the peaks and trends of each disease from infancy to adolescence for early detection and treatment. This retrospective observational study was conducted using Japan's National Database of Health Insurance Claims Specific Health Checkups from January 2012 to December 2016. Using peak ages and trends in the number of patients, we grouped diseases by the International Classification of Diseases chapters. Although diseases that peaked during infancy were the most common (10 disease chapters), other diseases peaked at school-going age and adolescence. Diseases in four chapters peaked during adolescence and continued to increase toward the age of 18. These four chapters included mental, behavioral, and neurodevelopmental disorders; diseases of the nervous system; the genitourinary system; and pregnancy, childbirth, and the puerperium. Childhood-onset diseases can affect long-term health and healthcare needs, and timely screening and guidance based on disease trends can provide an effective intervention. To establish a child healthcare system that provides preventive support for children and adolescents' physical, psychological, and social health, further research is needed to comprehensively understand the issues per age and developmental stage.

Cardiotocography use for fetal assessment during labor in low- and middle-income countries: A scoping review.

BACKGROUND: The use of cardiotocography (CTG) to improve neonatal outcomes is controversial. The medical settings, subjects, utilizations, and interpretation guidelines of CTG are unclear for low- and middle-income countries (LMICs). OBJECTIVES: To assess and review CTG use for studies identified in LMICs and provide insights on the potential for effective use of CTG to improve maternal and neonatal outcomes. SEARCH STRATEGY: The databases Medline, CINAHL, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) were searched for published and unpublished literature through September 2023. SELECTION CRITERIA: Publications were identified which were conducted in LMICs, based on the World Bank list of economies for 2019; targeting pregnant women in childbirth; and focusing on the utilization of CTG and neonatal outcomes. DATA COLLECTION AND ANALYSIS: Publications were screened, and duplicates were removed. A scoping review was conducted using PRISMA-ScR guidelines. RESULTS: The searches generated 1157 hits, of which 67 studies were included in the review. In the studies there was considerable variation and ambiguity regarding the study settings, target populations, utilizations, timing, frequency, and duration of CTG. While cesarean section rates were extensively investigated as an outcome of studies of CTG itself and the effect of additional techniques on CTG, other clinically significant outcomes, including neonatal mortality, were not well reported. CONCLUSIONS: Variations and ambiguities were found in the use of CTG in LMICs. Due to the limited amount of evidence, studies are needed to examine CTG availability in the context of LMICs.

Benefits to Clinicians of Nonpharmacological Distraction During Pediatric Medical Procedure.

CONTEXT: Nonpharmacologic distraction (NPD) during medical procedures in children is known to be beneficial to patients; however, no reviews have assessed their benefits to medical providers. OBJECTIVES: We aimed to assess the benefits of NPD to medical providers. DATA SOURCES: We searched 5 databases for relevant articles. STUDY SELECTION: Peer-reviewed published randomized controlled trials comparing NPD with standard care that included children who had undergone medical procedures were included. DATA EXTRACTION: Primary outcomes were procedure time, number of medical staff involved, and initial success rate of venipuncture. Two reviewers assessed the risk of bias by using the Cochrane Collaboration (Oxford, United Kingdom)'s Randomized Controlled Trials Risk of Bias Tool, and we performed a meta-analysis to assess efficacy. RESULTS: We included 22 trials with 1968 participants. The main NPD was audiovisual distraction, such as tablets. No significant difference was found in venipuncture procedure time (mean difference: -9.79; 95% confidence interval: -22.38 to 2.81; low certainty). We found no studies on the number of medical staff. CONCLUSIONS: Our review did not find any clear NPD-associated benefit for the medical provider. The review included a small amount of literature, analyzed a small number of cases, and had a low certainty of evidence regarding procedure duration; therefore, further studies are needed to conclude the benefits to clinicians of NPD.

Parents' preferences for respite care of children with medical complexity.

