Metropolitan Area Of Japan Research Articles

Correlation between fall experience and life functions among community-dwelling older adults in Japan

PurposeThis study investigated the correlation between the risk of falls and life functions, including motor function, cognitive function, and urinary disorders, among older adults residing in small cities in the metropolitan areas of Japan and evaluated the contents of fall prevention instructions. MethodsSixty-nine older adults residing at home participated in this case-control study conducted between September and October 2019. The survey items included questions pertaining to the history of falls; grip strength; the 30-s Chair Stand Test (CS-30), Functional Reach Test (FRT), and Timed Up and Go Test (TUG) scores; mental and cognitive functions [Test Your Memory-Japanese version test (TYM-J)]; living conditions; and urination status [Core Lower Urinary Tract Symptom Score (CLSS)]. ResultsParticipants with a history of falls had significantly lower CS-30 and FRT scores, and significantly higher TUG scores and CLSS than those with no history of falls. Grip strength bore significant correlations with the CS-30 and TUG scores. The CS-30 scores were correlated with the FRT and TUG scores. The FRT scores were correlated with the TUG and French State Activity Index (FAI) scores. The TUG scores were correlated with the TYM-J and FAI scores. The CLSS showed no significant correlations with the remaining items. The FRT scores and CLSS exerted a significant effect on the risk of experiencing falls. ConclusionBoth balancing ability and micturition status affect fall risk and should be considered in treatment strategies for urinary disorders in fall prevention programs for older adults.

Fundamental study on ambient noise reduction for analysis of hitting sound of professional baseball players

In recent years, the sound of a hitting ball during a baseball game has focused attention on the American Major League Baseball and Japanese professional baseball. It is reported that information such as the direction and distance of a batted ball can be detected from the sound. The sounds of players hitting the ball are sometimes expressed using various onomatopoeic. In our previous study, we recorded the sound of a baseball hit during hitting practice for players of a university baseball team in the Tokyo metropolitan area in Japan. Relationships between the acoustic characteristics of the sound and the distance and direction of the ball were clarified. In this research, acoustic analysis of professional baseball players' batted ball sounds from Youtube and other videos is used to identify the acoustic features and characteristics of the batted ball. This paper describes the method and accuracy of noise removal around the hitting sound extracted from the video using a convolutional neural network with images.

The feasibility and effectiveness of remote cognitive training on cognitive function and work performance in workers.

We aimed to determine whether remote cognitive training (CT) is feasible and has the potential to improve cognitive function and work performance in Japanese workers. From June to September 2020, this intervention time series study enrolled workers aged 18-65 years from 10 companies located in a metropolitan area of Japan. Cognitive function tests and self-administered questionnaires were completed by the participants three times: at baseline, after 12 weeks of CT, and after a further 12 weeks following cessation. We measured work performance with the question: "How would you rate your performance (compared with your optimum performance) over the past 4 weeks?" Responses were made via a visual analog scale (0-100). Cognitive function was assessed using the THINC-integrated tool, which is a brief, objective computerized cognitive assessment battery. For our computerized remote CT intervention, BrainHQ was used on the basis of our scientific rationale and the empirical literature. We recommended three 20-min sessions of BrainHQ per week and sent participants three reminders. In total, 119 participants were recruited to this study. Only 22.7% of the subjects achieved the recommended training time of 720 min over 12 weeks. The median training time was used to divide participants into long and short- training groups. The long-training group showed a greater improvement in attention and executive function than the short-training group but there was no significant improvement in work performance after CT compared to baseline. Our results suggest that although remote CT was not feasible enough, the effects on cognitive function can be expected by increasing training time and motivation.

