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Laparoscopic sacrocolpopexy (LSC) is attracting increasing attention as a minimally invasive surgery that provides excellent therapeutic effects on apical vaginal prolapse. However, its therapeutic effects on multi-compartmental pelvic organ prolapse (POP) remain unclear. Therefore, the aim of this review was to evaluate the efficacy of LSC on multi-compartmental POP compared with abdominal sacrocolpopexy (ASC). We extracted three articles on randomized controlled trials that compared LSC and ASC. A total of 247 patients (123 for LSC, 124 for ASC) were evaluated. There was no evidence of recurrence or reoperation in either group for the apical vaginal compartment. Regarding recurrence within the anterior vaginal compartment, there were no significant between-group differences in either of the two randomized controlled trials targeting vaginal vault prolapse. In contrast, in the randomized controlled trial targeting POP including cases with uteruses, there were more recurrent POP with grade II or more in the LSC group than in the ASC group (11/60 [18.3%] vs 1/60 [1.6%], P = 0.004). Reoperation for the posterior vaginal compartment was performed in three cases (2.5%) in the LSC group and in one case (0.8%) in the ASC group. The combined repeat surgery and mesh removal surgery rate was higher in the LSC group (8/119 [6.7%]) than in the ASC group (2/121 [1.7%], P = 0.049). LSC has an excellent therapeutic effect and is comparable to ASC for the treatment of apical prolapse. However, cystocele recurrence, repeat surgery of the posterior compartment, and mesh-related complications were more frequent in patients who had undergone LSC.

Objective To describe the circumstances of burn injury occurrence among Mongolian children and the products involved. Methods Study participants were children aged 15 years and younger who were admitted to the Burn Unit of the National Trauma Orthopedic Research Center from August 2015 to July 2016. We collected data on participant demographics and the aetiology and clinical features of their burn injuries, and we analysed the data based on the NOMESCO Classification model. Findings Of 906 children, 83% were aged 0–3 years, 66% were injured around the cooking area in the traditional tent‐like dwelling called a ger or a detached house where no specified kitchen exists, and 28% were injured in a kitchen. Burn injuries resulted mostly from exposure to overflowing hot liquids (93%). Electric pots and electric kettles were the products most frequently involved in causing burn injuries (41% and 14%, respectively). Of 601 major burn injuries, 52% were due to electric pots. Moreover, burn injuries inflicted by electric pots were most likely to be major burn injuries (83%). Children typically fell into electric pots, while electric kettles were often pulled down by children. Conclusion Burn injuries among Mongolian children mainly occurred in cooking area of a ger involving electric pots. The current practice of cooking on the floor should be reconsidered for child burn prevention.

Study Objective The objective of this study was to develop a novel morphological classification for Douglas fossa obliteration in endometriosis. Design Retrospective study. Setting Nippon Medical School Hospital. Patients or Participants 29 patients with endometriosis. Interventions On the basis of the recently revealed clinical knowledge of the membrane structure of the Douglas fossa and the anatomical information derived from cadaveric dissection, a hypothetical model of the normal Douglas fossa was established. This was used to examine past surgical videos (n = 29 cases) to evaluate the patterns that exist in Douglas fossa obliteration in endometriosis. Measurements and Main Results The recto–vaginal fascia that constitutes the front of the Douglas fossa has a wing-shaped structure, with the upper edge of the wing corresponding to the uterosacral ligaments (USLs). The tip of the wing is bifurcated (a λ-type structure), and the inside is connected to the rectum to form the upper part of the rectal lateral ligament. The outer side comprises the fusion surface between the peritoneum and the underlying ureterohypogastric fascia. Results The patterns of the Douglas fossa obliteration could be classified into six types: 1: normal, 2: upper peripheral lesion type, 3: lateral displacement type (right or left), 4: forward displacement type, 5: median elevation type, and 6: diffuse median elevation type (frozen pelvis); furthermore, in terms of proportions, there were 2 (7%), 8 (28%), 6 (20%), 1 (3%), 7 (24%), and 6 (21%) cases of each type, respectively. In the median elevation type, the left and right USLs and lateral ligaments were extremely shortened, the uterus and rectum were completely attached, and the Douglas fossa was completely closed. Conclusion The cases that showed complete occlusion of the Douglas fossa were either the median elevation type or the diffuse median elevation type.