BACKGROUND: The number of children with medical complexity (CMC) is increasing worldwide. For these children and their families, various forms of support are legislated; among them, short-stay respite care has a great unmet need. We examined such children's parents' preferences for respite care and their willingness to pay. METHODS: We used discrete choice experiments (DCEs) to estimate the parents' preferences and willingness to pay. Parents whose children used overnight short-stay respite services answered a questionnaire to compare two hypothetical facilities of respite care having seven attributes and three levels. The DCE data was analyzed using the conditional logit model. The willingness to pay was calculated based on DCE estimates. RESULTS: A total of 70 parents participated in this study and mean age of their children was 7.8 years (standard deviation [SD] 4.3). Among those children, 67 (96%) had the severest certification of disability, and 27 (38%) used a ventilator at home. We found that the parents' highest preferences was the best level of medical care level that can manage ventilators (coefficient 1.61, 95% confidence interval [CI]: 1.32-1.90). The better and best level of medical care, daily care, education/nursing, and emergency care were preferred over basic quality services. Willingness to pay for the best level of medical care was approximately 75,367 JPY per night. CONCLUSION: This study shows a need for respite care that can deliver high-level medical care, especially for the management of ventilators, to CMC. This finding can serve as a basis for promoting respite care services.

Trajectories of fathers' childcare involvement and child behavioral outcomes.

BACKGROUND: Father's closeness and playful behavior influence a child's emotional and cognitive development. In this study, we aimed to assess the long-term association of paternal involvement in childcare at 1-3 years of life on subsequent behavioral outcomes at 8 years of age. METHODS: Data were obtained from the 2010 cohort of the Longitudinal Survey of Newborns in the 21st century in Japan. We used group-based trajectory modeling to predict the trajectory of total childcare scores in surveys 1, 2 and 3 to determine the overall involvement of fathers in childcare during early childhood. The level of fathers' involvement in childcare was categorized as "low", "medium" and "high". Responses from the eighth survey were used to assess child behavioral outcomes using five indicators when the child was 8 years old. Crude and adjusted logistic regression analysis was conducted to estimate the odds ratio (OR) separately for each of the behavioral outcomes of the child. RESULTS: Among the 17,027 father-child dyads included in this study, two-thirds of the fathers were of the age group 30-39 years. Compared to low involvement, children of fathers with high involvement in childcare during the early childhood years were less likely to not want to go to school even after adjusting for covariates (adjusted OR, 0.46; 95% CI: 0.32-0.66). CONCLUSIONS: Children benefit from their fathers' involvement in early childcare activities. To improve a child's well-being, fathers should be encouraged by providing them with a suitable working environment with flexible arrangements and the opportunity to involve in childcare.

Studies of Health Insurance Claims Data in Japan: A Scoping Review.

Background: Health insurance claims data are used in various research fields; however, an overview on how they are used in healthcare research is scarce in Japan. Therefore, we conducted a scoping review to systematically map the relevant studies using Japanese claims data. Methods: MEDLINE, EMBASE, and Ichushi-Web were searched up to April 2021 for studies using Japanese healthcare claims data. We abstracted the data on study characteristics and summarized target diseases and research themes by the types of claims database. Moreover, we described the results of studies that aimed to compare health insurance claims data with other data sources narratively. Results: A total of 1,493 studies were included. Overall, the most common disease classifications were "Diseases of the circulatory system" (18.8%, n = 281), "Endocrine, nutritional, and metabolic diseases" (11.5%, n = 171; mostly diabetes), and "Neoplasms" (10.9%, n = 162), and the most common research themes were "medical treatment status" (30.0%, n = 448), "intervention effect" (29.9%, n = 447), and "clinical epidemiology, course of diseases" (27.9%, n = 417). Frequent diseases and themes varied by type of claims databases. A total of 19 studies aimed to assess the validity of the claims-based definition, and 21 aimed to compare the results of claims data with other data sources. Most studies that assessed the validity of claims data compared to medical records were hospital-based, with a small number of institutions. Conclusions: Claims data are used in various research areas and will increasingly provide important evidence for healthcare policy in Japan. It is important to use previous claims database studies and share information on methodology among researchers, including validation studies, while informing policymakers about the applicability of claims data for healthcare planning and management.

Association between the quality of care and continuous maternal and child health service utilisation in Angola: Longitudinal data analysis.

