Births In Japan Research Articles

Ecological analysis of secular trends in low birth weight births and adult height in Japan

BackgroundJapan, which currently maintains the highest life expectancy in the world and has experienced an impressive gain in adult height over the past century, has suffered a dramatic twofold increase...

Population health and regional variations of disease burden in Japan, 1990–2015: a systematic subnational analysis for the Global Burden of Disease Study 2015

SummaryBackgroundJapan has entered the era of super-ageing and advanced health transition, which is increasingly putting pressure on the sustainability of its health system. The level and pace of this health transition might vary across regions within Japan and concern is growing about increasing regional variations in disease burden. The Global Burden of Diseases, Injuries, and Risk Factors Study 2015 (GBD 2015) provides a comprehensive, comparable framework. We used data from GBD 2015 with the aim to quantify the burden of disease and injuries, and to attribute risk factors in Japan at a subnational, prefecture-level.MethodsWe used data from GBD 2015 for 315 causes and 79 risk factors of death, disease, and injury incidence and prevalence to measure the burden of diseases and injuries in Japan and in the 47 Japanese prefectures from 1990 to 2015. We extracted data from GBD 2015 to assess mortality, causes of death, years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted life-years (DALYs), life expectancy, and healthy life expectancy (HALE) in Japan and its 47 prefectures. We split extracted data by prefecture and applied GBD methods to generate estimates of burden, and attributable burden due to known risk factors. We examined the prefecture-level relationships of common health system inputs (eg, health expenditure and workforces) to the GBD outputs in 2015 to address underlying determinants of regional health variations.FindingsLife expectancy at birth in Japan increased by 4·2 years from 79·0 years (95% uncertainty interval [UI] 79·0 to 79·0) to 83·2 years (83·1 to 83·2) between 1990 and 2015. However, the gaps between prefectures with the lowest and highest life expectancies and HALE have widened, from 2·5 to 3·1 years and from 2·3 to 2·7 years, respectively, from 1990 to 2015. Although overall age-standardised death rates decreased by 29·0% (28·7 to 29·3) from 1990 to 2015, the rates of mortality decline in this period substantially varied across the prefectures, ranging from −32·4% (−34·8 to −30·0) to −22·0% (−20·4 to −20·1). During the same time period, the rate of age-standardised DALYs was reduced overall by 19·8% (17·9 to 22·0). The reduction in rates of age-standardised YLDs was very small by 3·5% (2·6 to 4·3). The pace of reduction in mortality and DALYs in many leading causes has largely levelled off since 2005. Known risk factors accounted for 34·5% (32·4 to 36·9) of DALYs; the two leading behavioural risk factors were unhealthy diets and tobacco smoking in 2015. The common health system inputs were not associated with age-standardised death and DALY rates in 2015.InterpretationJapan has been successful overall in reducing mortality and disability from most major diseases. However, progress has slowed down and health variations between prefectures is growing. In view of the limited association between the prefecture-level health system inputs and health outcomes, the potential sources of regional variations, including subnational health system performance, urgently need assessment.FundingBill & Melinda Gates Foundation, Japan Ministry of Education, Science, Sports and Culture, Japan Ministry of Health, Labour and Welfare, AXA CR Fixed Income Fund and AXA Research Fund.

0978 PREVENTION OF SUDDEN UNEXPECTED INFANT DEATH (SUID) DURING SLEEP AT NURSERY SCHOOLS

Sudden Unexpected Infant Death (SUID) is reported to occur in about one of every 6000–7000 live births in Japan. SUID occurs mainly during sleep in infancy and prevention of SUID at this age group is very important not only at home but also at nursery school. The aim of the study was to identify activities currently conducted at each nursery schools to prevent SIDS during the nap, and also the sleeping environment at nursery schools. A questionnaire asking about the activities related to SUID prevention and the sleeping environment was distributed to all the nursery schools in Ehime Prefecture, Japan. One hundred and eighty eight responses were included in the analysis. Percentage of activities currently conducted at each nursery school and sleep environment during the nap were analyzed. Percentage of activities including health checkup in the morning, monitoring by the childminder during the nap time, asking about the health condition of baby from the parents, taking care of baby sleeping position, measurement of body temperature, checking vital signs of sleeping baby, stimulate the baby while taking a nap, monitoring of sleeping baby with video recording, and putting a sensor on baby taking nap were conducted in 95.2%, 94.1%, 93.2%, 92.0%, 87.3%, 45.5%, 10.1%, 1.6% and 0.5% of nursery schools respectively. Sleep environment during nap time was controlled for temperature, light exposure and humidity in more than 80% of the nursery schools. Monitoring of the health condition of the baby and close watch on baby including the body position while napping was made in more than 80% of nursery schools to prevent SUID during nap. Sleep environment was sufficiently controlled in most nursery school.