Study Objective To investigate the accuracy and clinical value of a new adhesion scoring system using transvaginal ultrasonography for endometriosis. Design Prospective observational study. Setting Nippon medical school hospital, Tokyo, Japan. Patients or Participants 131 patients with endometriosis who underwent surgery at Nippon medical school Hospital. Interventions Before surgery, transvaginal ultrasonography and adhesion mapping were performed to determine the presence or absence of adhesions at 10 sites of the pelvis. Measurements and Main Results To determine the severity of pelvic adhesions, we developed an adhesion score (0-10). With the adhesion score, we assessed the effect of surgical adhesiolysis and evaluated the relationship between postoperative adhesions and infertility.Results: Of the 10 sites assessed for adhesions, the most frequent site of adhesions was the site between the left ovary and the uterus (70.5%). The overall sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio, and accuracy of adhesion mapping were 80.4%, 86.1%, 78.8%, 87.2%, 5.79, 0.23, and 83.9%, respectively. The adhesion score in this system was significantly correlated with the adhesion-related score in the r-ASRM classification (R2 = 0.734). Surgical adhesiolysis yielded only about 30% improvement postoperatively. The adhesion score in the non-in vitro fertilization (IVF) pregnancy group was significantly lower than that in the IVF pregnancy group (3.45 vs. 5.00; p = 0.04). Conclusion Our adhesion scoring system allowed an accurate prediction of the pelvic adhesion status and may potentially be an indicator of postoperative adhesions and infertility.

Heated tobacco products (HTPs) were first introduced to the Japanese market in 2014, as a less harmful alternative to cigarettes.1 Since then, HTPs quickly gained popularity. In 2019, 27% and 8% of men and women, respectively, were current smokers; among whom, 20% of both men and women used HTPs exclusively, and 7% and 5% of men and women, respectively, used both HTPs and conventional cigarettes.2 The sales share of HTPs in 2019 was 24% of tobacco products.3 To understand how the tobacco industry has increased market share of HTPs so shortly in Japan, we examined the recent trend of tobacco advertising in newspapers and magazines. It is noted that Japan is a Party to the WHO Framework Convention on Tobacco Control, but tobacco ads …

Objective: We evaluated the association between prehospital epinephrine administration by emergency medical services (EMS) and the long-term outcomes of out-of-hospital cardiac arrest (OHCA) with initial pulseless electrical activity (PEA) or asystole. Methods: We conducted a controlled, propensity-matched, retrospective cohort study by using Japan's nationwide OHCA registry database. We studied 110,239 bystander-witnessed OHCA patients aged 15–94 years with initial non-shockable rhythms registered between January 2008 and December 2012. We created 1–1 matched pairs of patients with or without epinephrine by using sequential risk set matching based on time-dependent propensity scores to balance the patients' severity and characteristics. We compared overall and neurologically intact survival 1 month after OHCA between cases and controls using conditional logistic regression models by category of the initial rhythm. Results: Propensity matching created 7,431 pairs in patients with PEA and 8,906 pairs in those with asystole. Epinephrine administration was associated with higher overall survival (4.49% vs. 2.96%; odds ratio [OR], 1.55; 95% confidence interval [CI], 1.30–1.85) but not with neurologically intact survival (0.98% vs. 0.78%; OR, 1.26; 95% CI, 0.89–1.78) in patients with PEA, and with higher overall survival (2.38% vs. 1.04%; OR, 2.34; 95% CI, 1.82–3.00) and neurologically intact survival (0.48% vs. 0.22%; OR, 2.28; 95% CI, 1.31–3.96) in those with asystole. Conclusions: Prehospital epinephrine administration by EMS is favorably associated with long-term neurological outcomes in patients with initial asystole and with long-term survival outcomes in those with PEA.

This study investigated whether the availability of transportation alternatives for older drivers is a determinant of the decision to cease driving. We recruited participants from a total of 7827 drivers aged 69 years or older living in Ibaraki Prefecture, Japan who were scheduled to renew their driving license between February and April 2011. In November 2010, we distributed questionnaires to collect data on predictors of driving cessation, and again in December 2012 to determine who had actually ceased driving. The relative impacts of factors related to driving cessation were then estimated. Of the 3089 respondents, 157 did not renew their license. The strongest determinants of this decision were having been advised to stop driving and if they had developed less confidence in their ability to drive safely. Even so, respondents were far more likely to have actually stopped driving if they were sure that someone else was available to provide a ride when they needed one. The final decision to stop driving is strongly influenced by personal convenience based on private transport, especially amongst drivers who have been advised to stop. The availability of public transport alternatives is not as important a factor in this decision.