Survival trends of extracorporeal membrane oxygenation support for pediatric emergency patients in regional and metropolitan areas in Japan

BackgroundTo assess the performance of pediatric extracorporeal membrane oxygenation (ECMO) centers, outcomes were compared between metropolitan and other areas. MethodsA retrospective cohort study was conducted at three regional centers on Kyushu Island and the largest center in the Tokyo metropolitan area of Japan. The clinical outcomes of patients of ≤15 years of age who received ECMO during 2010–2019 were investigated, targeting the survival and performance at discharge from intensive care units (ICUs), using medical charts. ResultsOne hundred and fifty-five patients were analyzed (regional, n = 70; metropolitan, n = 85). Survival rates at ICU discharge were similar between the two areas (64%). In regional centers, deterioration of Pediatric Cerebral Performance Category (PCPC) scores were more frequent (65.7% vs. 49.4%; p = 0.042), but survival rates and ΔPCPC scores (PCPC at ICU discharge–PCPC before admission) improved in the second half of the study period (p = 0.005 and p = 0.046, respectively). Veno-arterial ECMO (odds ratio [OR], 3.00; p < 0.03), extracorporeal cardiopulmonary resuscitation (OR, 8.98; p < 0.01), and absence of myocarditis (OR, 5.47; p < 0.01) were independent risk factors for deterioration of the PCPC score. A sub-analysis of patients with acute myocarditis (n = 51), the main indicator for ECMO, revealed a significantly higher proportion of cases with deteriorated PCPC scores in regional centers (51.9% vs. 25.0%; p = 0.049). ConclusionsThe survival rates of pediatric patients supported by ECMO in regional centers were similar to those in a metropolitan center. However, neurological outcomes must be improved, particularly in patients with acute myocarditis.

Preliminary insight into the relationship between bioaerosols and urban environment obtained from the COVID-19 self-quarantine period in the Tokyo metropolitan area

Anthropogenic activities and meteorological conditions influence the composition of urban bioaerosols. The COVID-19 epidemic drastically reduced anthropogenic activities in the metropolitan areas of Japan in 2020. This study examined inter-day fluctuations in airborne bacterial and fungal compositions in Tokyo, Japan, between April and June 2020, under exceptionally unusual conditions where the movement of people and economic activity had been greatly reduced. The result showed, as expected, that local meteorological factors, especially wind and precipitation, substantially impacted emissions and changes in bacterial and fungal aerosols. However, we found that variations in the composition of urban bioaerosols could potentially be affected by anthropogenic influences, such as the concentrations of nitrogen oxides, ozone, and particulate matter, and human density. Although such factors are not as influential as wind and precipitation, it was shown for the first time that drastic changes in human activities within an area can affect the dynamics of bioaerosols. This could be a finding that should be considered for public health issues related to air quality in changing urban areas such as fast-growing cities.

Abstract 18298: 10-Year Trends of In-Hospital Outcomes of Patients That Underwent Percutaneous Coronary Intervention for Cardiogenic Shock Complicating Acute Coronary Syndrome

Background: Cardiogenic shock complicating acute coronary syndrome (CS-ACS) is a life-threatening condition and percutaneous coronary intervention (PCI) remains a fundamental approach in its management. In recent years, notable advancements have emerged, including the utilization of mechanical circulatory support (MCS) devices and an enhanced understanding of patient selection for PCI. This study aims to assess the temporal trends in patient background and outcomes of patients who underwent PCI for CS-ACS. Methods: The Keio interhospital Cardiovascular Studies (KiCS)-PCI registry prospectively collects approximately 200 variables, which were defined in accordance with the National Cardiovascular Data Registry (NCDR), from the major teaching hospitals in Tokyo metropolitan area in Japan. Between 2009 and 2019, 24,671 consecutive cases were registered, 10,053 patients (40.7%) undergoing PCI for ACS, of which 870 patients (8.5%) had CS-ACS. We stratified CS-ACS patients into 4-time frame groups (T1: 2009-2011, T2: 2012-2013, T3: 2014-2016, and T4: 2017-2019), and examined the temporal trends in patient risk profiles using the NCDR score (ranging 0-100, reflecting predicted mortality rates). Additionally, we assessed the incidence and types of employed MCS as well as the in-hospital mortality rate. Results: During the study period, the proportion of CS-ACS remained stable, accounting for 8.0% in T1 to 8.2% in T4 of ACS-related PCI cases. The calculated NCDR risk score demonstrated minimal variation, ranging from 70.6 in T1 to 70.1 in T4. There was a notable decrease in the utilization of MCS (66.5% in T1 to 56.7% in T4), mainly driven by a reduction in the use of intra-aortic balloon pump (70.3% to 55.0%, p for trend&amp;lt;0.001), with a increase in the concomitant use of veno-arterial-extracorporeal membrane oxygenation (27.6% to 36.2%, p for trend&amp;lt;0.001). However, the in-hospital mortality rate for CS-ACS patients remained persistently high at 30%. Conclusion: Over the past decade, there have been notable changes in the peri-procedural management of CS-ACS, albeit no significant improvements in patient outcomes was observed. The result calls for additional efforts to enhance their management.