Background: Many low- and middle-income countries (LMICs) prioritise minimising maternal, neonatal, and infant mortality. To improve maternal and child health, various evidence-based interventions have been introduced. Quality of care is pertinent while strengthening service utilisations. Achieving optimal-quality care is often marred with difficulties, such as inadequate skills and knowledge of health workers, poor fidelity to protocols, and poor user acceptance. Angola is a LMIC facing these problems. This study aimed to demonstrate the influence of health facilities' quality of care at antenatal care (ANC) on subsequent maternal, newborn and child health (MNCH) service utilisation in Angolan pregnant women. Methods: Population-based cohort data from the Maternal and Child Health Handbook (MCH-HB) effectiveness study were analysed. The original study was conducted among women who became pregnant between March and April 2019 in Benguela Province, Angola. Socioeconomic and MNCH service utilisation indicators were collected through interviewer-administered structured questionnaires. The indicator of quality of care was a composite measure that assessed the implementation of the MCH-HB based on the RE-AIM framework, mostly consisted of common factors related to delivery and management of MNCH services. A multivariate logistic regression analysis was performed between quality of care, socioeconomic factors, and service utilisation indicators among the intervention group participants who had at least one ANC visit. Results: Of the 3351 pregnant women who visited ANC at least once, 2911 without missing values among explanatory or dependent variables were included in the analysis. Among them, 2032 (69.8%) were exposed to optimal-quality ANC, and 2058 (70.7%), 1573 (54.0%), and 941 (32.3%) achieved ANC target, facility delivery, and vaccination target for six-month-old infants, respectively. Exposure to suboptimal-quality care at ANC was associated with lower odds for facility delivery (adjusted odds ratio (AOR) = 0.60, 95% CI = 0.49-0.73) and the achievement of the vaccination target (AOR = 0.43, 95% CI = 0.33-0.55). A low socioeconomic status was inversely associated with health service utilisation indicators. Conclusions: Health facilities' quality of care influences subsequent MNCH service utilisation. Therefore, simultaneous efforts to improve quality of care and the mobilisation of pregnant women and communities are essential for enhancing maternal and child health.

Association of paternal factors with mothers' employment postchildbirth.

OBJECTIVES: The demand on Japanese women to fulfill their dual roles as mothers and labor force participants leads to a subsequent reduction of their employment hours, switching of occupations, or quitting the labor force. This study aims to examine paternal factors associated with mothers' employment status 18 months after childbirth. METHODS: We used data from the 2010 cohort of the Longitudinal Survey of Newborns conducted in Japan. We restricted our analysis to 10 712 mothers who had full-time employment 1 year before childbirth. A logistic regression analysis was conducted to assess paternal factors associated with mothers' employment after childbirth. RESULTS: One-third of the mothers with full-time employment before childbirth were not working full-time 18 months after delivery. We found that high childcare involvement (score 13-18) of fathers (OR, 1.20; 95% CI, 1.01-1.43) and fathers with part-time employment (OR, 1.59; 95% CI, 1.12-2.26) were associated with higher odds of mothers' full-time employment. Fathers' weekly work of ≥60 h (OR, 0.79; 95% CI, 0.71-0.88) and higher annual income decreased the odds ratios by over 20%. CONCLUSIONS: Fathers' work arrangements and involvement in childcare play a key role in helping mothers resume employment postchildbirth.

Randomized trial of advice from healthcare professionals to eliminate constriction by maternal clothing on the trunk to prevent preterm birth and improve health status.