Trends in perinatal mortality and its risk factors in Japan: Analysis of vital registration data, 1979\u20132010

As Japan has achieved one of the lowest perinatal mortality rates (PMR), our study aims to estimate trends in and risk factors for perinatal mortality among singleton births in Japan. We used Japanese vital registration data to assess trends in and risk factors for perinatal outcomes between 1979 and 2010. Birth and death registration data were merged. An autoregressive integrated moving average model was fitted separately by sex to the PMR and the proportion of stillbirths. A multilevel Poisson regression model was used to estimate risk factors for perinatal mortality. Between 1979 and 2010 there were 40,833,957 pregnancies and 355,193 perinatal deaths, the PMR decreased from 18.86 per 1,000 all births to 3.25 per 1,000 all births, and the proportion of stillbirths increased from 83.6% to 92.1%. Key risk factors for perinatal mortality were low or high birth weight, prematurity and post maturity, and being from poorer or unemployed families. A higher proportion of excess perinatal deaths could be averted by effective policies to prevent stillbirths and improved research into their interventions and risk factors. As the cost and challenge of maintaining perinatal mortality gains increases, policies need to be targeted towards higher risk groups and social determinants of health.

Dependency of the elderly and expectation of independent living at birth in Japan

Dependency of the elderly and expectation of independent living at birth in Japan

Über den ungewöhnlichen Lebensweg eines weiblichen Sandtigerhais (Carcharias taurus Rafinesque, 1810)

This paper provides some information on the life history and development data of the female sand tiger shark from its birth in Japan in 2001 to its removal from the Berlin Zoo Aquarium to the Ozeaneum in Stralsund in 2012. Within a period of ten and a half years, the length of the shark doubled from 1 to 2 meters and its weight increased from 12 to 200 kilograms.

A Case of Peripartum Cardiomyopathy Affected by Left Ventricle Thrombus

Peripartum cardiomyopathy (PPCM) mimicking dilated cardiomyopathy is defined as an idiopathic cardiomyopathy affecting perinatal or postnatal women with no cardiac history. It occurs in 1 in 20,000 births in Japan. A 25-year-old female without cardiology diseases presented to our hospital’s emergency department with upper abdominal pain, exertional dyspnea, and leg edema. One month prior, she gave birth to her first child via vaginal delivery. At 36 weeks of gestation, she was diagnosed with pregnancy hypertension by an obstetrician. Ultrasonography and non-contrast computed tomography were performed and revealed an edematous gallbladder as well as dilated hepatic and inferior jugular veins. Chest X-ray revealed cardiomegaly, lung edema, and pleural effusion. She was diagnosed with congestive heart failure. Transthoracic echocardiogram (TTE) revealed a dilated left ventricle with a reduced ejection fraction (EF) of 17%. Immediately after admission, diuretic agents, including furosemide and carperitide, were administered. Although her heart failure improved with sufficient diuretic treatment, thromboses measuring 16 × 8 and 29 × 11 mm in her left ventricle were revealed by TTE on day 10. Heparin sodium and warfarin potassium were initiated, which reduced the thromboses. Her symptoms improved, although EF was not restored to normal function. She was discharged on day 40 and an outpatient clinic follow-up was scheduled. Long-term prognosis of PPCM is currently unknown, and meticulous follow-up of the patient is required. Here we present a case of PPCM that was affected by a left ventricular thrombus. J Med Cases. 2016;7(12):550-553 doi: https://doi.org/10.14740/jmc2698w

