Estimates of hip fracture incidence in Japan using the National Health Insurance Claim Database in 2012-2015

Using the nationwide health insurance claims database, we found that the age-standardized hip fracture incidence rates in Japan indicated significant increase in males but no significant change in females during 2012-2015. The fracture risk in subjects aged 75-84 years indicated decrease in females but no change in males.

INTRODUCTION

Nationwide registry data on hip fractures have not yet been established in Japan. Using the newly developed National Database of Health Insurance Claims (NDB), which covers the entire Japanese population, we investigated the incidence rates of hip fractures and the associated regional differences. We also assessed the frequency of osteoporosis prescriptions, bone turnover marker (BTM) level, and bone mineral density (BMD) measurements.

METHODS

The annual numbers of hip fractures, osteoporosis prescriptions, and BTM level and BMD measurements by prefecture from 2012 to 2015 were obtained from NDB data. We calculated the standardized claims-data ratio (SCR) in each prefecture.

RESULTS

The age-standardized incidence rates from 2012 to 2015 indicated no significant change in females and significant increase in males (p value for trend; 0.920, 0.002, respectively). The fracture risk decreased in females aged 75-84 years and indicated no increase in females aged 85-89 years during 2012-2015, while the fracture risk indicated no change in males aged 75-84 years and increased in males aged 85-89 years. The frequency of osteoporosis prescriptions, BTM level measurements, and BMD measurements in the general population in the corresponding period increased with statistical or marginal significance in females and males. West-east regional differences were observed in the incidence rates; the highest SCR values in the western prefectures were approximately double the lowest values in the eastern prefectures.

CONCLUSIONS

The age-standardized hip fracture incidence rates indicated no significant change in females and significant increase in males in Japan from 2012 to 2015.

Utility of cervical length and quantitative fetal fibronectin for predicting spontaneous preterm delivery among symptomatic nulliparous women

OBJECTIVE

To validate the utility of fetal fibronectin (fFN) and cervical length (CL) in predicting preterm delivery among symptomatic nulliparous women.

METHODS

A retrospective cohort study of nulliparous women who presented with uterine contractions, abdominal pain, or cervical change at 21-34 gestational weeks at Fukushima Medical University Hospital, Japan, between 2008 and 2017. fFN (categorized as <50 ng/dL, 50-199 ng/dL, >200 ng/dL) and CL (≥15 mm or <15 mm) were evaluated simultaneously. Adjusted odds ratios (aORs) and confidence intervals (CIs) for preterm delivery before 37 or 34 weeks, and delivery within 28 or 14 days were calculated (references: fFN, <50 ng/dL; CL, ≥15 mm).

RESULT

Among 285 women who met the study criteria, CL less than 15 mm was a risk factor for preterm delivery before 37 (aOR, 4.1; 95% CI, 1.1-6.7) and 34 (aOR, 6.8; 95% CI, 2.3-20.2) weeks. fFN of 200 ng/dL or higher was a risk factor for delivery within 28 (aOR, 19.8; 95% CI, 4.3-90.2) and 14 (aOR, 10.8; 95% CI, 1.7-67.6) days.

CONCLUSION

Among symptomatic nulliparous women, short CL was found to be a risk factor for preterm delivery and higher fFN levels were related to short gestational latency.

The effect of the Great East Japan Earthquake on hypertensive disorders during pregnancy: a study from the Fukushima Health Management Survey

Objectives: This study aimed to assess the effects of the Great East Japan Earthquake on hypertensive disorder of pregnancy (HDP) in the Fukushima Prefecture.Methods: We used the results of the Fukushima Health Management Survey which targeted women who gave birth from 2011-2012. Pregnant women were divided into three groups according to their residential area during the disaster (affected, middle, and less-affected area), and four groups according to pregnancy trimester during the disaster (first, second, third trimester, or conception after the disaster). Adjusted odds ratio (aORs) for HDP of each residential area was calculated using logistic regression models, with pregnancy trimester during the disaster as references.Results: Overall, 8323 women participated in the study (affected area: 2207; middle area: 5183; and less-affected area: 933). For women living in the affected and middle areas in the third trimester, the disaster was a significant risk factor for HDP (aOR: 2.61, 1.02-6.66, aOR: 1.93, 1.10-3.40, respectively).Conclusions: To our knowledge, this is the first study to integrate patient residential areas and gestational age during the time of a disaster to estimate the risk of HDP. The third trimester of pregnancy at the time of the disaster was associated with HDP for the women living in the affected and middle areas. The knowledge of the data on disaster-related obstetrical complications can help obstetric care providers in a disaster area provide appropriate medical aid in an emergency.