To investigate mobile phone use while driving among student motorcyclists in Laos, we conducted a school-based questionnaire survey in central Vientiane in May 2014. Of the 883 high school students who reported to drive motorcycles at least once a week, 40% have ever used phones while driving motorcycles in both sexes. Those phone users had longer driving exposures than non-users, with about half engaging in phone use while driving at least 2 days a week and 70% engaging for 1 min or longer on an average day. They reported not just talking on the phone while driving but operating the phone such as dialling and text-messaging. In some instances, phone use was reportedly involved in their past crash experiences. To formulate a sound policy on this emerging distracting behaviour among motorcyclists, its contribution to the occurrence of overall crashes among motorcyclists should be investigated.

Background To deal with the increasing number of motor vehicle collisions (MVCs) among older drivers, a cognitive test has been introduced to a license renewal procedure for drivers aged ≥75 years since June 2009. This might have prompted the reduction or cessation of driving by older drivers. We therefore examined whether older drivers’ chance of experiencing MVCs as unprotected road users has increased after the test was introduced. Methods Using police-reported national data on MVCs from January 2005 through December 2016, we calculated the monthly injury rates (including deaths, severe injuries, and minor injuries) among unprotected road users (bicyclists and pedestrians) by sex and age group (70–74, 75–79, 80–84, and ≥85 years). The ratios of the injury rates of unprotected road users in the three oldest age groups (who were subjected to the test) to those aged 70–74 years (not subjected to the test) were also calculated. Then, we conducted an interrupted time-series analysis based on the injury rate ratios to control for extraneous factors affecting MVCs over the study period. Results There was a significant increase in traffic injuries of unprotected road users at the time the test was introduced among females aged 75–84 years, and at a later time among males aged ≥80 years and females aged ≥85 years. Conclusion Licensing policies for older drivers should be rigorously evaluated, taking into account the safety of older unprotected road users, and should be balanced against it.

Objectives To investigate the extent and patterns of regional disparities of road traffic injury rates involving elementary and junior high school children while commuting among Japan’s 47 prefectures. Methods We conducted a cross-sectional ecological study using the national police data for 2004–2013 on the number of children who were killed or seriously injured (KSI) in traffic collisions stratified by prefecture, grade, mode of transport, and purpose of trip (commuting or non-commuting). We calculated stratified KSI rates by dividing the number of KSI cases by the corresponding number of children and presented these rates for the 47 prefectures. Also, for pedestrian elementary school children and cyclist junior high school children, we regressed the KSI rates while commuting by prefecture on the non-commuting KSI rates and the proportion of people who live in the urban, densely inhabited districts. Results There were 6463 KSI cases while commuting. The ratios of the highest KSI rate to the lowest KSI rate among prefectures were 12, 30, and 58 for pedestrian elementary school children and pedestrian and cyclist junior high school children, respectively. The non-commuting KSI rates and the proportion of those living in densely inhabited districts were positively and inversely associated with the commuting KSI rates, respectively. The analysis of the residuals of the regression models did not identify prefectures with significantly higher or lower KSI rates while commuting than others. Conclusions There were large inter-prefecture disparities in the KSI rates while commuting, and the disparity was especially large among cyclist junior high school children.

Road traffic injury is a global issue, and now all countries are trying to decrease the number of deaths and disabilities, as it is set in the Sustainable Development Goals 3.6. In most of the developing countries, the number of road traffic injury deaths and disabilities are expected to rise, because of motorization, incomplete road safety and immature trauma care system. It has been said that strengthening Post Crash Response, such as developing Emergency Medical Service (EMS) System is one of the key factor to save lives and minimize the disabilities. To achieve better patient outcome by transporting through ambulance, the receiving hospital should have an adequate capacity to provide skills for resuscitation and definitive therapy. In fact, in most of the developing countries, capacity of in-hospital trauma care is immature and forced to cope with the limited resource. This is particularly clear in the least developing countries (LDCs). Nowadays, little is known about the impact of developing EMS system in LDCs. Since 2015, we have been working on the development of EMS in Vientiane Capital, Lao PDR, and conducting a survey to verify the impact of EMS system in Lao PDR. Lao PDR is one of the LDCs, which faces the rapid increase of road traffic injuries and ambulance services are run by the private non-profit sectors. In this presentation, we would like to share the thoughts about how we could develop EMS system in LDCs which would minimize the damage of road traffic accidents.

