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Safe obstetric care is a worldwide requirement. In Japan, a reduced number of obstetricians has prompted the centralization of obstetric facilities, and Japan's islands are expected to experience problems in handling deliveries. Although many pregnant women "move" to the mainland at later gestational weeks, "transport" from the island to the mainland may be occasionally needed when disorders manifest before the "move." Other women plan within-island deliveries; however, transport is required when complications arise. Managing delivery- or pregnancy-related problems may differ in transport by the population size of islands. We investigated the following issues in relation to the population size of Japan's islands: 1) How were deliveries handled on islands? 2) How many pregnant women were transported to the mainland? 3) What was the reason for and what affected transport? A total of 142 municipalities were selected to participate in a questionnaire survey, and 108 institutions from 106 municipalities responded. A comparative analysis by island size was performed using 2014 data: small-sized (population < 1,000), mid-sized (1,000 to 5,000), and large-sized (≥ 5,000). The percentage of women transported to the mainland from small-sized islands was significantly higher than that from large-sized islands (6.8 vs. 2.6% of all births in a year, respectively, P < 0.01). Transport was mainly in response to threatened preterm labor. Adverse weather was the most frequent factor affecting transport reliability. Our findings may contribute to a more detailed understanding of the state of obstetric care on Japan's islands.

Elucidating the perceptions of residents regarding medical group practice (GP) among rural communities (GP-R) in Japan will be useful for establishing this system in such communities. A survey by questionnaire, as made by experts in rural health, was conducted in 2017. The self-administered questionnaire inquired about the perceptions of residents for accepting the GP-R into the community's healthcare using seven major elements of GP-R. The questionnaire was randomly distributed to 400 adult residents who lived in rural communities with a recently launched GP and had access to clinics within the communities. Among the 321 respondents, comparisons were made between younger (≤sixties) and older (≥seventies) residents, and a stepwise multiple regression analysis was performed to extract the factors influencing acceptance of the GP-R system. The results showed that older residents had a greater disapprove of being treated by different physicians daily or weekly in clinics ( p < 0.001) and the use of telemedicine ( p < 0.001) compared with younger residents. Younger residents showed a greater disapproval of clinics closing on weekdays than older residents ( p = 0.007). Among all respondents, regardless of age groups, over half of residents approved of the involvement of nurse practitioners in the GP-R. Living with family and children was also extracted as an independent factor influencing a positive perception of the GP-R. These data suggest that the promotion of GP-R should consider generation gaps in the approach to medical practice as well as the family structures of residents. The involvement of nurse practitioners can also encourage the acceptance of GP-R in Japan.

Objectives　To reveal the features of death and subsequent funeral services, we analyzed self-reported obituaries in The Shimotsuke, a local daily newspaper in Tochigi, Japan. In addition, the usefulness and disadvantages of such a database of deaths based on the obituaries were discussed.Method　For a 5-year period, from January 2011 through December 2015, all the obituary columns in The Shimotsuke were computerized as a database and analyzed. Some results were compared with the vital statistics data in the corresponding period of time. Data analyzed were: dead persons' address (municipalities), name, sex, cause of death, age at death, date of death and funeral services, the chief mourner (Moshu), and so on.Results　During the observed 5-year period, 69,793 deaths appeared in the columns, which were 67.6% of the all deaths in the vital statistics. No difference was observed in the proportions between the sexes in the published deaths in comparison with the vital statistics. In both sexes, the proportion was low in 0-9 years old, then high among 10-19 years, decreasing in 20s, and after then the proportion increased according to the age. The proportion was low in city areas, such as Utsunomiya and Oyama, and high in some cities and towns in the northern or eastern parts of Tochigi prefecture. The highest was in Motegi Town (88.0%), and the lowest was Nogi Town (38.0%), which is located in the southern-most part of the prefecture and is closest to the Tokyo metropolitan area. Almost all the funeral services were conducted within a week of the death, and no delays were observed to have been caused by the short supply of cremation services, which exists in large cities in Japan. In case where the chief mourner was a child, a parent, or a spouse of a child, the male sex was dominant. Analyses of death from senile decay, suicide, and homicide indicated that the accuracy of the published cause of death was low. The date of the funeral services was strongly influenced by superstitions in this country.Conclusions　Observations of the self-reported obituaries in a local daily newspaper over five years revealed the situations of the deaths in the area that could not be observed using vital statistics. Despite limitations, the information was partially useful as a database.

Background: The number of patients and incidence rate of Kawasaki disease (KD) are increasing in Japan. We have therefore characterized the latest epidemiological information on KD., Methods: The 22nd nationwide survey of KD, which targeted patients diagnosed with KD in 2011 and 2012, was conducted in 2013 and included a total of 1983 departments and hospitals. In order to report on all patients with KD during the 2 survey years, we targeted hospitals of 100 beds or more with pediatric departments, or specialized pediatric hospitals., Results: From a total of 1420 hospitals and departments (71.6% response rate), 26,691 KD patients were reported (12,774 in 2011 and 13,917 in 2012; 15,442 males and 11,249 females). The annual incidence rates were 243.1 per 100,000 population aged 0 to 4 years in 2011 and 264.8 in 2012. The number of cases of KD recorded in 2012 was the highest ever reported in Japan. The incidence rate of complete cases was also the highest ever reported in Japan and contributed to the increase in the rate of total cases in recent years. The number of patients diagnosed per month peaked in January, and additional peaks were noted during summer months, although these peaks were lower than those seen in winter. Age-specific incidence rate showed a monomodal distribution with a peak in the latter half of the year in which patients were born., Conclusions: The number of patients and the incidence rate of KD in Japan continue to increase. A similar trend has also been seen for patients with complete KD.

