Western Part Of Japan Research Articles

Japan nosocomial infections surveillance (JANIS): a model of sustainable national antimicrobial resistance surveillance based on hospital diagnostic microbiology laboratories

BackgroundAntimicrobial resistance (AMR) is now recognized as a major threat to public health, and surveillance of AMR is essential for successful containment. In 2000, Japan Nosocomial Infections Surveillance (JANIS) Clinical Laboratory (CL) division has been launched as a voluntary AMR surveillance funded by the Ministry of Health, Labour and Welfare and managed by the National Institute of Infectious Diseases. In this study, we aimed to propose a model of sustainable national AMR surveillance which provides not only national AMR surveillance reports but also benchmarking reports to each hospital to facilitate infection control practices.MethodsJANIS CL division collects comprehensive specimen-based data complies with JANIS data format from participating hospitals each month. It had targeted only blood and cerebrospinal fluid samples but was expanded to all types of specimens in 2007 at revision of JANIS. The JANIS system interprets the antimicrobial susceptibility according to the same criteria and conducts removal of duplicates to allow accurate comparison between hospitals. Monthly feedback reports are created automatically within 48 h, while quarterly and annual reports are generated after data validation.ResultsAt the beginning, 468 hospitals were enrolled in the JANIS CL division, but the number of hospitals that submitted data decreased to 210 (45%) in 2006. After surveillance revision in 2007, annual recruitment of hospitals was initiated and as of 2015, 1475 hospitals participated, and 1461 (99%) of them submitted data throughout the year. Nationwide surveillance data collected over the past decade revealed that the prevalence of methicillin-resistant Staphylococcus aureus has decreased since 2008, and that its prevalence is higher in the western part of Japan, where the number of hospitals per capita is higher than in the eastern part.ConclusionsJANIS CL division serves a model of sustainable national AMR surveillance system. Comprehensive data for all specimens promotes understanding of the sampling frequency and prevalence of AMR. As a well-established system for providing rich information to guide action both locally and nationally, JANIS may also be utilized for sharing AMR data globally.

Severe fever with thrombocytopenia syndrome: epidemiology, pathophysiology, and development of specific treatment and prevention measures

Severe fever with thrombocytopenia syndrome (SFTS) was first reported in 2011 as an emerging virus infection caused by a novel Phlebovirus in the Bunyaviridae family [SFTS virus (SFTSV)]. In addition, it was reported to be endemic to Hubei, Henan, Shandong, and Heilongjiang provinces in China. The primary symptoms of SFTS are gastrointestinal symptoms such as fever, general fatigue, nausea, vomiting, and diarrhea. The total blood cell counts in patients with SFTS reveal thrombocytopenia and leukopenia. A woman in her 50s died due to multiorgan failure, intestinal hemorrhage, and hemophagocytosis in the autumn of 2012. She was retrospectively diagnosed with SFTS, suggesting that SFTS was endemic not only to China but also to Japan. Subsequently, SFTS was reported to be endemic to South Korea as well. Approximately 5 years have passed since the discovery of SFTS endemicity in Japan. To date, 40-100 patients with SFTS from the western part of Japan have been reported annually to the National Institute of Infectious Diseases. The case-fatality rate of SFTS is approximately 20%. This high case-fatality rate could be attributed to multiorgan failure, coagulopathy, and hemophagocytosis, which are induced in most patients with SFTS. Reportedly, an antiviral drug, favipiravir, was effective in treating SFTSV infection in an animal infection model. SFTSV has been found to circulate between wild animals and several species of ticks in nature, suggesting that we cannot escape the risk of infection with SFTSV and that SFTS will continue to occur in endemic areas. Hence, the development of specific treatment and preventive measures with SFTS vaccines is imperative.