Factors Associated With Intention of Future Pregnancy Among Women Affected by the Fukushima Nuclear Accident: Analysis of Fukushima Health Management Survey Data From 2012 to 2014

Background

Little is known about the association between the anxiety toward the effects of radiation on reproduction caused by the Fukushima nuclear accident and the birth rate of people in Fukushima. Therefore, we examined changes and associated factors of future pregnancy intention among mothers in Fukushima Prefecture.

Methods

Using data from three postal surveys among women who registered their pregnancies in the prefecture (N = 6,751 in 2012, N = 6,871 in 2013, and N = 6,725 in 2014), we analyzed the factors associated with women’s intention of future pregnancy using multivariable logistic regression models.

Results

The proportion of mothers with pregnancy intention increased from 53.5% in 2012 to 57.9% in 2014, especially among multiparas (P for trend <0.001). Factors inversely associated with pregnancy intention of both groups were older maternal age (adjusted odds ratio [aOR] 0.92 for primipara and 0.87 for multipara), poor subjective health (aOR 0.75 and 0.81, respectively), and presence of depressive symptoms (aOR 0.71 and 0.79, respectively) (P < 0.01 for all items). In addition, not living with husband (aOR 0.24), dissatisfaction with obstetrical care (aOR 0.89) and child abnormalities (aOR 0.72) were inversely associated with pregnancy intention among primiparas, while receiving infertility treatment (aOR 2.05) was positively associated among multiparas (P < 0.01 for all items). A separate analysis of 2012 and 2013 data showed that concern about radiation contamination of breast milk was associated with pregnancy intention among primiparas (aOR 0.61, P < 0.001).

Conclusions

Mothers’ concern about radiation was associated with lower pregnancy intention, especially among primiparas. Providing quality obstetrical and mental health care and parenting support may be the keys to maintaining the temporal increase in fertility.

The Japan Environment and Children's Study (JECS) in Fukushima Prefecture: Pregnancy Outcome after the Great East Japan Earthquake

Japan Environment and Children's Study (JECS) is nationwide birth cohort study that was initiated in January 2011 to investigate the effect of environmental factors on children's health. Soon after the JECS started, the Great East Japan Earthquake occurred on March 11, 2011, with subsequent nuclear accident at the Fukushima Daiichi Nuclear Power Plant, causing catastrophic damage in Fukushima Prefecture. After the disaster, JECS was relaunched to cover all areas in Fukushima Prefecture due to public concern. In this study, we used the results of individuals enrolled in JECS, who gave birth during 2011-2014 in Fukushima Prefecture, to elucidate pregnancy outcomes in Fukushima Prefecture. The study consisted of 12,804 maternal outcomes. We thus found that the prevalence rates of preterm birth < 37 weeks, low birth weight (LBW) < 2,500 g, and LBW < 1,500 g were 5.6 %, 9.5%, and 0.8%, respectively; these rates are in accordance with the National Vital Statistics of 2014. The proportion of major anomaly among the newborns was 1.7%, the value of which was lower than other epidemiological studies. This study also found that severe obstetrics outcomes, such as hypertensive disorder of pregnancy and placental abruption, were most frequently seen among teenage mothers with low socioeconomic status. A prefecture-wide birth cohort study following a large-scale disaster may provide valuable information for obstetric care providers and residents to improve obstetric and perinatal care for pregnant women after a disaster.

The Effect of Maternal Age at the First Childbirth on Gestational Age and Birth Weight: The Japan Environment and Children's Study (JECS)

BACKGROUND

In Japan, mean maternal age at first childbirth is increasing. The aim of this study was to investigate whether maternal age at the first childbirth is a risk factor for preterm birth (PTB), low birth weight (LBW), and small for gestational age (SGA).