Perinatal Mortality Rate in Weekend Birth in Japan

Background: It was unknown whether risk of perinatal mortality rate (PMR) was higher in weekend than week days births in Japan and how Japanese obstetricians attempted to reduce numbers of weekend births. Methods and Findings: Retrospective observational study on 301510 women registered in the Japan Society of Obstetrics and Gynecology registry system who gave birth to singleton infants at gestational week ≥ 22 between 2005 and 2009. The proportion of women giving birth vaginally vs. by caesarean section with and without uterotonics was determined according to day of the week. Perinatal mortality included stillbirth and early neonatal death within one week after live birth occurring on and after gestational week 22. The PMR was similar between weekdays and weekend births (2.0% [4898/240455] vs. 2.0% [1217/61055], respectively). The fractions of Sunday and Thursday births were smallest and largest, respective; the mean ± SD fractions of Saturday and Sunday births were 10.4 ± 0.2% and 9.9 ± 0.3%, respectively, while those of Monday, Tuesday, Wednesday, Thursday, and Friday births were 14.6 ± 0.3%, 16.5 ± 0.2%, 15.9% ± 0.4%, 17.1% ± 0.4%, and 15.6% ± 0.3% of all 301510 births, respectively. The numbers of vaginal births with uterotonics and of caesarean births per day were approximately double and ~3.6-fold greater for weekdays than for those for weekend, respectively. Conclusions: The PMR did not differ between births that occurred on weekdays and weekend. Frequent uterotonic use and caesarean delivery on weekdays explained the disproportionately reduced number of weekend births.

Experience of the New Zealand maternity care system by a group of Japanese women in one centre.

A Corresponding Author: mwkeiko@ yahoo.co.jp Findings: The women had a range of experiences including some dilemmas and conflicts during their pregnancy, birth and postnatal care. This care differed from what they would expect had they given birth in Japan where care is shaped by the distinctly Japanese birth knowledge and culture. The women also experienced language and communication barriers even though they did not have problems with speaking English in their daily lives. Discussion: The Japanese women's understanding of care in the New Zealand maternity system was influenced by the generally more relaxed image of New Zealand society, and issues emerged as a result of communication difficulties between the women and the care providers. This lack of communication was related to Japanese women's generally passive attitude, where conflict is avoided in the desire to maintain harmony and not cause offence. Conclusion: When sharing information with Japanese women, care providers need to recognise that immigrant women hold knowledge from a different cultural history and maternity care system. Knowledge of these different cultural approaches to birth will enable better communication and help immigrant women make better informed decisions and receive more appropriate care throughout their childbearing experience in New Zealand.

Cause-Specific Gender Differences in Potential Gains in Life Expectancy at Birth in Japan, 1965–2010.

Cause-Specific Gender Differences in Potential Gains in Life Expectancy at Birth in Japan, 1965–2010.

Child Maltreatment Among Singletons and Multiple Births in Japan: A Population-Based Study.

The occurrence of multiple births has been recognized as a risk factor for child maltreatment. However, few population-based studies have examined the relationship between multiple births and child maltreatment. This study aimed to evaluate the degree of risk of child maltreatment among singletons and multiple births in Japan and to identify factors associated with increased risk. Using population-based data, we analyzed the database of records on child maltreatment and medical checkups for infants aged 1.5 years filed at Nishinomiya City Public Health Center between April 2007 and March 2011. To protect personal information, the data were transferred to anonymized electronic files for analysis. After adjusting by logistic regression for each associated factor and gestation number, multiples themselves were not associated with the risk of child maltreatment. However, compared with singletons, multiples had a significantly higher rate of risk factors for child maltreatment, including low birth weight and neural abnormality. Moreover, compared with mothers of singleton, mothers of twins had a significantly higher rate of poor health, which is a risk factor of child maltreatment. Multiples were not associated with the risk of child maltreatment. However, compared with singletons, multiples and their mothers had a significantly higher rate of risk factors of child maltreatment.