Temporal and Spatial Excess Leukemia Deaths Around the Nuclear Power Plant in Kyushu, Japan (1970-2005)

Background/AimExcess incidence of cancer including leukemia among people living in the vicinity of Nuclear Power Plant (NPP) in normal operation has been reported on from Germany, France, the United Kingdom, Korea, and others. But in Japan, any epidemiologic investigations have not been conducted yet while 18 NPP facilities have discharged radioactive substances e.g. tritium. 13 among 47 prefectures in Japan had NPPs until 2010, and 7 of them were ranked in top 15 leukemia mortality. We estimated the Standardized Mortality Ratios (SMRs) on leukemia of municipalities around the NPPs in Kyushu area, the western parts of Japan, and then summarized their temporal-spatial changes with using empirical Bayesian estimates.MethodsWe estimated leukemia SMRs with using data of age-sex specific five-year municipal population among 1965-2005 of Japanese Census, age-sex specific cause-specific leukemia deaths of Japanese Vital Statistics, and leukemia deaths of each municipalities. To adjust spatial variations of SMRs in the towns and villages with sparse population, we have applied empirical Bayes method with Poisson distribution model.ResultsSMRs of leukemia in the study region increased after beginnings of the operation of NPPs. The municipalities located the nearest to NPP had excess SMR (3.69: 95% CI, 3.11-5.56) comparing to farther areas of the prefecture. NPP Reactor type of the study areas was Pressurized Water Reactor (PWR) which released more radioactive substances comparing to Boiling Water Reactor (BWR). The study suggests the relationship between leukemia and NPPs normally operated in Japan.

Investigating the Effects of Metacognitive Instruction in Listening for EFL Learners

This study investigated the effects of metacognitive instruction in listening for EFL learners over a semester. Participants (N = 48) were sampled from TOEIC classes in a private university in the western part of Japan where the researcher had been working as an English instructor. They were sophomores whose majors were not English. The experimental group (n = 26) received metacognitive instruction in listening (i.e., they were taught how to listen to texts and how to improve listening skills through metacognitive processes as well as activities such as planning, monitoring, and reflecting). The contrast group (n = 22), taught by the same teacher, did not receive metacognitive instruction although they listened to the same listening materials and received more listening input. Results of the questionnaire (SRLLQ, the Self-Regulated Learning in Listening Questionnaire, Kobayashi, 2017a) showed that students in both groups became more self-regulated learners, but it was also found that the experimental group made greater gains in listening proficiency and regulation of cognition. Moreover, it was verified that learners with low listening proficiency in the experimental group benefited the most from such metacognitive instruction.

Wide difference in biologics usage and expenditure for the treatment of patients with rheumatoid arthritis in each prefecture in Japan analyzed using "National Database of Health Insurance Claims and Specific Health Checkups of Japan".

To analyze the biologics usage and expenditure for the treatment of patients with rheumatoid arthritis (RA) in each prefecture throughout Japan using the national open database, the Ministry of Health, Labour and Welfare of Japan disclosed; in Oct 2016, the data of the top 30 most-frequently prescribed drugs during a 1-year period from April 2014 to March 2015 in each prefecture in Japan, along with the patients' age and sex. Seldom-used drugs were excluded. We picked up only biologics for the present study. The total expenditure on biologics used in each prefecture was correlated with the population thereof. However, there was a big difference, up to ~ twofold, in the average expenditure used for an RA patient: highest in Toyama and lowest in Wakayama. There was also a big difference, ~ 4.5-fold, in the number of rheumatologists/1000 RA patients, highest in Kyoto and lowest in Aomori. The average expenditure used for an RA patient was correlated with the number of rheumatologists in the western part of Japan. Etanercept seemed to be used most frequently to Japanese RA patients followed closely by infliximab. Abatacept was used more frequently to the elderly than other biologics. There was a big difference in the number of rheumatologists and expenditure on biologics for the treatment of an RA patient among prefectures in fiscal 2014. Factors that brought this unevenness need to be scrutinized for universal implementation of good RA care throughout Japan, where there are uniform health insurance system and free access to rheumatologists.

