JMA journal最新文献

Introduction: Few studies have explored the preventive efficacy of vaginal progesterone (VD) treatment for preterm delivery (PTD) in Japanese clinical practice. In this study, the efficacy of the VD treatment in pregnant women with a short cervix (sCX) diagnosed after 24 weeks is evaluated, focusing on perinatal outcomes.

Methods: A retrospective historical cohort study. Clinical data of 273 singleton women hospitalized for preventing PTD were extracted. Inclusion criteria are diagnosed sCX at 24-33 weeks. We excluded women with factors including treatment start before 24 weeks, medically induced PTD, PTD on admission day, and fetal demise. Consequently, logistic regression analyses were conducted on data from 79 women during Period 1 (November 2015 to March 2018, using prolonged intravenous ritodrine hydrochloride) and 82 women during Period 2 (August 2018 to August 2022, implementing VD treatment), adjusting maternal age, parity, body mass index, gestational age, cervical length, and histological chorioamnionitis. The primary outcomes involved PTD <37 and <34 weeks and neonatal intensive care unit admission. Secondary outcomes included the interval from the diagnosis of sCX to delivery <14 and <28 days, infant intubation, and surfactant administration. Since VD use is off-label in Japan, we obtained written informed consent prior to treatment.

Results: VD treatment (Period 2) significantly decreased the incidence of PTD (birth < 37 weeks) (adjusted odds ratios [ORs] 0.43, 95% confidence intervals [CIs] 0.19-0.96), impending delivery within 14 and 28 days after confirming sCX (adjusted OR 0.12, 95% CI 0.06-0.72; adjusted OR 0.25, 95% CI 0.09-0.74, respectively), and neonatal intubation rate (adjusted OR 0.17, 95% CI 0.04-0.75).

Conclusions: The VD treatment can prevent PTD in asymptomatic women with sCX diagnosed after 24 weeks of gestation. Although further validation is warranted, these findings may contribute to expanding the use of VD treatment in Japanese clinical practice.

Introduction: Although the associations between lifestyle behavioral changes over time and the risks of cancer and cardiovascular diseases are documented worldwide, evidence specific to the Japanese population remains limited. This study aimed to elucidate the trajectories of lifestyle behaviors and their associations with health conditions.

Methods: We analyzed health checkup data from the Japan Medical Data Center Claims Database from 2005 to 2019, specifically those of individuals who underwent 10 consecutive annual checkups. We focused on smoking, frequency of drinking alcohol, and regular exercise habits as the exposure factors. A group-based trajectory model was employed to estimate the patterns of single and multiple trajectories for three exposures. Furthermore, a linear mixed-effects model was used to assess the association between trajectory patterns and longitudinal changes in health conditions (body mass index, systolic blood pressure [sBP], LDL-cholesterol, and HbA1c).

Results: This study included 51,064 Japanese subjects aged 20-59 years at their initial health checkup. We identified seven trajectory groups (Groups 1-7) that represented a high percentage of subjects in the following order: Group 3 (inactive, 31.0%), Group 5 (long-term smoking, 26.9%), and Group 2 (daily drinkers, 11.0%). The only lifestyle behavioral change observed was smoking cessation. Groups 3 and 5 exhibited higher sBP (Group 3: β = 1.18, standard error [SE] = 0.60, p = 0.05; Group 5: β = 1.33, SE = 0.61, p < 0.05) and LDL-cholesterol levels (Group 3: β = 3.80, SE = 1.36, p < 0.05; Group 5: β = 3.04, SE = 1.37, p < 0.05) than the nonsmoking, nondrinking, and regular exercise groups. Group 2 exhibited significantly high sBP (β = 2.43, SE = 0.62, p < 0.001), with an observed interaction effect over time (p < 0.05).

Conclusions: Regular exercise and abstinence from smoking and drinking may be essential to avoid deterioration of health conditions.

I have long harbored the impression that professors of clinical medicine specialties tend to produce fewer first-authored papers after their professorship appointments, despite their prior output of first-authored papers. This humble experiment attempted in providing some suggestions for this issue. I identified 11 chief professors of the obstetrics and gynecology departments of Japanese medical universities who were appointed professorships during 201X - 201X + 3 (covering 4 years). The numbers of PubMed-indexed first-authored papers were retrieved: 7-4 years prior (Period 1), 3-0 years prior (Period 2), and 1-4 years after (Period 3) their professorship appointments. 1) The "total" number of papers in Periods 1, 2, and 3 was 38, 33, and 4, respectively. 2) The "median" number of papers written by an individual professor in Periods 1, 2, and 3 was 3, 2, and 0, respectively. 3) "Annual average" paper numbers per person before (Periods 1 + 2) versus after (Period 3) was 0.81 ((38 + 33)/(11 persons × 8 years)) and 0.09 (4/(11 × 4))/person/year, respectively. I did the same for "corresponding-authored papers or last-authored papers." The results were as follows: 1) the "total" was 50, 74, and 143, respectively; 2) the "median" was 4, 5, and 7, respectively; and 3) the "annual average" was 1.41 versus 3.25/person/year. Thus, immediately after professorship appointments, the number of first-authored papers markedly decreased, although that of corresponding- or last-authored papers increased. The reason for this phenomenon may be multifactorial. However, societies should create an atmosphere where professors are relieved from excessive burdens and should be encouraged to engage in first-author paper writing as before if they desire. Societies want to hear professors' own voices which enrich academic discourse. Although the present experiment targeted only Japanese obstetrics and gynecology professors for a limited time, I hope to provoke some discussion regarding paper writing and professorship.

Introduction: Similar to other countries, in Japan, the demand for primary care pediatricians has increased due to the surge in pediatric allergic diseases, and with the change in a paradigm shift regarding the prevention of pediatric allergic disease in the last 20 years, they have had an increased need for retraining. To offer better support to children and their caregivers, educational needs for bridging the gap between knowledge and practice must be met. Therefore, we developed an educational program including practical and interactive approaches for pediatricians in 2012.

Methods: To evaluate the effectiveness of a 2-week program, behavioral changes, knowledge and skill improvements in clinical practice, and the satisfaction level of participants before and after the course were investigated. Kirkpatrick's four levels of training evaluation were employed to assess the educational effect. Seven years (April 2014 to March 2021) worth of results were assessed.

Results: A total of 65 pediatricians voluntarily participated in the program. Most of them were <40 years old and came from various regions of Japan. Results of pretraining and posttraining questionnaires in terms of their knowledge and skills on a four-point scale revealed significant improvements. Participants also reported their behavioral changes after 6 months of the course and evaluated the program's practicality. Each participant set new goals to be achieved in 6 months, and 36 (76.6%) of them set objectives for implementing oral food challenge tests.

Conclusions: The results revealed that the program not only enhanced their knowledge and skills for practice but also changed their behaviors toward clinical practice. In pediatric allergy, where community primary pediatricians have important roles to play, such an educational program should be further developed.

The most important purpose of medical meetings is to share knowledge with the audience. Medical meetings should be audience-friendly. The presenter and chairperson play crucial roles in these meetings. We wish to put forward some personal proposals to make meetings audience-friendly. For the presenter, state the conclusion or significance first (in the case of case presentation), cite a fundamental article only, and do not skip reading in the summary slide. For the chairperson, be a timekeeper, stop the presentation when there are important mistakes, and choose a question that illustrates the significance of the study and thus interests the audience. All the meeting participants should understand this and support audience-friendly meetings.