Background: The long-term outcomes of Kawasaki disease (KD) are unknown., Methods: Fifty-two collaborating hospitals collected data on all patients who had received a new definite diagnosis of KD between July 1982 and December 1992. Patients were followed until December 31, 2009 or death. Standardized mortality ratios (SMRs) were calculated based on Japanese vital statistics data., Results: Of the 6576 patients enrolled, 46 (35 males and 11 females) died (SMR: 1.00; 95% CI: 0.73-1.34). Among persons without cardiac sequelae, SMRs were not high after the acute phase of KD (SMR: 0.65; 95% CI: 0.41-0.96). Among persons with cardiac sequelae, 13 males and 1 female died during the observation period (SMR: 1.86; 95% CI: 1.02-3.13)., Conclusions: In this cohort, the mortality rate among Japanese with cardiac sequelae due to KD was significantly higher than that of the general population. In contrast, the rates for males and females without sequelae were not elevated.

Objectives: The purpose of this study was to examine the epidemiological features of self-injury in Japan, and to investigate the factors associated with a history of self-injury, using nationwide random sample data on Japan in 2010., Methods: Questionnaires were distributed to 2,693 subjects, aged 16-49 years, randomly selected from the all over Japan using 2-stage stratified random sampling; the answers regarding self-injury were analyzed. Potential risk factors were compared between those who answered that they had a history of self-injury (self-injury group) and those who answered that they did not (non-self-injury group)., Results: Responses were obtained from 1,540 participants (response rate, 57.2%). Lifetime prevalence of having 1 or more self-injury events was 7.1% overall (3.9% for men; 9.5% for women) and approximately half of them reported a repetitive history of self-injury. Lifetime prevalence of self-injury was highest in those aged 16-29 years (9.9%, 16-29 years; 5.6%, 30-39 years; 5.7%, 40-49 years). Lifetime prevalence among women (16-29 years, 30-39 years, and 40-49 years) decreased with age (15.7%, 7.5%, and 5.8%, respectively), however, that among men increased with age (3.0%, 3.4%, and 5.5%, respectively). Compared with the non-self-injury group, those in the self-injury group were significantly more likely to have a history of cigarette smoking (self-injury group, 47.5%; non-self-injury group, 28.2%; adjusted odds ratio [95% confidence interval]: 2.18 [1.32-3.58]), childhood abuse (23.6% and 3.7%, respectively, 4.24 [2.18-8.25]), induced abortion (30.3% and 12.7%, respectively, 1.93[1.13-3.30]); moreover, they were significantly less likely to answer that they had a happy life when they were junior high school students (41.1% and 78.6%, respectively, 0.45 [0.25-0.79]). In addition, those in the self-injury group were more likely to report a history of parental divorce, that they did not have good communication with their parents, and that they did not have respect and appreciation for their parents; however, these factors were not significant after adjustment., Conclusion: These results are consistent with those of previous research reports in which the lifetime prevalence of self-injury was high among women aged 16-29 years, and in which self-injury was more likely to occur among individuals who had a history of cigarette smoking and childhood abuse. Such individuals should be provided care to prevent self-injury. In addition, from a social point of view, research examining family environments including these factors is required.

Facioscapulohumeral muscular dystrophy (FSHD) is an autosomal dominant muscular disorder in which the disease locus has been mapped to chromosome 4q35-qter. In most patients, the DNA rearrangements associated with FSHD have been found in the EcoRI fragment detected by the p13E-11 probe, and deletions of the 3.2 kb repeat units within the fragment are thought to cause the disease. To examine FSHD-associated DNA rearrangements in the Japanese population, we performed Southern blot analysis of the genomic DNA, using the p13E-11 and pFR-1 probes, in 158 Japanese individuals, including 38 FSHD patients from 19 families. We found that all but one (a possible affected recombinant) of the Japanese FSHD patients (97.4%) had specific smaller (< 28 kb) EcoRI fragments which cosegregated with the disease; this included four patients who had severe inflammatory changes in the muscle and eight patients with de novo DNA rearrangements. We found no FSHD patient who had a fragment larger than 28 kb. By contrast, only two of 35 Japanese controls (5.7%) had EcoRI fragments smaller than 28 kb. Our patients showed anticipation, i.e. decreased size of the EcoRI fragment in parallel with earlier onset of the disease (r = 0.531, P = 0.003, with younger age at onset in children (17.8 +/- 7.0) than their affected parents (31.5 +/- 14.8) (P = 0.019). However, since each family had a specific small EcoRI fragment associated with the disease, the differing clinical severity within a family cannot be explained by the size of the fragment alone.(ABSTRACT TRUNCATED AT 250 WORDS)