Highly Time-Resolved Atmospheric Observations Using a Continuous Fine Particulate Matter and Element Monitor

We measured the fine particulate matter (PM2.5) and element (S, Pb, K, Si, Ca, Fe, Mn, and Zn) concentrations in March 2015 using a continuous PM2.5 mass and element concentration monitor at Sanyo Onoda, which is located in the western part of Japan. In addition to the PM2.5 concentration measurements, this instrument can continuously and automatically analyze the elements in PM2.5 without sample pretreatment using X-ray fluorescence at a high time resolution. The PM2.5 concentrations measured with our apparatus and the system from the Yamaguchi Prefectural Government had a good correlation, with a correlation coefficient of 0.931. The increase in the PM2.5 concentration in the case of the westerly wind indicates that the air mass includes a high concentration of particulate matter that is transported from the Asian continent. The anthropogenic components (S, Pb, and K) showed a strong correlation with PM2.5. However, there was a moderate correlation between the crustal components (Si, Ca, and Fe) and PM2...

Clinical course of the patients with spinocerebellar ataxia type 3/Machado-Joseph disease in the Hokuriku district in Japan

Background: Spinocerebellar ataxia type 3/Machado-Joseph disease (SCA3/MJD) is a common autosomal-dominant cerebellar ataxia in Japan. The Hokuriku district is located in the central, western part of Japan, and has a high relative frequency and prevalence of SCA3/MJD.

Molecular survey of Bartonella henselae and Bartonella clarridgeiae in pet cats across Japan by species-specific nested-PCR.

Cats are known to be the main reservoir for Bartonella henselae and Bartonella clarridgeiae, which are the agents of 'cat-scratch disease' in humans. In the present study, we investigated the prevalence of the two Bartonella species on 1754 cat bloods collected from all prefectures in Japan during 2007-2008 by a nested-polymerase chain reaction (PCR) targeting the 16S-23S rRNA internal transcribed spacer region. Overall, Bartonella DNA was detected in 4·6% (80/1754) of the cats examined. The nested-PCR showed that 48·8% (39/80) of the positive cats were infected with B. henselae mono-infection, 33·8% (27/80) with B. clarridgeiae mono-infection and 17·5% (14/80) were infected with both species. The prevalence (5·9%; 65/1103) of Bartonella infection in the western part of Japan was significantly higher than that (2·3%; 15/651) of eastern Japan (P < 0·001). Statistical analysis of the cats examined suggested a significant association between Bartonella infection and FeLV infection (OR = 1·9; 95% CI = 1·1-3·4), but not with FIV infection (OR = 1·6; 95% CI = 1·0-2·6).

Using a pregnancy decision support program for women choosing birth after a previous caesarean in Japan: A mixed methods study.

Opportunities for women and providers to use decision aids and share decisions about birth after caesarean in practice are currently limited in Japan. This is despite known benefits of decision aids to support value-sensitive healthcare decisions. To explore Japanese women's decision making experiences using a decision aid program for birth choices after caesarean. A mixed methods study was conducted among 33 consenting pregnant women with previous caesarean in five obstetrics institutions located in the western part of Japan. Outcome measures included change in level of decisional conflict, change in knowledge, and preference for birth method. Semi-structured interviews examined women's decision making experiences, and qualitative data were analyzed using thematic analysis. The participants in the program experienced a statistically significant improvement in knowledge and reduction in decisional conflict about birth after caesarean. Four themes were identified in the qualitative data related to decision making: change in women's knowledge about birth choices, clarifying women's birth preference, feelings about shared decision making, and contrasting feelings after receiving information. This study confirmed potential benefits of using the decision aid program. However, uncertainty about mode of birth continued for some women immediately prior to the birth. This finding emphasized the need to identify additional ways to support women emotionally throughout the process of decision making about birth after caesarean. It was feasible to adapt the decision aid for use in clinical practice. Future research is necessary to examine its effectiveness when implemented in Japanese clinical settings.

Four Myxobolus spp. (Myxosporea: Bivalvulida) from the gill lamellae of common carp (Cyprinus carpio) and Japanese silver crucian carp (Carassius langsdorfii) in the western part of Japan, with the description of three new species (M. tanakai n. sp., M. paratoyamai n. sp., and M. ginbuna n. sp.).

