阿江 竜介

目的 全国的な疫学調査である「第5回 男女の生活と意識に関する調査」のデータをもとに、わが国の自傷行為についての統計解析を行い、自傷経験に関連する要因を明らかにする。方法 全国から層化二段無作為抽出法を用いて選出された2,693人に調査票を配布し、自傷経験に対する回答の解析を行った。自傷経験があると答えた群(以下、自傷群)とないと答えた群(以下、非自傷群)の2群間で比較を行った。結果 1,540人(回収率57.2%)の対象者が回答した。全体の7.1%(男の3.9%、女の9.5%)に少なくとも1回以上の自傷経験があり、男女ともに自傷経験者の約半数が反復自傷経験者であった。16-29歳における自傷経験率が9.9%と最も高く、30-39歳、40-49歳はそれぞれ5.6%、5.7%とほぼ同等であった。男女別では、年齢階級別(16-29歳、30-39歳、40-49歳)で、女はそれぞれ15.7%、7.5%、5.8%と若年ほど自傷経験率が高く、男は3.0%、3.4%、5.5%と若年ほど低かった。群間比較では、喫煙者(自傷群47.5%、非自傷群28.2%、調整オッズ比[95%信頼区間]:2.18[1.32-3.58])、虐待経験者(23.6%、3.7%、4.24[2.18-8.25])、人工妊娠中絶経験者(30.3%、12.7%、1.93[1.13-3.30])の割合が自傷群で有意に高く、中学生時代の生活が楽しかったと答えた者(41.1%、78.6%、0.45[0.25-0.79])は有意に低かった。調整後有意差は認めなかったが自傷群では、すべての性・年齢階級において、両親の離婚を経験した者、中学生時代の親とのコミュニケーションが良好ではなかったと答えた者、親への敬意・感謝の気持ちがないと答えた者の割合が高い傾向を認めた。結論 多くの先行研究と同様に、自傷経験率は16-29歳の女で高く、また、喫煙者や虐待経験者で自傷経験率が高いことが示された。自傷行為の予防には、これらに該当する者に対して重点的にケアを提供する必要がある。また、社会的な観点から言えば、これらの要因を持つ家庭環境についても、今後明らかにしていく必要があろう。(著者抄録)

Background: When analyzing regional disparities in healthcare resources, hospital accessibility is given little consideration. We surveyed accessibility from residential districts to medical institutions using GIS (Geographic Information System) and estimated Gini coefficient for each hospital distribution.<br>Methods: The subjects were 2,688 census mesh blocks ( "Cho-cho-aza" ) and 109 hospitals in Tochigi prefecture. The number of hospitals located within the road distances of 5 km, 10 km and 15 km from the geometrical center of each block was calculated using GIS. The Gini coefficient of each hospital per 100 residents was calculated among the regions located within 5 km, 10 km and 15 km from the geometrical center of the census mesh block.<br>Results: The population of each block was 748±1,067 (mean±SD), and the road distance to the nearest hospital from the center of each block was 4.3±4.5 km. The number of census mesh blocks with distances from the center of each block to the nearest hospital within 5 km, 5-10 km, 10-15 km and more than 15 km were 1909 (71.0%), 561 (20.9%), 139 (5.2%) and 79 (2.9%) respectively. The number of hospitals located within 5 km, 10 km and 15 km were 3.3±4.7, 8.3±8.6 and 14.4±11.4. Gini coefficients were 0.65, 0.52 and 0.43.<br>Conclusion: When analyzing regional disparities in healthcare resources, it is necessary to take into account not only the number of physicians and beds, but also accessibility. Gini coefficient is useful to estimate geographical distributions, and can be used as an indicator for improvement projects for hospitals.

PURPOSE: Overweight or obesity is a known risk factor for cesarean delivery although there is minimal data among Japanese women. The aim of the study was to examine the effect of prepregnancy body mass index (BMI) on singleton cesarean delivery among term nulliparous women using a national sample from the Human Milk Survey. METHODS: Data from the Human Milk Survey between 1998 and 2008 were used for the secondary analysis. Women were categorized as underweight (BMI < 18.5 kg/m(2)), normal weight (18.5 ≤ BMI < 25.0), or overweight (BMI ≥ 25.0) based on their prepregnancy BMI. The association between maternal prepregnancy BMI and cesarean delivery was assessed using logistic regression models. RESULTS: A total of 915 women were included in the analysis. The proportion of cesarean section was 10.1%. Overall, 17.1% of the women were underweight while 6.0% were overweight. After adjusting for maternal age, smoking status, pregnancy complications, and infant birthweight, overweight women were 2.7 times more likely to have a cesarean delivery compared to normal weight women (adjusted odds ratio [adjusted OR] = 2.7, 95% confidence interval [CI] = 1.4-5.4), and underweight women were half as likely to have a cesarean delivery compared to normal weight women (adjusted OR = 0.5, 95% CI = 0.2-1.1). CONCLUSIONS: Being overweight before pregnancy more than doubled the risk of cesarean delivery independent of age, smoking, pregnancy complications, and infant birthweight among term nulliparous women. Overweight Japanese women should be advised to achieve normal prepregnancy BMI in their preconception period to prevent cesarean delivery.