O68. Management of eclampsia and stroke during pregnancy

Introduction Eclampsia and stroke during pregnancy are major causes of maternal death in the world. Despite the ubiquity of these conditions and their public health impact, neither their etiologies nor therapeutic strategies for their treatment have been established. Objectives To establish the etiologies and therapeutic strategies for eclampsia and stroke during pregnancy, Methods We performed a questionnaire based long-term survey in Aichi prefecture, Japan in 2007, 2010, and 2013. Aichi prefecture accounts for 7% of the Japanese population as well as 7% of annual births in Japan. The questions were designed to obtain detailed information about the cases of eclampsia and stroke during pregnancy experienced by the participating institutions between 2005 and 2012 including the number of cases of each condition; their locations, outcomes, and prognoses; and the treatments employed. Questionnaire recovery rate was 100%. Results This survey revealed the following findings; 66% of deliveries were managed in primary medical facilities, 38% of eclampsia and 39% of stroke occurred at primary medical facilities, and 26% of stroke occurred at home. 37% of eclampsia and 18% of stroke occurred during labor. More than half of them were associated with hypertension firstly detected after the onset of labor (labor onset hypertension). We revealed that 24% of pregnant women who remained normotensive throughout pregnancy developed labor onset hypertension. We also investigated a lot of cases with eclampsia and/or stroke and revealed important issues regarding their management. In case with eclampsia, we should give priority to emergent care and fetal heart rate monitoring. Accurate antihypertensive and anticonvulsive treatment are necessary. While discrimination between eclampsia and stroke is difficult, brain CT and MRI can detected most of hemorrhagic stroke. When stroke is detected, collaborative treatment with neurosurgeon should be started. Detailed blood pressure measurement during labor is also important especially on having thought about the existence of labor onset hypertension. Conclusion These findings might aid the development of therapeutic strategies for pregnant women with eclampsia or stroke.

Prevalence of human T-cell leukemia virus type 1 carrier in Japanese pregnant women in 2013.

Since September 2010, in Japan serological screening for the detection of human T-cell leukemia virus type 1 (HTLV-1) antibodies can be performed for all women during pregnancy with the Japanese public funds for strategies for prevention of HTLV-1 vertical transmission, because Japan, especially Kyushu area, has been reported to be one of the areas of highest prevalence of HTLV-1 in the world [1, 2]. In our previous study [3], we examined the prevalence of HTLV-1 carrier in Japanese pregnant women according to the implement rate and results of HTLV-1 screening and confirmation tests of women who gave births in Japan in 2011. The total rates of positive HTLV-1 screening tests and positive western blot (WB) test in positive screening tests were 0.32% and 49.8%, respectively in 2011. Considering the response rate and the rate of implementation of WB test, the number of HTLV-1 carrier in Japanese pregnant women in 2011 was estimated to be 1,560 (0.15%). In addition, although the number of delivery in Kyushu area was only 14% of Japanese deliveries, 53% of HTLV-1 carrier of Japanese pregnant women was present in Kyushu area. Recently, the migration of Japanese people from Kyushu area to the metropolitan areas has been thought to contribute to a significant decrease of HTLV-1 carriers in Kyushu area and an increase in Kanto (including Tokyo) area in Japan [1, 4]. To confirm this migration in Japanese pregnant women, on December 2014, we requested again 2,544 obstetrical facilities that are members of Japan Association of Obstetricians and Gynecologists (JAOG) to provide information of HTLV-1 tests in pregnant women who delivered at ≥ 22 weeks’ gestation in 2013. A total of 1,356 (53.3%) of 2,544 obstetrical facilities responded and information on a total of 538,167 women, accounting for approximately 54% of all deliveries that occurred in Japan during the study period (approximately 1,001,800 births) was provided. In 2013, the total rates of positive HTLV-1 screening tests and positive WB test in positive screening tests were 0.35% and 50.8%, respectively. Considering the response rate and the rate of implementation of WB test, the number of HTLV-1 carrier in Japanese pregnant women in 2013 was estimated to be 1,780 (0.18%). Table 1 shows the difference in the estimated number of HTLV-1 carrier based on positive WB test by area in Japan between 2011 and 2013. The estimated number of HTLV-1 carrier in 2013 seemed to be more than that in 2011, especially in the northeast and southwest (Kyushu) areas. In addition, 51% of HTLV-1 carrier of Japanese pregnant women was present in Kyushu area, although the number of delivery in Kyushu area was only 13% of Japanese deliveries in 2013. Although the migration of Japanese people from Kyushu area to the metropolitan areas has been supposed to contribute to a significant decrease of HTLV-1 carriers in Kyushu area, the estimated number of HTLV-1 carrier of pregnant women seemed to be increased in Kyushu area. In addition, the estimated rate of HTLV-1 carrier in pregnant women in Kyushu area was still significantly higher than that in the other areas (P < 0.01 by the Chi-square test). Therefore, there are still remaining problems concerning the locality for strategies for prevention of HTLV-1 vertical transmission in Japan.