Approximately three dozen Myxobolus spp. (Myxozoa: Myxosporea: Bivalvulida) have been described to parasitize the gills of carp of the genera Cyprinus and Carassius. Hitherto, these fish were often introduced to temperate waters worldwide as food and ornamental fish from Asia, their place of origin. The present study examined the myxosporean infection of seven common carp (Cyprinus carpio) and seven Japanese silver crucian carp (Carassius langsdorfii) collected from the Fushinogawa River around the university in Yamaguchi City, Japan, during the period April 2015 to October 2016. In total, four Myxobolus spp. were detected in the gill lamellae of Cy. carpio and Ca. langsdorfii, i.e., two species in each species of fish. The four species were characterized morphologically and genetically based on the 18S ribosomal RNA gene (rDNA). A new species, Myxobolus tanakai n. sp., from four individuals of Cy. carpio had an elongated pyriform spore (15.4-18.6μm by 6.3-8.4μm), resembling the spore shape of Myxobolus koi from Cy. carpio or Carassius auratus in Japan, China, and the USA, but bigger than it (13.2-15.6μm by 6.6-7.8μm). The new species formed a clade with M. koi but was distinct from any of the isolates of this species (nucleotide identities less than 98.6%). The second new species, Myxobolus paratoyamai n. sp., from a single Cy. carpio with its one prominent and one rudimentary polar capsule closely resembled the spore morphology of Myxobolus toyamai from Cy. carpio or Carassius gibelio in Japan, China, and the USA. However, the isolate formed a clade with Myxobolus longisporus from Cy. rubrofuscus in China rather than with M. toyamai isolates (nucleotide identities less than 97.9% with known species). Another new species, Myxobolus ginbuna n. sp., from two individuals of Ca. langsdorfii had similar-shaped spores to Myxobolus wulii, but the dimensions were smaller (11.7-13.9μm by 8.5-9.8μm vs. 17.6-18.5μm by 8.9-10.0μm). This new species formed a clade with M. wulii but was distinct from any of the M. wulii isolates from Ca. gibelio in China (nucleotide identities less than 99.1%). An additional species, Myxobolus pyramidis, from six individuals of Ca. langsdorfii was morphologically and genetically similar to the previous record from Ca. gibelio in China (99.6% nucleotide identity of the 18S rDNA). Two of these six individuals were mix-infected with M. ginbuna n. sp. This is a new host and geographical distribution record for M. pyramidis.

A study of associations among attachment patterns, maltreatment, and behavior problem in institutionalized children in Japan

The present study investigates the relationships among children's history of maltreatment, attachment patterns, and behavior problems in Japanese institutionalized children. Twenty-nine children (12 boys and 17 girls) from three different institutions in the Kinki area (Western part of Japan) participated in this study. Their average age was 6. 41-years (ranging from 4 to 10). Thirteen of the children (44.8%) had history of maltreatment before they were institutionalized. Children's attachment was assessed by the Attachment Doll Play Assessment (George & Solomon, 1990, 1996, 2000). The child’s main caregiver answered the Child Behavior Checklist (CBCL; Archenbach, 1991) to identify children's behavior problems. Results indicated a significant relationship between maltreatment history and attachment pattern. The relationship between attachment pattern and behavior problem was also confirmed. Implications and limitations of this study were discussed.

CONTRACTING-OUT OF HOUSEHOLD WASTE COLLECTION SERVICES IN JAPAN

We first report three empirical findings from our survey on the contracting-out of municipal waste collection services in Japan: (1) the rate of contracting-out and the contract price are inversely related, (2) this inverse relationship tapers out as the contracting rate becomes sufficiently high, and the contract price even tends to go up as the contracting rate approaches 100% and (3) there is a significant disparity in the contracting rates between the eastern and western parts of Japan. In order to account for these observations, we then set up a simple analytical model and examine its implications. Also, we discuss the issues that a potential hold-up situation could give rise to when the services are completely contracted out to private firms.