The major effector cells for cellular adaptive immunity are CD8+ cytotoxic T lymphocytes (CTLs), which can recognize and kill virus-infected cells and tumor cells. Although CTLs exhibit strong cytolytic activity against target cells in vitro, a number of studies have demonstrated that their function is often impaired within tumors. Nevertheless, CTLs can regain their cytotoxic ability after escaping from the tumor environment, suggesting that the milieu created by tumors may affect the function of CTLs.As for the tumor environment, the patho-physiological situation present in vivo has been shown to differ from in vitro experimental conditions. In particular, low pH and hypoxia are the most important microenvironmental factors within growing tumors. In the present study, to determine the effect of these factors on CTL function in vivo, we examined the cytolytic activity of CTLs against their targets using murine CTL lines and the induction of these cells from memory cells under low pH or hypoxic conditions using antigen-primed spleen cells. The results indicated that both cytotoxic activity and the induction of functional CTLs were markedly inhibited under low pH. In contrast, in hypoxic conditions, although cytotoxic activity was almost unchanged, the induction of CTLs in vitro showed a slight enhancement, which was completely abrogated in low pH conditions.Therefore, antigen-specific CTL functions may be more vulnerable to low pH than to the oxygen concentration in vivo. The findings shown here provide new therapeutic approaches for controlling tumor growth by retaining CTL cytotoxicity through the maintenance of higher pH conditions.

In aging societies, increasing numbers of older drivers are involved in motor vehicle collisions (MVCs), and preserving their safety is a growing concern. In this study, we focused on whether older drivers were more likely to cause MVCs and injuries than drivers in other age groups. To do so we compared at-fault MVC incidence and resulting injury risks by drivers' ages, using data from Japan, a country with a rapidly aging population. The at-fault MVC incidence was calculated based on distance traveled made for non-commercial purposes, and the injury risks posed to at-fault drivers and other road users per at-fault MVCs. We used MVC data for 2010 from the National Police Agency of Japan and driving exposure data from the Nationwide Person Trip Survey conducted by a Japanese governmental ministry in 2010. The at-fault MVC incidence showed a U-shaped curve across the drivers' ages, where teenage and the oldest drivers appeared to be the highest risk groups in terms of causing MVCs, and the incidence was higher for female drivers after age 25. The injury risk older drivers posed to other vehicle occupants because of their at-fault MVCs was lower than for drivers in other age groups, while their own injury risk appeared much higher. As the number of older drivers is increasing, efforts to reduce their at-fault MVCs appear justified.

To investigate modes of secondary school students' commuting to school and their unsafe driving practices in Laos, we conducted a roadside observation in front of the gate of a selected school in central Vientiane in December 2011. Of the 544 students observed, the majority came to school on foot (43%), followed by motorcycle (36%), and bicycle (14%). Of the 195 students who commuted by motorcycle, 45 (23%) drove it themselves. Of the 150 students who commuted as pillion riders, 35 (23%) were driven by a student or another child driver. The prevalence of helmet use among students (3%) was much lower than adults (66%). It was common for adult drivers to wear a helmet but to leave student pillion riders unhelmeted on the same motorcycle. Carrying two or three pillion riders was also often observed. The study revealed the necessity for measures to promote safe travel to school.

In Japan, a driving lesson consisting of a lecture, a driver aptitude test, on-road driving assessment and a discussion session was added to the driving license renewal procedure for drivers aged 75 years or older in 1998 and for drivers aged 70 years or older in 2002. We investigated whether these additions contributed to a reduction in at-fault motor vehicle collisions (MVCs) by examining the trend of the at-fault MVC rates per licensed driver and the rate ratios of the older drivers relative to those aged 65–69 years for the years 1986–2011. All data were derived from nationwide traffic statistics. If the introduction of the lesson was effective in reducing at-fault MVCs of older drivers, the rate ratio should have declined, given that the lesson targeted only the older drivers. We found this was not the case, i.e., there was no declining trend in the at-fault MVC rate ratios of both drivers aged 75 years or older and drivers aged 70 years or older, relative to drivers aged 65–69 years, after the driving lesson at license renewal became mandatory for these older drivers. Therefore, the mandatory lesson for the older drivers at license renewal needs to be reconsidered.

Summary Needs for surgical care are growing in low- and middle-income countries. Existing surgical care capacity indicators, focusing on the availability of equipment, personnel, and operation and anaesthetic skills, are not intended to evaluate perioperative nutrition management, which influences surgical outcomes. In this narrative review, we describe the prevalence of malnutrition and its clinical consequences among surgical patients in low- and middle-income countries, suggest potential measures to improve nutrition management and discuss the necessity of considering nutrition management as a component of surgical care capacity.