Posterior fossa syndrome in a patient with an ornithine transcarbamylase deficiency

The posterior fossa syndrome (PFS) is a well-known clinical entity and mainly occurs in children. Ornithine transcarbamylase deficiency (OTC) is the most common urea cycle disorder, which occurs in an estimated 1 per 50.000 live births in Japan. Symptoms are mostly due to hyperammonemia and include nausea, vomiting, lethargia and even convulsions and coma. Common neurological symptoms at presentation of a hyperammonemia are a decreased level of consciousness, abnormal motor function or seizures. In this case we describe a girl with late onset OCT deficiency presenting with transient mutism and subsequent dysarthria, ataxia and behavioural changes. This is an exceptional report of a not yet described neurologic syndrome in OTC.Synopsis: Neurologic symptoms in ornithine transcarbamylase deficiency do not only occur during an episode of hyperammonemia and may present as a transient neurologic symptoms compatible with the posterior fossa syndrome.

Gender Equity, Opportunity Costs of Parenthood, and Educational Differences in Unintended First Births: Insights from Japan.

We examine educational differences in the intendedness of first births in Japan using data from a nationally representative survey of married women (N = 2,373). We begin by describing plausible scenarios for a negative, null, and positive educational gradient in unintended first births. In contrast to well-established results from the U.S., we find evidence of a positive educational gradient in Japan. Net of basic demographic controls, university graduates are more likely than less-educated women to report first births as unintended. This pattern is consistent with a scenario emphasizing the high opportunity costs of motherhood in countries such as Japan where growing opportunities for women in employment and other domains of public life have not been accompanied by changes in the highly asymmetric roles of men and women within the family. We discuss potential implications of this suggestive finding for other low-fertility settings.

Climate change is associated with male:female ratios of fetal deaths and newborn infants in Japan

To evaluate whether climate change is associated with male:female ratios (sex ratios) of fetal deaths and births in Japan. A population-based cohort study. Not applicable. Newborn infants and fetuses spontaneously aborted after 12weeks of gestation. None. Yearly sex ratios of fetal deaths and newborn infants and monthly fetal death rates and sex ratios of newborn infants. A statistically significant positive association was found between yearly temperature differences and sex ratios of fetal deaths; a statistically significant negative association was found between temperature differences and sex ratios of newborn infants from 1968 to 2012, and between sex ratios of births and of fetal deaths. The sex ratios of fetal deaths have been increasing steadily along with temperature differences, whereas the sex ratios of newborn infants have been decreasing since the 1970s. Two climate extremes, a very hot summer in 2010 and a very cold winter in January 2011, showed not only statistically significant declines in sex ratios of newborn infants 9months later in June 2011 and October 2011 but also statistically significant increases of fetal death rates immediately, in September 2010 and January2011. The recent temperature fluctuations in Japan seem to be linked to a lower male:female sex ratio of newborn infants, partly via increased male fetal deaths. Male concepti seem to be especially vulnerable to external stress factors, including climate changes.

Continuity, Confidence, Compassion and Culture: Lessons learned from Japanese midwives

PurposeTo explore midwifery practice through the eyes of Japanese midwives and midwifery students, with the aim of identifying traditional childbirth practices and models of midwifery care that lead to higher rates of physiologic birth as experienced by women in Japan.Research QuestionsWhat specific cultural factors influence pregnancy care and childbirth practices in Japan? What factors and practices are associated with physiologic birth in Japan? How could traditional Japanese practices be utilized by midwives in the United States to improve birth outcomes?SignificanceDespite its relationship with Western culture, Japan continues to promote physiologic birth without complications, at lower rates than many other developed nations. With a comparatively low cesarean rate of 18.6% in 2011 and one of the lowest maternal mortality rates in the world, cultural factors are clearly important. Recognition of traditional Japanese midwifery practices and unique models of midwifery care that can increase opportunities for physiologic birth have the potential to reverse the increasing trend for birth intervention in other countries.MethodsMixed methods were used to explore midwifery practices in Japan. A pilot survey, translated into Japanese, was administered to midwives (n = 9) and midwifery students (n = 9) in 2 prefectures in Japan (one urban, one rural). Two focus groups were conducted to further explore culturally specific midwifery attitudes, practices, and future challenges in maintaining low birth‐intervention rates in Japan. Visits to hospital and community settings (Josanin or birthing homes) enhanced understanding of described practices.ResultsThe prominent role of midwives in all low‐risk pregnancies in Japan was felt to increase opportunities for women to achieve physiologic birth. Interventions commonly used in the United States were reserved for complicated pregnancy. Japanese midwives recognized danger in increasing epidural use and the value of midwifery care in preventing unnecessary intervention. Important aspects of care included midwifery presence, compassion, confidence in women, non‐pharmacologic pain relief, movement/upright labor positions, and education provided by midwives.DiscussionGreater access to continuity of midwifery care in the United States could contribute to better birth outcomes. A larger study of Japanese midwives is planned to further explore effective practices that could be used in US settings to improve opportunities for physiologic birth.