AIM: Women's clothing during pregnancy may influence perinatal outcomes. A preliminary study suggested that midwives' advice to avoid wearing tight clothing during pregnancy may reduce the risk of preterm delivery. We examined the effects of such advice to pregnant women on the risk of preterm birth and health status during pregnancy. METHODS: An open-label evaluator-blinded randomized controlled trial was conducted at the National Centre for Child Health and Development in Tokyo, Japan. Normal pregnant women were randomly assigned to receive constrictive clothing elimination care or standard care at 20 weeks gestation. The control group was issued leaflets concerning anemia prevention at entry and skin care at 30 weeks' gestation, along with a brief explanation and answers to questions by midwives as standard care. The intervention group received advice from midwives concerning avoiding constrictive clothing in addition to standard care. The primary outcome was the incidence of preterm birth (<37 weeks). The secondary outcomes were 12 indicators related to preterm delivery or health status. RESULTS: Among 624 randomly assigned women, 599 (intervention group, n = 306; control group, n = 293) completed the study between February 2015 and August 2016. The incidence of preterm birth in the intervention and control groups was 4.2% (13/306) and 5.1% (15/293), respectively (p = 0.614). There were no significant differences regarding any secondary outcomes, including obstetric outcomes and physical/mental indicators, during pregnancy. CONCLUSIONS: Advice from midwives to avoid constrictive clothing during pregnancy did not influence the incidence of preterm birth or maternal health status. TRIAL REGISTRATION: UMIN000016853 (March 30, 2015).

Association between the continuum of care and postpartum depression among Angolan mothers.

BACKGROUND: This study investigated the association between maternal and child health service utilization patterns and postpartum depression (PPD). METHODS: This study analyzed a dataset of women who participated in a randomized controlled trial to examine the effectiveness of the Maternal and Child Health Handbook in Angola. We defined probable PPD as an Edinburgh Postpartum Depression Scale (EPDS) score ≥ 10. The EPDS was administered at approximately 6 months postpartum. Service utilization patterns were defined using numbers of antenatal care (ANC), facility delivery, and vaccination visits by 6 months postpartum. The association between service utilization patterns and PPD was examined using logistic regression analyses adjusting for socioeconomic factors and parity. The continuum of care (CoC) complete pattern (four ANC/facility delivery/four vaccination) was used as a reference. RESULTS: The data of 7087 participants whose children were alive and aged 6 months or older at the endline survey were analyzed. Prevalence of PPD was 17.9 % in urban and 43.2 % in rural municipalities. In urban municipalities, dropouts from the CoC at delivery and after delivery had significantly higher odds of PPD (AOR = 1.45, 95 % CI = 1.00-2.10; AOR = 1.57, 95 % CI = 1.24-1.99). In rural municipalities, dropouts from the CoC after delivery (AOR = 1.60, 95 % CI = 1.12-2.28) had significantly higher odds of PPD. LIMITATIONS: The onset of depressive symptoms was not assessed. The EPDS was validated in some Portuguese speaking countries but not in Angola. CONCLUSION: PPD was associated with irregular service utilization patterns such as dropouts from the CoC. Therefore, CoC and mental health must be promoted simultaneously.

[Survey results on the status of implementation of population approach projects for fathers across Japan by their municipalities].

Objectives　This study aimed to examine the status of implementation and details of population-based approach projects that primarily target fathers nationwide. It also seeked to discuss the possibility of providing childcare support to fathers in the community.Methods　This study analyzed the overall results of two surveys undertaken. The primary survey was conducted between December, 2020 and February, 2021 by administering a mail questionnaire within 1,741 municipalities across Japan. A secondary interview survey was then conducted from August to September, 2021, among the municipalities that responded that they are "implementing projects mainly for fathers," and those that obtained consent to participate in this survey.Results　The 837 municipalities (response rate = 48.1%) that responded to the primary survey were included in the analysis. Many municipalities provided paternal and family support in addition to childcare support for mothers, at the time of issuing maternal and child health handbooks and in parent classes. This support was inclusive of distributing leaflets and pamphlets for fathers (P=0.036), encouraging fathers to participate in parent classes (P<0.001), setting dates and times that are easy for fathers to participate in (P<0.001), and including content for fathers (P<0.001). There were significantly more responses from local governments of the municipalities with a total population of 70,000 or more. The number of municipalities that "implemented childcare support that primarily targeted fathers instead of mothers" was 54 or 6.5% of the total. However, about 70% of the municipalities that had not implemented such programs recognized the need for their implementation. In the 21 municipalities where the interviews were conducted, there were 10 projects implemented during pregnancy, 12 during the childcare period after delivery, and 1 implemented across both. The contents of the implemented programs varied widely, with each municipality devising its own programs based on regional characteristics, which had generally favorable evaluations from the participants. In contrast, many municipalities mentioned that the small number of participants was an issue.Conclusion　Although fathers are encouraged to participate in childcare and housework within households, it is rare for them to be given opportunities to gain the required knowledge and skills. Most projects provide support for fathers as supporters of mothers. Going forward, in addition to surveys targeting fathers, there is a need to present project models that can be implemented by the local governments.