Why do aftershocks occur? Relationship between mainshock rupture and aftershock sequence based on highly resolved hypocenter and focal mechanism distributions

In order to clarify the origin of aftershocks, we precisely analyze the hypocenters and focal mechanisms of the aftershocks following the 2000 Western Tottori Earthquake, which occurred in the western part of Japan, using data from dense seismic observations. We investigate whether aftershocks occur on the mainshock fault plane on which coseismic slip occurred or they represent the rupture of fractures surrounding the mainshock fault plane. Based on the hypocenter distribution of the aftershocks, the subsurface fault structure of the mainshock is estimated using principal component analysis. As a result, we can obtain the detail fault structure composed of 8 best-fit planes. We demonstrate that the aftershocks around the mainshock fault are distributed within zones of 1.0–1.5 km in thicknesses, and their focal mechanisms are significantly diverse. This result suggests that most of the aftershocks represent the rupture of fractures surrounding the mainshock fault rather than the rerupture of the mainshock fault. The aftershocks have a much wider zone compared with the exhumed fault zone in field observations, suggesting that many aftershocks occur outside the fault damage zone. We find that most aftershocks except in and around the large-slip region are well explained by coseismic stress changes. These results suggest that the thickness of the aftershock distribution may be controlled by the stress changes caused by the heterogeneous slip distribution during the mainshock. The aftershock is also distributed within a much wider zone than the hypocenter distribution observed in swarm activity in the geothermal region, which is thought to be caused by the migration of hydrothermal fluid. This result implies a difference in generation processes: Stress changes due to the mainshock contribute primarily to the occurrence of aftershocks, whereas earthquake swarms in the geothermal region are caused by fluid migration within the localized zone. Graphical abstract.

Epidemiological study of relapsing fever borreliae detected in Haemaphysalis ticks and wild animals in the western part of Japan.

The genus Borrelia comprises arthropod-borne bacteria, which are infectious agents in vertebrates. They are mainly transmitted by ixodid or argasid ticks. In Hokkaido, Japan, Borrelia spp. were found in deer and Haemaphysalis ticks between 2011 and 2013; however, the study was limited to a particular area. Therefore, in the present study, we conducted large-scale surveillance of ticks and wild animals in the western part of the main island of Japan. We collected 6,407 host-seeking ticks from two regions and 1,598 larvae obtained from 32 engorged female ticks and examined them to elucidate transovarial transmission. In addition, we examined whole blood samples from 190 wild boars and 276 sika deer, as well as sera from 120 wild raccoons. We detected Borrelia spp. in Haemaphysalis flava, Haemaphysalis megaspinosa, Haemaphysalis kitaokai, Haemaphysalis longicornis, and Haemaphysalis formosensis. In addition, we isolated a strain from H. megaspinosa using Barbour-Stoenner-Kelly medium. The minimum infection rate of ticks was less than 5%. Transovarial transmission was observed in H. kitaokai. Phylogenetic analysis of the isolated strain and DNA fragments amplified from ticks identified at least four bacterial genotypes, which corresponded to the tick species detected. Bacteria were detected in 8.4%, 15%, and 0.8% of wild boars, sika deer, and raccoons, respectively. In this study, we found seasonal differences in the prevalence of bacterial genotypes in sika deer during the winter and summer. The tick activity season corresponds to the season with a high prevalence of animals. The present study suggests that a particular bacterial genotype detected in this study are defined by a particular tick species in which they are present.

THE FRAMEWORK OF THE IMAGE OF TOWNS PROMOTING AS &lt;i&gt;SHOKYOTO&lt;/i&gt; THROUGH AN ANALYSIS OF SIGHTSEEING BROCHURES