Executives, legislatures, and whales: the birth of Japan's scientific whaling regime

Why did Japan begin scientific whaling, a policy that benefits few domestically and alienates many around the world? In this essay, I argue that Japan’s scientific whaling regime was formed as a result of a ‘two-level game’ between President Reagan and Prime Minister Nakasone. Although Reagan was faced with a unified, anti-whaling Congress, he himself was not much concerned about the issue. Nakasone was also not particularly concerned about whaling, and he initially was faced with a Diet that was divided on how to deal with whaling (although it became less divided over time). Ultimately, these circumstances led Japan to develop the scientific whaling regime that persists to this day.

Association of Antenatal Corticosteroids and the Mode of Delivery with the Mortality and Morbidity of Infants Weighing Less than 1,500 g at Birth in Japan

Objective: This study aimed to re-evaluate the effectiveness of antenatal corticosteroids (ACS) and to analyze the association between ACS and the mode of delivery in the context of perinatal morbidity and mortality in very-low-birth-weight (VLBW) infants. Study Design: This retrospective cohort study involved 15,765 VLBW infants born between 2003 and 2008 at less than 34 weeks of gestation and weighing less than 1,500 g at birth. Data were obtained from the Japanese neonatal research network database. Univariate and multivariate logistic regression analyses were performed to evaluate the impact of ACS and mode of delivery on the risk of infant mortality and morbidity. Results: Administration of ACS was associated with decreases in mortality rate, intraventricular hemorrhage (IVH) and retinopathy of prematurity (ROP), and was not associated with the incidence of respiratory distress syndrome (RDS), periventricular leukomalacia or necrotizing enterocolitis (NEC). When the administration of ACS was analyzed in the context of different modes of delivery, the incidence of IVH and ROP tended to decrease with cesarean section deliveries, whereas the incidence of RDS tended to decrease and the incidence of NEC tended to increase for infants delivered vaginally. The incidence of chronic lung disease tended to increase in association with both delivery methods. Conclusions: This large cohort study reconfirms that ACS treatment is associated with decreases in infant mortality and severe morbidity. Furthermore, the delivery method may be associated with severe morbidity in VLBW infants exposed to ACS.

Multiple pregnancy, short cervix, part-time worker, steroid use, low educational level and male fetus are risk factors for preterm birth in Japan: A multicenter, prospective study

To examine the relationship between preterm birth and socioeconomic factors, past history, cervical length, cervical interleukin-8, bacterial vaginosis, underlying diseases, use of medication, employment status, sex of the fetus and multiple pregnancy. In a multicenter, prospective, observational study, 1810 Japanese women registering their future delivery were enrolled at 8⁺⁰ to 12⁺⁶ weeks of gestation. Data on cervical length and delivery were obtained from 1365 pregnant women. Multivariate logistic regression analysis was performed. Short cervical length, steroid use, multiple pregnancy and male fetus were risk factors for preterm birth before 34 weeks of gestation. Multiple pregnancy, low educational level, short cervical length and part-timer were risk factors for preterm birth before 37 weeks of gestation. Multiple pregnancy and cervical shortening at 20-24 weeks of gestation was a stronger risk factor for preterm birth. Any pregnant woman being part-time employee or low educational level, having a male fetus and requiring steroid treatment should be watched for the development of preterm birth.