METHODS

We used the results of Japan Environment and Children's Study (JECS) who gave birth in 2011-2014. Cases of primiparous singleton pregnancies where the subject was ≥20 years and delivered after 22 weeks were included. All subjects were categorized into five groups according to maternal age: 20-24, 25-29, 30-34, 35-39, and ≥40 years. Adjusted odds ratios (aORs) for PTB (before 37 and 34 weeks), LBW (<2,500 g and <1,500 g), and SGA were calculated using a logistic regression model, with the 20-24-year age group as reference.

RESULTS

We analyzed 38,412 singleton primiparous pregnancies. The aORs of all outcomes increased in parallel with each maternal age group >30 years. The aORs of PTB before 37 and 34 weeks, LBW <2,500 g, LBW <1,500 g, and SGA in the 30-34-year age group were 1.39 (95% confidence interval [CI], 1.16-1.67), 2.23 (95% CI, 1.45-3.41), 1.34 (95% CI, 1.18-1.53), 2.30 (95% CI, 1.35-3.94), and 1.24 (95% CI, 1.05-1.46), respectively.

CONCLUSION

The present study showed that higher maternal age (>30 years) at the first childbirth was an independent risk factor for PTB, LBW, and SGA.

Mild phenotypes associated with an unbalanced X-autosome translocation, 46,X,der(X)t(X;8)(q28;q13)

Unbalanced X-autosome translocation can result in various phenotypic manifestations. We present the first case of 46,X,der(X)t(X;8)(q28;q13) in a 34-year-old female with relatively mild manifestations, including congenital heart disease, epicanthal fold, mild intellectual disability, and menstrual irregularity. Our findings expand the known spectrum of unbalanced X-autosome translocations, for improved clinical management.

Evaluation of anticancer agents using patient-derived tumor organoids characteristically similar to source tissues

Patient-derived tumor xenograft models represent a promising preclinical cancer model that better replicates disease, compared with traditional cell culture; however, their use is low-throughput and costly. To overcome this limitation, patient-derived tumor organoids (PDOs) were established from human lung, ovarian and uterine tumor tissues, among others, to accurately and efficiently recapitulate the tissue architecture and function. PDOs were able to be cultured for >6 months, and formed cell clusters with similar morphologies to their source tumors. Comparative histological and comprehensive gene expression analyses proved that the characteristics of PDOs were similar to those of their source tumors, even following long-term expansion in culture. At present, 53 PDOs have been established by the Fukushima Translational Research Project, and were designated as Fukushima PDOs (F-PDOs). In addition, the in vivo tumorigenesis of certain F-PDOs was confirmed using a xenograft model. The present study represents a detailed analysis of three F-PDOs (termed REME9, 11 and 16) established from endometrial cancer tissues. These were used for cell growth inhibition experiments using anticancer agents. A suitable high-throughput assay system, with 96- or 384-well plates, was designed for each F-PDO, and the efficacy of the anticancer agents was subsequently evaluated. REME9 and 11 exhibited distinct responses and increased resistance to the drugs, as compared with conventional cancer cell lines (AN3 CA and RL95-2). REME9 and 11, which were established from tumors that originated in patients who did not respond to paclitaxel and carboplatin (the standard chemotherapy for endometrial cancer), exhibited high resistance (half-maximal inhibitory concentration >10 µM) to the two agents. Therefore, assay systems using F-PDOs may be utilized to evaluate anticancer agents using conditions that better reflect clinical conditions, compared with conventional methods using cancer cell lines, and to discover markers that identify the pharmacological effects of anticancer agents.

The change of fetal heart rate short-term variability during the course of histological chorioamnionitis in fetal sheep

OBJECTIVE

Histological chorioamnionitis (CAM) is related to neonatal mortality and morbidity. However, identifying intrauterine inflammation before delivery is challenging. The aim of this study was to investigate the changes in fetal heart rate (FHR) short-term variability (STV) during the course of histological CAM.

