峰 友紗

type:text [要約] OECD（経済協力開発機構）による保育の質に関する議論の要点を整理し，特に低年齢児の保育の質に関する議論と，OECDが行った幼児教育・保育従事者調査の国際比較の結果を概観した。その結果，第一に，保育の質の中でも子どもに最も直接的に作用する質の側面として「プロセスの質」が注目されていること，低年齢児保育のプロセスの質として「互恵的で応答的な関係性」「ケアと教育の一体性」「乳児特有の発達ニーズ」「家庭との連携の重要性」が挙げられていた。第二に，プロセスの質の調査方法として，尺度等を用いた自己報告の質問紙調査，Situational Judgement Questionsによる質問紙調査，観察評定があり，それぞれの長短があることを確認した。観察評定だけでなく保育者の信念や認識も調べることの重要性も指摘された。第三に，国際比較調査から各国共通の特徴と日本独自の特徴があること，低年齢児保育ならではの特徴があることも示唆された。以上をふまえ，海外の低年齢児保育の質に関する取り組みに学ぶと同時に，我が国ならではの質の確保・向上のための取り組みが必要であることを考察した。

PURPOSE: To assess long-term premature mortalities in Japan for providing evidence of strategies for sustainable development in population health. METHODS: Descriptive study for observing the trends of premature mortalities due to 10 major causes and all-cause in Japan was conducted using governmental statistics taken between 2011 and 2019. Years of life lost (YLL) was calculated for each cause, and the trends of these were examined by joinpoint regression analysis. RESULTS: The means of YLL for all-cause through 2011 to 2019 were 8,121,565.1 in males and 6,743,198.4 in females. For each cause, the trends of age-standardized YLL were downward except for malignant neoplasm of pancreas and heart failure in males, and malignant neoplasm of pancreas, malignant neoplasm of breast, and age-related physical debility in females. One significant joinpoint for heart failure was found in males, and one significant joinpoint for each of malignant neoplasm of pancreas and age-related physical debility were found in females. CONCLUSIONS: Premature mortalities due to malignant neoplasm of pancreas in both sexes, heart failure in males and malignant neoplasm of breast in females were issues to be prioritized for promoting population health in Japan.

OBJECTIVES: On March 11, 2011, a magnitude 9 earthquake (the Great East Japan Earthquake) occurred off the east coast of Japan. After the Fukushima Daiichi Nuclear Power Plant accidents, as of 2016, people were not allowed to live in the 6 districts (Tomioka, Okuma, Futaba, Namie, Katsurao, Iidate) in Fukushima Prefecture. In the present study, we aimed to evaluate the long-term effects of displacement on all-cause mortality in Fukushima Prefecture. METHODS: Data regarding population and deaths from 2009 to 2016 in Fukushima Prefecture were obtained from the governmental statistics. The age-adjusted all-cause mortality were compared among the 4 areas in Fukushima Prefecture; the Eastern, Middle, Western, and Displacement areas. RESULTS: The age-adjusted all-cause mortality rates in the Eastern and Displacement areas were higher than in the other 2 areas from 2009 to 2011. During the period from 2012 to 2016, all-cause mortality in the Displacement area decreased to the lowest, while the morality in the Eastern area remained the highest. CONCLUSIONS: Against all expectations, after the earthquake, all-cause mortality in the Displacement area was continuously lower than in the rest of the Fukushima Prefecture. Following disasters, long-term monitoring should be organized to meet local health-care needs.

Considering the variety of stakeholders surrounding hospitals, hospital financial distress should be understood as a social issue, rather than just a matter involving the hospital owners. The present study aimed to assess Japanese hospital insolvency and related factors based on a nationwide financial dataset, and to identify indicators of the risk of insolvency. The legal financial reports used included a balance sheet and a profit-and-loss statement of hospitals owned by healthcare corporations, representing about 70% of all Japanese hospitals. This case-control study with descriptive analyses was conducted to clarify the financial status of healthcare corporations and to assess associations between specific factors and insolvency. Insolvency was found in 5.9% of healthcare corporations in 2016. Insolvency was significantly associated with operational income per sales (odds ratio, 0.16), and both short- and long-term borrowings per sales (odds ratios: 1.46 and 1.22 in this order). The present study found that 5.9% of Japanese healthcare corporations were insolvent, and hospital profitability and borrowing (both short- and long-term) could be key factors related to preventing hospital insolvency in Japan. To maintain sustainable healthcare services by hospitals, decision makers should consider the risk of insolvency, and balance the amount of borrowings against sales.

BACKGROUND: Unlike traditional East Asian medicine, the necessity of health care services for cold extremities is yet to be acknowledged in Western medicine. In this study, we aimed to conduct an epidemiological evaluation of this unremarkable symptom among women in Japan. MATERIALS AND METHODS: A cross-sectional study was conducted from February 2016 to April 2017, and data of 238 women throughout Japan were analyzed. Questionnaires were used to examine participants' demographics, health-related behaviors, health status, and frequency of subjective symptoms over the past 1 year. The association between cold extremities and other subjective symptoms was examined by the multiple logistic regression analysis. RESULTS: The prevalences of mild and severe cold extremities were 49.6% and 35.3%, respectively. Temperature and utilization of health care services were not significantly different by the severity of cold extremities. The accompanying symptoms that were significantly associated with the cold extremities were shoulder stiffness, fatigue, low back pain, headache, nasal congestion, itching, injury, and difficulty hearing. After multiple logistic regression analysis, low back pain (OR: 4.91) and difficulty hearing (OR: 4.84) kept the significance. Factors related to cold extremities including mental quality of life, sleep quality, and habitual drinking were significantly associated with other accompanying symptoms. CONCLUSION: Women with cold extremities have various accompanying symptoms and health-risk behaviors. Symptomatic treatment for cold extremities may not be sufficient, and comprehensive care would be required.

BACKGROUND: Although several studies have focused on the association between maternal smoking during pregnancy and rapid weight gain (RWG) during infancy, the dose-response relationship has not yet been confirmed, and very few studies have included Asian populations. Using a record-linkage method, we examined the association between maternal smoking during pregnancy and RWG in infants at around 4 months of age to clarify the dose-response relationship. METHODS: Two databases were used: maternal check-ups during pregnancy and early infancy check-ups (between April 1, 2013 and March 31, 2014 in Okinawa, Japan) were linked via IDs and provided to us after unlinkable anonymizing. For 10,433 subjects (5229 boys and 5204 girls), we calculated the change in infants' weight z-score by subtracting the z-score of their birth weight from their weight at early infancy check-ups. Smoking exposure was categorized into five groups. We used Poisson regression to examine the association of maternal smoking during pregnancy with RWG in early infancy. RESULTS: Overall, 1524 (14.6%) were ex-smoker and 511 (4.9%) were current smoker. Compared with the reference category of non-smokers, the adjusted risk ratio of RWG was 1.18 (95% confidence interval [CI], 1.06-1.32) for ex-smokers, 1.18 (95% CI, 0.93-1.50) for those who smoked 1-5 cigarettes per day, 1.57 (95% CI, 1.24-2.00) for those who smoked 6-10 cigarettes per day, and 2.13 (95% CI, 1.51-3.01) for those who smoked ≥11 cigarettes per day. There was a clear dose-response relationship. CONCLUSION: Our study suggests that maternal smoking during pregnancy is associated in a dose-dependent manner with increased risk of RWG in early infancy.