Effectiveness of the maternal and child health handbook for improving continuum of care and other maternal and child health indicators: A cluster randomized controlled trial in Angola.

Background: The maternal and child health (MCH) handbook is promoted as a tool for strengthening continuum of care. We assessed the effect of a MCH handbook intervention package on continuum of maternal and child health care and health outcomes for mother and child. Methods: We conducted an open-label, parallel two-arm cluster randomized controlled trial in Angola. We randomly assigned municipalities in Benguela province through block randomization to a group using a package of enhanced maternity care service (which included the MCH handbook distribution and its supplementary intervention) and another using usual care (two stand-alone home-based records). We included women who were pregnant at the beginning of the trial period and attended a public health care facility for maternity care services. Neither health care providers, study participants nor data assessors were masked, but the statistician was. The primary outcome was a measure of service utilization assessed via achievement of maternal behavior-based continuum of care at three months postpartum. We conducted an intention-to-treat analysis in women with available data. Results: We randomized 10 municipalities to either the intervention (five clusters) or control (five clusters) group. Of the 11 530 women approached between June 8, 2019, and September 30, 2020, 11 006 were recruited and 9039 included in the final analysis (82%; 3774 in the intervention group and 5265 in the control group). The odds for achievement of maternal behavior-based continuum of care in the intervention group was not significantly different from that in the control group (adjusted odds ratio (aOR) = 1.18, 95% confidence interval (CI) = 0.46-2.93) at three months postpartum. However, the odds of initiating antenatal care clinic use were significantly higher in the intervention group (odds ratio (OR) = 5.16, 95% CI = 2.50-10.67). No harms associated with the intervention were reported. Conclusions: Distribution of the MCH handbook and its supplementary interventions promoted initiation of antenatal care service use, but did not increase service utilization sufficiently enough for attainment of study defined maternal behavior-based continuum of care. Registration: ISRCTN20510127.

The long-term association between paternal involvement in infant care and children's psychological well-being at age 16 years: An analysis of the Japanese Longitudinal Survey of Newborns in the 21st Century 2001 cohort.

BACKGROUND: Some studies conducted in the United Kingdom have shown long-term associations between paternal involvement in childcare and adolescents' mental health issues. However, findings were inconsistent, and similar epidemiologic studies have not been conducted in other countries in Europe or Asia. Thus, we aimed to examine this association using Japanese population-based cohort study data. METHODS: The Japanese Longitudinal Survey of Newborns in the 21st Century commenced in 2001. Data from 18,568 16-year-olds enrolled in the survey were analyzed. Poor psychological well-being was assessed using the WHO-5 Well-being Index. Paternal involvement in childcare-in tasks such as changing diapers-was assessed at the children's 6 months of age. We created four groups from least involvement to most active involvement based on the frequency of fathers' performing the tasks. RESULTS: The risk of poor psychological well-being was lower among more active involvement groups compared with the least involvement group, after adjusting for potential confounders (risk ratios = 0.90 [95 % confidence intervals: 0.85, 0.95] for the most active group). LIMITATIONS: Due to 16 years of follow-up, loss to follow-up may have caused a selection bias. CONCLUSIONS: Our study is the first in Asian countries to show that fathers' active involvement in childcare is associated with poor psychological well-being in adolescence. Encouraging fathers' involvement in childcare may ameliorate prevalent issues of school refusals and withdrawals in the long term in Japan.

Prevalence and Associated Factors of Psychological Distress Among Single Fathers in Japan.