STUDY DESIGN

Changes in STV were measured in 7 chronically instrumented fetal sheep at 111-120 days of gestation. Lipopolysaccharide (LPS) was infused into the amniotic cavity for 2 days following the 4th postoperative day to develop histological CAM. STV was determined based on the R to R interval of the fetal electrocardiogram. We continued to observe the changes in STV until the time of intrauterine fetal death (IUFD). The umbilical cord and fetal membranes were evaluated histologically after IUFD. The experiment was divided into two phases: 1) the acute phase, defined as the 24-hour period between the first and second injections of LPS and 2) the perimortem phase, defined as the period between the second injection of LPS and IUFD. Changes in STV in both the acute and perimortem phases were evaluated using Friedman's test. A probability of <0.05 was accepted as statistically significant.

RESULTS

The fetuses died, on average, at 23.7 ± 4.9 h after the second injection of LPS. Both the umbilical cord and fetal membranes showed histological evidence of severe inflammation. During the perimortem phase, there were statistically significant differences in STV at each time point. STV increased significantly at 6, 4, and 3 h before intrauterine fetal death compared to the baseline.

CONCLUSION

Our study suggests that STV increased as the fetal condition deteriorated during the course of histological CAM.

Relevant obstetric factors associated with fetal heart rate monitoring for cerebral palsy in pregnant women with hypertensive disorder of pregnancy

AIM

The study identifies the relevant obstetric factors associated with fetal heart rate (FHR) monitoring for cerebral palsy (CP) in pregnant women with hypertensive disorders of pregnancy (HDP).

METHODS

The subjects were neonates with CP (birth weight ≥ 2000 g, gestational age ≥ 33 weeks) who were approved for compensation for CP by the Operating Organization of the Japan Obstetric Compensation System between 2009 and 2012. After selection of women with antepartum HDP, obstetric characteristics associated with FHR monitoring were analyzed.

RESULTS

The subjects included 33 neonates with CP whose mothers suffered from HDP during pregnancy and 450 neonates whose mothers did not develop HDP. The rates of placental abruption (48.5% vs. 20%; P < 0.001) and light-for-gestational age (12.1% vs. 2.2%; P = 0.011) were significantly higher in women with HDP than in those without HDP. Regarding FHR pattern analysis, fetal bradycardia was observed on admission to hospital in 94% of women with placental abruption. In women without placental abruption, FHR was likely to indicate a favorable pattern on admission, but became worse with the progression of labor.

CONCLUSION

This is first study to clinically demonstrate FHR patterns in CP cases in association with HDP. Although antepartum CP is undetectable, pregnant women with HDP should be placed under strict observation and management to minimize fetal hypoxic conditions during labor.

Factors Associated with Infant Feeding Methods after the Nuclear Power Plant Accident in Fukushima: Data from the Pregnancy and Birth Survey for the Fiscal Year 2011 Fukushima Health Management Survey

Objectives The objective of this study was to assess the frequency of and factors associated with infant feeding methods after the Fukushima nuclear power plant accident using data from the Fukushima Health Management Survey. Methods We conducted an anonymous self-administered questionnaire survey of 16,001 women who gave birth around the time of the Great East Japan Earthquake and registered their pregnancies at Fukushima Prefecture municipal offices between August 1, 2010 and July 31, 2011. The responses of 8366 women were analyzed. Chi square tests and multiple logistic regression analysis were used to compare various factors between women who had formula-fed their children because of concern regarding radioactive contamination or other reasons and those who had breastfed exclusively. Results The percentage of women who had breastfed exclusively was 30.9 %. The percentage of women who had both breastfed and formula-fed or formula-fed exclusively was 69.1 %, of which 20.3 % formula-fed because of concern regarding radioactive contamination of breast milk. The use of formula feeding because of concern about radioactive contamination was significantly higher in women who had resided within the evacuation area and those whose regular antenatal care had been interrupted. The use of formula feeding for other reasons was significantly higher in women who had resided within the evacuation area and lower for those who had willingly switched to another medical institution. Conclusions for Practice Our results suggest the importance of providing breastfeeding support to women who are forced to evacuate or whose antenatal care is interrupted after a disaster.

Unique Learning System for Uterine Artery Embolization for Symptomatic Myoma and Adenomyosis for Obstetrician-Gynecologists in Cooperation with Interventional Radiologists: Evaluation of UAE From the Point of View of Gynecologists Who Perform UAE

STUDY OBJECTIVE

To evaluate a unique learning system for uterine artery embolization (UAE) and examine its feasibility and clinical outcomes for the treatment of symptomatic uterine leiomyomas and adenomyosis when performed by obstetrician-gynecologists in cooperation with interventional radiologists (IVRs).