Evaluating the quality of life for sustainable urban development

As urbanization is rapidly progressing worldwide, the cities need to assess their quality of life (QOL) not only to check their infrastructure but also to keep pace with the changing citizens' sense of values and lifestyles. We propose an integrated method to evaluate urban QOL from the detailed spatial aspects of a city with the subjective preferences of its citizens. In this study, we collected the spatial data of urban setting attributes at a 500-m mesh scale, and the subjective preferences that vary based on individual attributes, to evaluate the QOL across five metropolitan areas in Japan. Our results reveal a greater disparity in QOL within larger metropolitan areas. The optimal urban population density for the best QOL tends to be around 4000 people/km2. This level strikes a balance between the benefits and drawbacks associated with urban QOL, such as enhanced living and cultural opportunities versus high housing costs and limited space. Moreover, QOL within a city varied according to geographic location, and these differences were amplified by subjective preferences. These findings contribute to our understanding of the disparities in urban QOL, and provide a scientific basis for urban policies that achieve diversity and inclusiveness.

The Relationship between the Evaluation of Public Transport Services and Travel-Based CO2 Emissions from Private Transport Modes in Regional and Metropolitan Areas in Japan

Promoting public transport use is expected to contribute to reducing CO2 emissions in the transport sector. Using Okayama City and Central Tokyo as representative case studies of regional and metropolitan areas in Japan, this study examines the impact of the evaluation of the ‘hard’ and ‘soft’ attributes of rail and bus services on the overall evaluation. This study then explores the relationship between the overall evaluation and usage frequency of rail and bus services, as well as the relationship between the usage frequency and travel-based CO2 emissions from private transport modes. Furthermore, this study investigates whether the emissions cause differences in the evaluation of the ‘hard’ and ‘soft’ attributes of public transport services. The findings suggest prioritising an improvement in ‘hard’ rather than ‘soft’ attributes in order to reduce emissions through the use of public transport in regional areas. However, in metropolitan areas, no relationship was found between the evaluation of public transport services and emissions, presumably because of the lower ownership rate of private cars that residents can use freely and the markedly higher level of rail and bus services. This study provides a methodological reference for analysing the potential to reduce travel-based emissions from private transport modes by enhancing public transport service contents.

Tracking the Effect of Human Activity on MeSO-net Noise Using Seismic Data Traffic—Did Seismic Noise in Tokyo Truly Decrease during the COVID-19 State of Emergency?