Objectives : To determine factors related to peoples' preference for visiting home-doctors when experiencing new health problems.<br>Method : A questionnaire survey was conducted of people receiving annual health checkups in municipalities in the vicinity of Jichi Medical University Hospital. We surveyed personal characteristics, test equipment, having of a home-doctor, and answers to an assumed scenario (asking about willingness to visit a home-doctor in case of getting certain health problems).<br>According to the responses to the scenario, we divided the subjects into two groups (a home-doctor group: visiting a home-doctor; and a specialist group: not visiting a home-doctor) and statistically compared the two groups.<br>Results : In the analytic sample of 1,829, the home-doctor group numbered 1,097 individuals (60%) and the specialist group numbered 732 individuals (40%). The home-doctor group statistically had more home-doctors than the specialist group (adjusted odds ratio, 95% confidence interval: 2.47, 2.00-3.05).<br>More home-doctors in the home-doctor group had test equipment than home-doctors in the specialist group: Gastrointestinal test equipment (gastroscopy, colonoscopy, or ultrasonography) (adjusted odds ratio, 95% confidence interval: 1.39, 1.06-1.83).<br>Conclusion : We revealed two factors relating to the preference for visiting home-doctors: First, those people had home-doctors, and, second, the home-doctors had test equipment.

プライマリ・ケア(PC)医の養成と充足は、わが国だけでなく諸外国でも同様に喫緊の課題として認識されている。しかし、研修医がPC医への進路を選択する意思決定に、どのような医学教育が影響を与えているかは明らかにされていない。そこで我々は、後期研修医が将来のキャリアとしてPC医を目指す進路志向に関連する要因を検討した。・無作為に選出された281の臨床研修指定施設のうち137施設(48.8%)が回答した。卒業後3年目または4年目の後期研修医724人を対象に自己記入式質問紙調査を実施し、将来のキャリアとしてPC医を志向する群(n=175、24.2%)と専門医を志向する群(n=549、75.8%)についての比較を行った。・さらに、卒前に将来のキャリアとして専門医を志向していた者(n=442、61.1%)の中で、初期研修後にPC医への進路志向に変化した群(n=33、7.5%)と変化しなかった群(n=409、92.5%)についての比較を追加した。・卒前からPC医への進路を志向していた者(調整オッズ比(95%信頼区間):9.85(6.24-15.5))、現在(後期研修中に)PC医として勤務している者(7.58(4.92-11.7))、将来へき地勤務を希望する者(2.24(1.36-3.68))が、将来のキャリアとしてPC医を有意に志向する傾向があった。・卒後にへき地での研修を体験した後期研修医は、将来の進路志向が専門医からPC医に変化する傾向があった(粗オッズ比(95%信頼区間):2.18(1.05-4.49))。卒後のへき地体験は、研修医の進路志向の変化に影響を及ぼすことが示唆された。・へき地での研修を組み入れた卒後のPC教育は、将来のPC医の養成と充足に効果的に寄与する可能性がある。(著者抄録)

BACKGROUND: Although regular nationwide surveys of Kawasaki disease (KD) are conducted in Japan, there is no system for detecting the real-time epidemic status of this disease. METHODS: A web-based surveillance system for KD was developed. After consideration of the number of patients reported by prefecture to the 19th nationwide survey, 355 pediatric departments were asked to participate in the surveillance, and 225 agreed. Since January 2008, pediatricians in these 225 hospitals have reported KD patient data immediately after diagnosis. The daily numbers of patients are available to the public via the internet at http://www.kawasaki-disease.net/kawasakidata/. The validity of the data in 2008 was evaluated using the Japanese 20th nationwide survey of KD as the gold standard. RESULTS: A total of 3376 patients were reported to the web-based surveillance system from the 1st week through 52nd week of 2008. The number of patients reported to the nationwide survey during the same period was 11 680: a total of 4950 patients from the hospitals participating in the web-based surveillance and 6730 from other hospitals. The epidemic curves were similar, and the correlation coefficient between the web-based surveillance and the total numbers in the nationwide survey was 0.806 (P < 0.01). CONCLUSIONS: The web-based surveillance system for Kawasaki disease in Japan demonstrated good validity.