This paper aims to clarify the framework of the image of places in contemporary society through the analysis of words on sightseeing brochures of the towns which promote themselves as Shokyoto (little Kyoto). These towns attempt to enhance their historical value by borrowing the image of Kyoto, old Japanese capital city. They have obtained unique historical image which have transformed from that of Kyoto. Local governments and tourist offices of these towns have published sightseeing brochures to express their historical attractions. Therefore, the framework of their image can be read from them. Firstly, the contents of historical attraction of each town were examined from two aspects of words on sightseeing brochures; Value Objects and their history (Fig. 1, 2 and 3, Table 1 and 2). Hierarchical relations between Value Objects were considered to capture the whole historical attraction of each town, which are composed of all Value Objects in each sightseeing brochure. These relations were analyzed from the context and the appearance frequency of Value Objects in the text, we found 56 groups of hierarchically-linked Value Objects (Value Groups) (Fig. 4 and 5). Consequently, a set of Value Groups can be recognized as the whole historical attraction of each town from words on the sightseeing brochures. Secondly, according to the content of Value Object which is on the top of hierarchy, the characters of each Value Group were classified into following four categories; whole-of-town type, space-of-town type, life-in-town type, and periphery-of-town type. Space-of-town type and life- in-town type were classified further into four categories; linear-space type, spotted-space type, activity type and article type (Fig. 6). Thirdly, in order to capture the whole historical attraciton of each town, the set of Value Groups in each sightseeing brochure was considered, and 6 patterns were extracted (Table 3). We found characteristic relations between combinations of Value Groups and geographical distribution of the towns; towns located to the east of Kyoto tend to include whole-of-town type, and towns located to the west of Kyoto tend to include space-of-town type. These results suggest the difference of the meaning of Kyoto between eastern and western part of Japan. Finally, all the results above were compared with those of Koedo (little Edo), which were investigated in the previous report (Fig. 7, 8, 9 and 10). As a result, characteristic frameworks of the image of Shokyoto and Koedo were found relatively: The pattern which consists of several whole-of-town types (pattern ウ), and the pattern which includes periphery-of-town type (pattern P) were peculiar to Shokyoto. Meanwhile, the pattern which consists of single life-in-town type (pattern III), and the pattern which consists of several space-of-town types ( pattern IV) were peculiar to Koedo. These results suggest distinctive frameworks of the image of Shokyoto and Koedo: The framework of Shokyoto is a metaphorical image of Kyoto, which overlook the whole character of the town. On the other hand, the framework of Koedo is a metonymic image of Edo, which highlights either spatial or cultural character of the town.

Distribution of three algicidal Alteromonas sp. strains in seagrass beds and surrounding areas in the Seto Inland Sea, Japan

Harmful algal blooms (HABs) often cause great damage to the fish aquaculture industry in the western part of Japan. Bacteria that effectively kill such phytoplankton are found in coastal seawater and are considered to influence the occurrence of HABs. Algicidal bacteria are found in abundance in seagrass beds; however, the distribution of particular bacterial strains has not yet been clarified. In this study, we determined the abundance of three algicidal Alteromonas sp. strains that were isolated as Chattonella antiqua-killing bacteria in seagrass beds and their surrounding areas in summers of 2013–2015. The strains were detected using a quantitative polymerase chain reaction (qPCR) amplification method. Two of the three algicidal bacterial strains were remarkably abundant in the seawater of an enclosed seagrass bed compared to the surrounding areas. In addition, the abundance of the three algicidal bacteria decreased when the eelgrass withered in late summer. These results suggest that growth of these algicidal bacteria was stimulated by eelgrass. The bacterial abundance estimated by qPCR was much greater than that determined by the culture-dependent method in June 2015 when the eelgrass grew thickly. This implies that the qPCR assay could be a sensitive tool to evaluate algicidal bacteria in natural environments.

Disaster Imagination Game at Izunokuni City for preparedness for a huge Nankai Trough earthquake

The Disaster Imagination Game (DIG) is a newly developed method for disaster drills based on the knowledge of the Commanding Post Exercises of the Japan Self Defense Force, which uses maps and transparent overlay. The Izunokuni City office held a local liaison meeting for disaster medical care. The related organizations shared all information and confirmed the cooperating system for the huge disaster. In addition to providing information of various hazards created by the huge Nankai trough earthquake, the DIG was performed by the participants. The worst case scenario for such a huge Nankai Trough earthquake would be for a magnitude 9-class earthquake to hit the central and western parts of Japan. After this procedure, the local citizen recognized the importance of self-help and mutual assistance. In addition, vitalization of self or public transportations was an increasingly important task because multiple roads could not be utilized due to quake liquefaction damage or landslides. After exchanging ideas and participating in the DIG, the participants deepened their understanding on relief activities. In addition, the DIG resulted in understanding between each participant and building face-to-face relationships, and the most important factor for disaster relief was accomplished.