BACKGROUND: In Japan, ten percent of single-parent households are led by fathers. Taking care of children as a single father is very stressful and could put a strain on their health. It is very important to prevent and identify psychological distress among fathers for both their own health and to avoid negative impacts on children. This study aims to determine the prevalence of and factors associated with psychological distress among single fathers and understand how it is different from partnered fathers. METHODS: We used data from the Comprehensive Survey of Living Conditions 2016. Psychological distress, assessed using the K6 scale, was analyzed among 868 single and 43,880 partnered fathers. Logistic regression analysis was performed to assess the risk factors for psychological distress, such as employment type, sleep hours, and smoking and drinking habits. RESULTS: Single fathers had a higher proportion (8.5%) of psychological distress compared to partnered fathers (5.0%). A larger percentage of single fathers had a lower educational level and were more likely to be non-regular workers, self-employed, or unemployed than partnered fathers. Among single fathers, the crude and adjusted odds ratio for employment type and sleep hours were significantly associated with psychological distress. CONCLUSION: As single parents who are self-employed or directors are likely to have significantly reduced psychological distress than those with regular jobs, measures are needed to improve the work-family balance for non-self-employed fathers. There is a need to provide greater financial assistance and other social welfare support to single parents to ensure their and their children's good health.

Labor risk factors for fetal heart rate abnormality after combined spinal-epidural analgesia.

OBJECTIVE: To explore the association between obstetric factors or outcomes and fetal heart rate (FHR) abnormalities after combined spinal-epidural analgesia (CSEA). METHODS: Women with singleton term deliveries who received CSEA at our institution between January 1 and December 31, 2017, were analyzed using medical records. We performed a logistic regression analysis to compare factors and outcomes between cases with and without new FHR abnormalities within 1 h after CSEA. RESULTS: Of the 393 women, 163 showed the new occurrence of FHR abnormality after CSEA. Rupture of the membrane (odds ratio [OR] 2.49; 95% confidence interval [CI] 1.52-4.09; P < 0.01) and dilatation of the cervix (OR 1.24; 95% CI 1.07-1.44; P < 0.01) were significantly associated with FHR abnormalities. There were significant differences in FHR abnormality rates between women with cervical dilatation of 2 cm or less and 3 cm or more (OR 2.20; 95% CI 1.01-4.81; P = 0.047) and 6 cm or less and 7 cm or more (OR 2.46; 95% CI 1.01-6.01; P = 0.048). FHR abnormalities were not significantly associated with cesarean delivery during labor, instrumental delivery, APGAR score below 7 at 1 or 5 min, or umbilical arterial blood gas pH less than 7.2. CONCLUSION: Rupture of the membrane and an advanced dilated cervix were risk factors for FHR abnormality when CSEA was initiated.

Comparison of mortality and survival without major morbidities of very preterm infants with very low birth weight from Japan and Brazil / Comparação entre mortalidade e sobrevida sem morbidades importantes dos recém-nascidos prematuros de muito baixo peso entre o Japão e o Brasil

Abstract Objective: This study was carried out to understand the disparities in mortality and survival without major morbidities among very premature and very low birth weight infants between participating Neonatal Intensive Care Units (NICUs) from the Brazilian Network on Neonatal Research (RBPN) and the Neonatal Research Network of Japan (NRNJ). Methods: Secondary data analysis of surveys by the RBPN and NRNJ was performed. The surveys were conducted in 2014 and 2015 and included 187 NICUs. Primary outcome was mortality or survival without any major morbidity. Logistic regression analysis adjustment for confounding factors was used. Results: The study population consisted of 6,406 infants from the NRNJ and 2,319 from the RBPN. Controlling for various confounders, infants from RBPN had 9.06 times higher adjusted odds of mortality (95%CI 7.30-11.29), and lower odds of survival without major morbidities (AOR 0.36; 95%CI 0.32-0.41) compared with those from the NRNJ. Factors associated with higher odds of mortality among Brazilian NICUs included: Air Leak Syndrome (AOR 4.73; 95%CI 1.26-15.27), Necrotizing Enterocolitis (AOR 3.25; 95%CI 1.38-7.26), and Late Onset Sepsis (LOS) (AOR 4.86; 95%CI 2.25-10.97). Conclusions: Very premature and very low birth weight infants from Brazil had significantly higher odds for mortality and lower odds for survival without major morbidities in comparison to those from Japan. Additionally, we identified the factors that increased the odds of in-hospital neonatal death in Brazil, most of which was related to LOS.