DESIGN

Retrospective study (Canadian Task Force classification II-2).

SETTING

University hospital.

PATIENTS

One hundred seventy-three patients who underwent UAE for symptomatic leiomyomas and adenomyosis.

INTERVENTIONS

We examined the medical records of patients who underwent UAE for symptomatic uterine leiomyomas and adenomyosis at our department between 2003 and 2012 using our learning system for UAE for obstetrician-gynecologists in cooperation with IVRs. The charts of all patients were reviewed, and data on etiologic factors, past medical history of leiomyomas and adenomyosis, symptoms, details of UAE, and clinical outcomes after UAE were extracted.

MEASUREMENTS AND MAIN RESULTS

A total of 173 patients who underwent 177 UAEs were identified, including 4 patients who underwent embolization twice because of primary treatment failure or symptom recurrence. During the study period, 2 gynecologists successfully acquired endovascular skills. The technical success rate was 97.7% (174 of 177). The duration of fluoroscopy in procedures performed by obstetrician-gynecologists who acquired endovascular skills was not significantly different from that in procedures performed by IVRs at our institution; however, this duration was significantly longer in procedures performed by obstetrician-gynecologists who did not have sufficient experience with our learning protocol for UAE because of inadequate live observation of UAEs performed by skilled IVRs. Complications that necessitated discontinuation of the procedure occurred in 2.3% of cases (4 of 177). The clinical outcomes were similar to those reported in previous studies. Adverse events after UAE included myeloid passages in 7.0% (11 of 158), infections in 2.5% (4 of 158), vaginal discharge in 2.5% of patients with leiomyomas (4 of 158), and vaginal discharge in 7.1% of patients with adenomyosis (1 of 14). All the adverse events were adequately treated by the obstetrician-gynecologists themselves. The timing of hysterectomy due to complications or recurrence of symptoms after UAE varied widely.

CONCLUSION

UAE performed by obstetrician-gynecologists in cooperation with radiologists can be achieved safely and successfully with acceptable clinical outcomes. Live observation of the procedure performed by skilled IVRs is essential to improving the skills and reducing the fluoroscopic time of obstetrician-gynecologists.

The Japan Environment and Children's Study (JECS) in Fukushima Prefecture-A progress report on the enrollment stage

The Japan Environment and Children's Study is an ongoing nationwide birth cohort study that is being conducted at 15 regional centers throughout Japan. The recruitment of subjects in the study area within Fukushima Prefecture, which includes Fukushima City, Minami Soma City and Futaba County, was begun on January 31, 2011 with the cooperation of the obstetrics and gynecology departments of local medical institutions. On March 11, soon after the start of recruitment, the Tohoku region was hit by an unprecedented disaster in the shape of the Great East Japan Earthquake, which was closely followed by the Tokyo Electric Power Company's Fukushima Daiichi Nuclear Power Plant accident. As a result of the disaster, the study area in Fukushima Prefecture was expanded on October 1, 2012 to include 59 municipalities across Fukushima Prefecture. Three points are seen as particularly important: 1) Radiation risk communication, 2) The motto is "Be attentive. Be supportive.", and 3) Establishing cooperating partnerships. With the cooperation of all concerned, the recruitment period ended on March 31, 2014. The tentative total number of the participants enrolled at the Fukushima Regional Center was 34,666 (13,134 pregnant mothers, 8,695 fathers and 12,837 children born before November 30, 2014 as of June 2016).