Abstract Human activities cause seismic noise over 1 Hz (cultural noise), and the recent articles have reported that the curtailing of socioeconomic activities during the novel coronavirus (COVID-19) pandemic in 2020 appeared to reduce high-frequency seismic noise amplitudes in cities. The Tokyo metropolitan area in Japan, where seismic stations are densely distributed and various anthropogenic activities have been closely monitored, is an ideal study area to investigate the effect of human activity on high-frequency seismic noise during the pandemic. We demonstrated that the magnitude of seismic data traffic (SDT), indexed by the packet size of continuous seismic data in WIN32 format, is a good indicator for monitoring time-dependent changes in high-frequency noise levels. The SDT of 169 Metropolitan Seismic Observation network (MeSO-net) stations—a continuous accelerometer network that is mostly located at schools in the Tokyo metropolitan area—decreased by approximately 1%–3% from March to June 2020, when a state of emergency in Japan was first declared, compared with that in the previous year. We revealed that the SDT decrease was prominent only at stations near school buildings, and the SDT trend was uncorrelated with the temporal changes in the population and vehicular traffic volume near the seismic stations. We also found strong correlations between the SDT reduction and school size (classified by the number of students enrolled), implying that the noise decrease at the MeSO-net stations during the pandemic was strongly influenced by school-based activities. Thus, the noise reduction observed at MeSO-net stations during the COVID-19 pandemic in 2020 did not provide strong evidence of quieting in the Tokyo metropolitan area.

Parental support for physical activity and children’s physical activities: a cross-sectional study

BackgroundPhysical activity (PA) in school-aged children is imperative for physical and mental development. However, there has been reduced PA among children in recent years owing to environmental changes, resulting in declining physical strength and athletic ability. Although parents’ and children’s PA has been found to be correlated, the specific parental caregiving attitudes associated with children’s actual levels of PA during school-age years remain unknown. Therefore, this study aimed to examine the relationship between parental support for PA and children’s levels of PA.MethodsIn 2017, a self-reported questionnaire survey was administered to 1,515 third-grade students (8–9 years old) and their caregivers in Nagoya, Aichi, a major metropolitan area in Japan. The main items surveyed included the attitudes of children and parents towards PA and the children’s actual PA level. Multiple regression analysis was conducted with parental involvement related to PA as the explanatory variable and children’s PA as the objective variable.ResultsIn total, 717 children with valid responses were included in the analysis. The mean age of the children was 9.08 ± 0.33 years; 366 (51.0%) were boys, and 351 (49.0%) were girls. For moderate-to-vigorous and vigorous PA, PA levels tended to be significantly higher in children whose parents provided logistic support such as enrolling their children in a sports club. However, for moderate PA and walking, PA levels tended to be significantly higher in children whose parents used community resources. Modeling and limiting sedentary activities were not associated with children’s PA.ConclusionsThe results of this study suggest that direct parental assistance for PA such as logistic support encourages children to engage in moderate-to-vigorous PA; in addition, parental use of community resources may encourage children to engage in moderate and light PA such as walking. Conversely, indirect and negative involvement such as modeling and limiting sedentary activities were not associated with children’s PA. Therefore, logistic support may need to be strengthened to encourage moderate-to-vigorous and vigorous PA, which is important for children’s health.

Sustainable lifestyle: Urban household carbon footprint accounting and policy implications for lifestyle-based decarbonization

Cities, as the primary hubs of economic activities and the end-points of goods and services consumption, bear significant responsibility for the majority of global greenhouse gas emissions. Consequently, there is a pressing need for more granular data at the subnational level to formulate effective and feasible measures in line with current decarbonization targets. In this study, we present the carbon footprint embodied in household consumption behavior of 11 major metropolitan areas in Japan. Furthermore, our study innovatively introduces a temporal perspective, employing time organization as an insightful indicator to delineate the disparities in carbon footprints that arise from varying carbon intensities of distinct activities. The results are given from the following three aspects: 1) structural comparison of urban household carbon footprints; 2) time-based activity differences and drivers; and 3) inequality analysis among different activity-based carbon footprints. Here, we found that eating contributes most substantially to the carbon footprint. Conversely, transportation activities manifest the greatest regional inequality in carbon footprints. These findings provide indispensable evidence for the development of city-specific net-zero-emission goals within Japan. Furthermore, they exemplify the value of incorporating a temporal dimension into household carbon footprint analyses, thereby providing a broader perspective for future investigations in this field.

Building Relationships Between Community Care Professionals and Convenience Stores in Japan: Community-Based Participatory Research.