RESUMO Objetivo: Este estudo foi realizado para compreender as disparidades na mortalidade e sobrevivência sem as principais morbidades entre recém-nascidos muito prematuros e de muito baixo peso entre Unidades de Terapia Intensiva Neonatal (UTINs) participantes da Rede Brasileira de Pesquisas Neonatais (RBPN) e Rede de Pesquisa Neonatal do Japão (NRNJ). Métodos: Foi realizada uma análise dos dados secundários dos bancos de dados da RBPN e da NRNJ. As pesquisas foram realizadas em 2014 e 2015 e incluíram 187 UTINs. O desfecho primário foi mortalidade ou sobrevida sem qualquer morbidade importante. Utilizou-se a análise de regressão logística com ajuste para os fatores de confusão. Resultados: A população do estudo foi composta por 6.406 recém-nascidos do NRNJ e 2.319 do RBPN. Ajustando para diversos fatores de confusão, os prematuros da RBPN tiveram 9,06 vezes maiores chances de mortalidade (IC95% 7,30-11,29) e menores chances de sobrevivência sem morbidades importantes (AOR 0,36; IC95% 0,32-0,41) em comparação com os da NRNJ. Fatores associados a maiores chances de mortalidade entre as UTINs brasileiras incluíram: síndrome de escape de ar (AOR 4,73; IC95% 1,26-15,27), enterocolite necrosante (AOR 3,25; IC95% 1,38-7,26) e sepse de início tardio (AOR 4,86; IC95% 2,25-10,97). Conclusões: Os recém-nascidos muito prematuros e de muito baixo peso do Brasil apresentaram chances significativamente maiores de mortalidade e menores chances de sobrevivência sem as principais morbidades em comparação aos do Japão. Além disso, identificamos os fatores que aumentam as chances da morte neonatal no Brasil, sendo a maioria relacionada à sepse tardia.

Barriers, facilitators, and implementation strategies for the initiation of Child Death Review system in Japan: a modified Delphi method study.

BACKGROUND: To further curb preventable child deaths, some countries have implemented Child Death Review (CDR). CDR is a comprehensive multidisciplinary process that investigates, reviews, and registers all child deaths to consider prevention strategies. This study deciphered the barriers, facilitators, and implementation strategies in Japan. METHODS: This study used a three-round modified Delphi method. The expert panel consisted of local government officers and health professionals responsible for the CDR pilot project in Japan. As a modification, the initial list of barriers, facilitators, and implementation strategies to address each barrier and facilitator was prepared based on project reports and interviews with local government officers. Throughout the three rounds, the panel evaluated predefined barriers and facilitators, suggested and evaluated additional items, and appraised the potential effectiveness of the implementation strategies on barriers and facilitators which they were meant to address. The importance of barriers and facilitators, and the potential effectiveness of implementation strategies were evaluated using 5-point Likert scale. The priority of the combinations of barriers, facilitators, and implementation strategies were determined considering their importance and effectiveness. RESULTS: A total of 31 experts participated in the panel. Response rates were 96.8%, 80.6%, and 90.3% for the first, second, and third rounds, respectively. A total of 13 barriers, eight facilitators, and 72 implementation strategies corresponding to the barriers and facilitators reached consensus. At the national government level, a barrier-strategy combination of "lack of legislation (barrier)" and "legislation for CDR (strategy)," and a facilitator-strategy combination of "good multi-agency collaboration (facilitator)" and "official notices from the national government (strategy)" were at the highest priority. At the local government level, combinations of "lack of legislation (barrier)" and "constant budget allocations (strategy)," "lack of legislation (barrier)" and "citizens' acceptance (strategy)," and "good multi-agency collaboration (facilitator)" and "appointment of a full-time staff (strategy)" were at the highest priority. CONCLUSION: This study demonstrated that legislation is the key to better implementation of CDR in Japan. Legislation can address various barriers such as personal information collection, multi-agency collaboration, high workload, and budget instability. Without legislation, careful strategies must be taken to solve difficulties caused by its absence. TRIAL REGISTRATIONS: None.