Study on Risk Reduction of Electric Power Supply Restriction by Reinforcement of Interconnection Lines Between Areas for the Nankai Trough Earthquake

Estimating electric power supply restrictions after the Nankai Trough earthquake and evaluating the need for reinforcing the capacity of lines interconnecting power supply areas, we found that capacity reinforcement of the Chubu-Kansai interconnection line used an electricity supply capability in the 60 Hz area of the western part of Japan after the disaster. We also found that this is effective in reducing risk in electric power supply restrictions, based on certain conditions. We also found by estimating construction and maintenance costs that the capacity reinforcement of the Chubu-Kansai interconnection line reduces risk and costs less than an east-west interconnection line.

Exposure to air pollutants during the early weeks of pregnancy, and placenta praevia and placenta accreta in the western part of Japan

BackgroundPlacenta praevia is an obstetric complication involving placental implantation in the lower uterine segment. Given the suggested aetiology of placenta praevia, adverse biological effects of air pollutants, such as plasma viscosity increment, endothelial dysfunction, and systemic inflammation, have the potential to induce low implantation. We explored the association between exposure to air pollutants during the pregnancy period up to implantation, and placenta praevia, in pregnant Japanese women. The outcome also included placenta accreta, which often exists in combination with placenta praevia. MethodsFrom the Japan Perinatal Registry Network database, we obtained data on 40,573 singleton pregnant women in western Japan (Kyushu-Okinawa Districts) between 2005 and 2010. We assigned pollutant concentrations (suspended particulate matter [SPM], ozone, nitrogen dioxide [NO2], and sulphur dioxide [SO2]), measured at the nearest monitoring station to the respective delivery hospital of each woman. A logistic regression model was used to adjust for several covariates. ResultsThe odds ratios (ORs) of placenta praevia per 10 units increase were 1.12 (95% confidence interval (CI)=1.01–1.23) for SPM over 0–4weeks of gestation, and 1.08 (1.00–1.16) for ozone. The association between exposure to NO2 and SO2, and praevia, was in the direction of increased risk. SPM exposure during 0–4weeks was associated with placenta accreta without praevia (OR=1.33, 95% CI=1.07–1.66). We found no association with exposure to air pollutants during 5–12weeks and the second trimester. ConclusionsExposure to air pollutants through to implantation was positively associated with placenta praevia and accreta.

Seasonal influenza vaccine (A/New York/39/2012) effectiveness against influenza A virus of health care workers in a long term care facility attached with the hospital, Japan, 2014/15: A cohort study.

The 2014/15 influenza season started earlier than usual, and intense activity was reflection of circulation of antigenically-drifted and vaccine-mismatched dominant A(H3N2) viruses. Although inpatients and health-care workers (HCWs) had a high influenza vaccination coverage rate well prior to the beginning of influenza season, numerous outbreaks of influenza A(H3N2) infection with fatal cases were reported in long-term care facilities (LTCFs) in Japan during 2014/15 influenza season. In January 2015, we were given opportunity to conduct outbreak investigation of influenza A at facility A (LTCF attached with hospital) in Western part of Japan. We evaluated overall and occupation-stratified influenza vaccine effectiveness (VE) among HCWs at facility A using a retrospective cohort design. Overall VE, occupation-stratified VE and adjusted VE (AVE) with 95% confidence intervals (CIs) were estimated using the following formula: (1-relative risks (RR) or 1-adjusted RR)×100%. Overall vaccine coverage rate among HCWs was 85%. Overall VE for HCWs was 28% (95% CI:-70 to 67) and overall AVE was 3% (95% CI:-34 to 30). Although there was no severe cases, our results indicated that even with high vaccination coverage rate with appropriate vaccination timing, the VE was low for HCWs, which echoes with previously reported VE from other northern hemisphere countries. However, rehabilitation group who had high awareness against influenza as a group and carried out intensive precautions from early influenza season had no cases. We conclude that multiple preventive measures in addition to high vaccination rate is necessary for preventing influenza of HCWs working at LCTFs.