Convenience stores play an important role in supporting community-dwelling older adults' lives. We started community-based participatory research (CBPR) in Nerima City, Tokyo Metropolitan area in Japan to develop a collaborative relationship to support older adults in the community-based integrated care system. This study aimed to describe the CBPR process and evaluate building face-to-face relationships between health/social care professionals and the owners/employees of convenience stores. Using CBPR, health/social care professionals in community general support centers (CGSCs) directly approached convenience stores based on the public support agreement between the convenience store chain company and the municipality. To evaluate the face-to-face relationship building between convenience store owners/employees and CGSCs' staff, we administered questionnaire surveys to convenience stores in Nerima City and two control cities from 2017 to 2019, and about 100 convenience stores completed the survey each year. Statistical analyses showed significant improvements in their knowledge for relationships with the CGSCs in Nerima City, including "knowledge of the CGSCs' function" (P = 0.001), "knowing individual professionals in the CGSCs" (P = 0.023), and "knowledge of when to contact the CGSCs" (P = 0.002), compared with control cities. Helping behavior for older adults at convenience stores also increased significantly in Nerima City (P = 0.034). The CGSCs' direct approach based on the public support agreement would effectively promote building relationships at convenience stores, leading to an age-friendly community.

Relationship between objective cognitive functioning and work performance among Japanese workers.

We aimed to explore the relationship between objective cognitive functioning and work performance among Japanese workers. From February to November 2019, this cross-sectional study enrolled workers aged 18-65 years from 10 companies located in a metropolitan area of Japan. We emailed invitations to participate to employees of companies that had agreed to cooperate with the study. We measured work performance with the question, "How would you rate your performance (compared with your optimum performance) over the past 4 weeks?" Responses were made via a visual analog scale (range: 0-100). Cognitive functioning was assessed using the THINC-integrated tool (THINC-it®). THINC-it® is a brief, objective computerized cognitive assessment battery. Associations between work performance and cognitive functioning tests were examined using logistic regression analysis. In total, 353 individuals provided e-consent to participate, of whom 276 were included in the analysis (after omitting those with missing values). The median work performance was used to divide participants into high- (scoring ≥ 80%) and low- (scoring < 80%) performing groups. The P-values for trends indicated that association between cognitive domains, such as attention, executive functioning and working memory was significant (P < .05). Work performance was significantly associated with cognitive function for the two tests that assess attention, executive functioning, and working memory in general workers. Our results suggest that objective cognitive functioning may be related to work performance. Longitudinal investigations may allow for the establishment of causality.

Changes in visits to green spaces due to the COVID-19 pandemic: Focusing on the proportion of repeat visitors and the distances between green spaces and visitors’ places of residences

Through a quantitative approach, this study aimed to clarify the changes in the number of visitors and visits to green spaces according to green space type before and after the COVID-19 pandemic. We explored the changes in the proportion of repeat visitors and the distance between green spaces and visitors’ places of residence. We used KDDI Location Analyzer, which performs novel analysis using mobile phone GPS and census data. The study area included 10 target sites (urban parks and nature trails in the backcountry) located in the Sapporo metropolitan area in Japan. The survey period included snow-free seasons from 2019 to 2021, and 2019 was considered the period “before the pandemic.” The results revealed that the number of visits during the pandemic increased compared with those before the pandemic, except for those of urban parks near the city center. In 2020, the proportion of repeat visitors increased for all 10 target sites. In addition, since the outbreak of the pandemic, distances between all urban parks and visitors’ residences decreased. The same trend was observed for nature trails in the backcountry close to the city center. These findings indicate a generally decreasing trend in the number of visits to green spaces as many people have been refraining from visiting the site since the outbreak of the pandemic. Contrastingly, the number of visits by repeat visitors who reside close to the target sites has increased in some cases, which compensated for the general decreases.

Economic, cognitive, and social paths of education to health-related behaviors: evidence from a population-based study in Japan.