Influence of radiofrequency-electromagnetic waves from 3rd-generation cellular phones on fertilization and embryo development in mice

The purpose of this study was to evaluate the effects of 3rd-generation (3G) cellular phone radiofrequency-electromagnetic wave (RF-EMW) exposure on fertilization and embryogenesis in mice. Oocytes and spermatozoa were exposed to 3G cellular phone RF-EMWs, 1.95 GHz wideband code division multiple access, at a specific absorption rate of 2 mW/g for 60 min, or to sham exposure. After RF-EMW exposure, in vitro fertilization and intracytoplasmic sperm injection were performed. Rates of fertilization, embryogenesis (8-cell embryo, blastocyst), and chromosome aberration were compared between the combined spermatozoa and oocyte groups: both exposed, both non-exposed, one exposed, and the other non-exposed. Rates of fertilization, embryogenesis, and blastocyst formation did not change significantly across the four groups. Considering that the degree of exposure in the present study was ≥100 times greater than daily exposure of human spermatozoa and even greater than daily exposure of oocytes, the present results indicate safety of RF-EMW exposure in humans. Bioelectromagnetics. 38:466-473, 2017. © 2017 Wiley Periodicals, Inc.

From Devastation to Recovery and Revival in the Aftermath of Fukushima’s Nuclear Power Plants Accident

Japan’s earthquake, tsunami, and subsequent Fukushima nuclear power plant accident in March 2011 forced the evacuation of 185 000 residents. Psychological and social impacts exacerbated by long-term evacuation and widespread rumors have influenced residents’ physical and mental health, despite the fact that no direct fatalities occurred from radiation exposure. However, during the 5 years following the accident, steady recovery in industrial and economic activity has lessened previously widespread, deeply rooted stigma and self-stigma among a significant number of affected victims. More than 21 000 of 62 800 people who evacuated from Fukushima are gradually returning, and concurrently, Fukushima’s economic and social recovery are progressing, as can be seen from remarkable increases in residential construction, recovering agricultural production, job growth, and industrial output. Although post-disaster interventions such as seminars and dialogues with residents are credited with building resilience, a significant proportion of people in the area have depressive tendencies and loss of purpose.

The Fukushima Nuclear Accident Affected Mothers’ Depression but Not Maternal Confidence

The Fukushima nuclear power plant accident caused widespread radiation contamination. Mothers of young children were at risk of negative emotional and mental health consequences. Using data from 2 independent prefecture-wide surveys of pregnant women, we examined the associations of disaster-related stressors with both maternal self-confidence and depressive symptoms. Two postal surveys were conducted targeting women who registered their pregnancies in Fukushima Prefecture (n = 6686 in 2012 and n = 6423 in 2013). The proportions of mothers with lower self-confidence in child rearing and with depressive symptoms were 53% and 25% in 2012 and 55% and 24% in 2013, respectively. After adjusting for maternal and infant characteristics, evacuation and concern about radiation were significantly associated with depressive symptoms but not lower maternal confidence, although these 2 outcomes were significantly associated. Mothers in Fukushima showed resilience in parenting, whereas their experiences and concerns in the aftermath of nuclear disaster were associated with depressive symptoms.

Pregnancy and Birth Survey of the Fukushima Health Management Survey

The Pregnancy and Birth Survey was started by Fukushima Medical University as part of the Fukushima Health Management Survey in 2011 in order to assess the physical and mental health of mothers and provide parenting support (telephone counseling) for those in need. The present study reviewed the major findings from 4 annual surveys conducted from 2011 to 2014. Overall proportions of preterm deliveries, low birth weight infants, and congenital anomalies in the first year were almost the same as those in national surveillance data. The prevalence of depressive symptoms among the mothers held steady at about 25% over the 4 years. Regarding the content of parenting counseling, the proportion of mothers who voiced concerns about radiation decreased each year. This survey should be continued to provide support to mothers in Fukushima.

Fukushima Mothers’ Concerns and Associated Factors After the Fukushima Nuclear Power Plant Disaster

This study aimed to clarify the frequency of and temporal changes in the content of mothers’ free written opinions obtained in the Fukushima Health Management Survey Pregnancy and Birth Survey from 2011 to 2013. A self-administered questionnaire was mailed to women who delivered babies in Fukushima Prefecture. The questionnaire asked about maternal and child health. Expression of mothers’ concerns about radiation decreased over time. Common to the top 5 codes across the 3 years were “radiation effect on fetus and infant” and “information provision including survey results.” Participants who wrote free opinions were significantly more likely to be aged ≥30 years and to have depressive symptoms. Our descriptive analysis of the qualitative data showed a clear shift in mothers’ concerns from radiation-related issues to their own physical and mental health. Mothers who expressed concerns were more likely to report negative physical and mental health.