There is substantial evidence on the association between lower education and unhealthy behaviors. However, the mechanism underlying this association remains unclear. This study aimed to examine whether income, health literacy, and social support mediate the association between education and health-related behaviors. A questionnaire survey was conducted in metropolitan areas in Japan from 2010 to 2011 among residents aged 25-50 years. Data from 3663 participants were used in this study. Health literacy was measured using the Communicative and Critical Health Literacy scale. Health-related behaviors were current smoking, poor dietary habits, hazardous drinking, and lack of exercise. Poisson regression analyses with robust variance estimators were conducted to examine the associations between education and these health-related behaviors. Multiple mediation analyses were conducted to estimate the magnitudes of the mediating effects of income, health literacy, and social support on these associations. Less educated participants had higher risks of all unhealthy behaviors. Income mediated the associations of education with smoking (6.4%) and exercise (20.0%). Health literacy mediated the associations of education with dietary habits (15.4%) and exercise (16.1%). Social support mediated the associations of education with dietary habits (6.4%) and exercise (7.6%). The education-drinking association was mediated by income in the opposite direction (-10.0%). The proportions of the total effects mediated by income, health literacy, and social support were 9.8% for smoking, 24.0% for dietary habits, -3.0% for drinking, and 43.7% for exercise. These findings may provide clues for designing effective interventions to reduce educational inequalities in health-related behaviors.

Impact of telecommuting on Japanese Citizen's travel, activities, and residential locations: Experiences and future expectations under COVID-19 pandemic

In the past few years, telecommuting has diffused on a large scale across many developed countries; however, its popularity in Japan is low due to various factors and cultural differences. The outbreak of COVID-19 has made the adoption of telecommuting indispensable, reaching an unprecedented level in Japan, bringing dramatic changes in the lifestyles and behaviors of citizens. This study investigates how and to what extent this pandemic-induced telecommuting affected employees’ travel, activities, and residence locations and explores their expectations of post-pandemic life. The data were collected through the online questionnaire survey across three major metropolitan areas in Japan that incorporates a comprehensive set of questions regarding telecommuting implementation and feasibility, lifestyles before and during the pandemic, and expected way of life after the pandemic, and the total of 2045 respondents were collected. The analysis has been done based on revealed preference data considering two time periods i.e., before COVID-19, during COVID-19, and for the post-COVID 19 scenario where stated preferences are considered. In the first step, telecommuting behavior, telecommuting preferences and plans, and activity patterns are estimated based on aggregate sample data. Next, by using the stated preference survey conducted, ordered probit model and mixed logit model are applied to identify factors influencing post-pandemic telecommuting frequency and residential location preference, respectively. The analysis revealed two major findings: telecommuting brought significant changes in multiple aspects of people’s lifestyles and activities that might persist after the pandemic; although determinants that govern telecommuting frequency and residential location choice after COVID-19 may differ across metropolitan areas, commuting/telecommuting frequency is the prime factor influencing residential location decisions. The findings of this research can guide transportation and urban planners in establishing effective travel demand management tools and sustainable urban networks for the new-normal era.

Occupational accidental injury deaths in Tokyo and Chiba prefectures, Japan: A 10-year study (2011-2020) of forensic institute evaluations.

Occupational accidental injury deaths (OAIDs) are a major social problem, and the analysis of individual cases is important for developing injury prevention measures. In this study, OAIDs with autopsies performed at forensic facilities in the metropolitan area of Japan (Tokyo and Chiba prefectures) from 2011 to 2020 were reviewed. The epidemiological characteristics of these OAIDs (n=136), which accounted for 13.5% of OAIDs reported in the region during the study period, were compared with those of non-occupational accidental injury deaths (non-OAID) cases (n=3926). Among OAID cases, 134 (98.5%) were men and 13 (9.6%) were foreign-born workers, which was significantly more than in non-OAID cases (p < 0.001, respectively). OAIDs were most frequent in construction (39.0%) followed by the manufacturing category (21.3%). The percentage of OAIDs in workers aged 65 and over showed an increasing trend. Most accidents occurred just after the start of work or just before the workday ended, as well as during the peak months of the year. The most common type of accident was fall/crash from a height (25.0%), and the most common injury site was the chest; none of these cases were confirmed to have been wearing a safety belt properly. Among foreign-born workers, the most common type of accident was caught in/between. As the working population is expected to change in the future, and an increase in the number of older adults and foreign workers is expected, it is necessary to take preventive measures such as improving the work environment based on ergonomics and providing safety education.

The stay coefficient: a novel quantification of the relationship between stay time and travel time for urban shopping behavior analysis

ABSTRACT Shoppers typically want to spend an amount of time at a destination that is proportional to the travel time required to arrive there; thus, the travel time can be considered the cost of their trip. This is likely to be the case across regions with different urban structures and cultures. The purpose of this study was therefore to analyze the shopping behaviors contained in travel survey data from three metropolitan areas in Japan to identify common patterns and indicators based on travel time and stay time, thereby obtaining an understanding to inform future trade area analyses. Both the travel time and stay time associated with shopping behavior were found to be log-normally distributed regardless of metropolitan area, and four shopping behavior patterns common among the metropolitan areas were identified. The “stay coefficient” was then defined to express the elasticity of stay time according to travel time, and its values were similar according to shopping behavior pattern regardless of metropolitan area. The stay coefficient proposed in this study can therefore be applied to identify shopping behavior patterns in any urban area based on the relationship between travel time and stay time, realizing a novel approach to the analysis of and marketing for trade areas when planning the construction or renovation of commercial facilities. This approach can help inform the decisions of urban policy makers, marketing advisors, and commercial facility operators, and should be of interest to researchers and practitioners working with geospatial, shopping, and other human behavioral characteristics.

Impact of the First-Fourth Waves of the COVID-19 Pandemic on New Applications for Long-term Care Insurance in a Metropolitan Area of Japan.

Impact of the First-Fourth Waves of the COVID-19 Pandemic on New Applications for Long-term Care Insurance in a Metropolitan Area of Japan.

Hopes expressed in birth plans by women diagnosed with fetal anomalies: a qualitative study in Japan

BackgroundRecent advances in prenatal screening and diagnosis have resulted in an increasing number of women receiving a diagnosis of fetal anomalies. In this study, we aimed to clarify the hopes for childbirth and parenting of women diagnosed with fetal anomalies and to suggest a family-centered care tailored for this situation in perinatal settings.MethodsA descriptive qualitative study was performed. We recruited women diagnosed with fetal anomalies who were over 22 years old, beyond 22 weeks of gestation, and had scheduled pregnancy and delivery management at a tertiary perinatal medical center specializing in neonatal and pediatric care in a metropolitan area of Japan from April 2019 to December 2019. Women who were willing to participate received support from a midwife to create birth plans. Data were collected from the documented birth plans submitted by 24 women and analyzed using content analysis.ResultsWe identified three themes of women’s hopes based on the descriptions of the submitted birth plans: (1) Hopes as women who are expecting childbirth, (2) Hopes as mothers of a baby, (3) Hopes of being involved in the family needs. Several distinctive hopes were clarified in the context of the women’s challenging situations. In describing their hopes, the women were neither overoptimistic or overstated their actual situations, nor caused embarrassment to the healthcare providers. The importance of supporting their involvement in baby matters in the way each family wants also emerged. However, several barriers to fulfilling the women’s hopes were identified including the babies’ conditions and hospital regulations against family visits or presence.ConclusionAll three themes identified in the study provide important insights for analyzing more deeply ways of implementing a family-centered care for women diagnosed with fetal anomalies in perinatal settings. To improve women’s engagement in decision-making as a team member, women’s hopes should be treated with dignity and respect, and included in the perinatal care of women with abnormal fetuses. Further research is needed to improve the inclusion of women’s hopes in their care in clinical settings.Trial registrationUMIN Clinical Trials Registry: UMIN000033622 (First registration date: 03/08/2018).