This study investigated the distribution of motorcyclists, including drivers and passengers, who were involved in road traffic crashes and admitted to hospital in Vientiane Capital, Laos. The focus was on child motorcycle drivers and passengers under 15 years. A hospital-based injury surveillance database in Vientiane Capital was used. The surveillance was performed in two hospitals. From 1 September to 31 December 2009, 3968 patients were admitted to the participating hospitals with road traffic injuries. Patients under 15 years accounted for 10.8% (427/3968). The majority of patients under 15 years were motorcycle drivers or passengers (71.7%, 306/427). Child motorcyclists including drivers and passengers were less likely to wear a helmet than adults (adjusted odds ratio [OR], 0.3, 95% confidence interval [CI], 0.2-0.5, for children 10-14 years; adjusted OR: 0.1, 95% CI, 0.05-0.4, for children under 10 years). It is suggested that stricter regulation enforcement for child motorcycle drivers and passengers may be needed. In addition, barriers against wearing helmets for motorcycle drivers and passengers in Laos should also be examined in further studies.

To reduce Pt loading in proton exchange membrane (PEM) fuel cells, we synthesized (111) faceted octahedral PtNi nanoparticles supported by carbon black (octahedral PtNi NPs/C) using a new chemical method, and evaluated the effect of reduction of Pt loading and durability in actual PEM fuel cells. We confirmed that the synthesized particles were octahedral and the PtNi alloy nanoparticles had a size of 10–15 nm. In high resolution transmission electron microscopy analysis, nearly all exposed surfaces of the octahedral PtNi NPs were identified as (111) facets. Energy dispersion X-ray spectroscopy analysis showed that the corners and edges of the octahedral PtNi NPs were richer in platinum than the internal region, thus it was determined that the octahedral PtNi NPs adopted a core–shell structure. Mass activity of octahedral PtNi NPs/C as a cathode in fuel cells was 3.4 times higher than that of commercial Pt catalysts. This corresponds to a 71% reduction of Pt for the cathode. In potential cycling tests, the octahedral PtNi NPs/C also exhibited better durability than the commercial Pt catalysts.

This study aimed to exhaustively examine associations between prehospital variables and emergency care resource needs among blunt trauma patients. The study included blunt trauma patients aged 15 years or older who were admitted to a tertiary care medical center in Osaka, Japan, from January 2005 to December 2009. The primary end point was a composite measure of overall emergency care resource needs. Predictive variables were easily detectable upper and lower extremity injuries. A multivariate logistic regression model was used to identify associations between the predictive variables and the end point; this model included other covariates known to be associated with emergency care resource needs (demographic characteristics, mechanism of injury, and physiological parameters). Of 982 blunt trauma patients, 81 died, and 573 required overall emergency care resources. Upper extremity injury (odds ratio [OR], 2.60) and lower extremity injury (OR, 4.50) were significantly associated with overall emergency care resource needs after controlling for other covariates. The results of this study suggest that easily detectable extremity injuries may be useful predictors of the emergency care resource needs of trauma patients. Further studies are needed to validate the predictive values of these injuries and to determine ways to use information about extremity injuries to improve triage decisions.

Whereas many people at high risk of developing type 2 diabetes are detected through screening in a Japanese healthcare setting, they do not necessarily seek primary care for diagnosis and treatment in the early stages of the disease. This study aimed to identify the most effective health communication method for the diabetes screening report to encourage primary care consultation. This facility-based cohort study involved 1,128 Japanese participants identified from the routine diabetes screening database from 2003 to 2009 who were considered to be at high risk of type 2 diabetes. Multiple logistic regression analyses were performed to estimate the relative effectiveness of the health communication method—a letter or an interview—regarding the likelihood of seeking primary care. The study controlled for sex, age, family history of diabetes, perceived symptoms, recommendation for diabetes care, undergoing treatment for other diseases, detection of comorbidity, request for referral to a specialist, and counseling by a public health nurse or dietician after screening. The proportion of participants who sought primary care after screening was 7 %. Those who received feedback on diabetes screening via physician interview were more likely to seek primary care consultation (odds ratio 2.6, 95 % confidence interval 1.2–5.6). Health communication in the form of an interview with a physician after diabetes screening may encourage people at high risk of type 2 diabetes to seek primary care, yet very few seek primary care in the early stage of the disease. Therefore, more effective communication methods are needed.

Aim The aim of this study was to assess the cut-off age of the risk factors for postoperative recurrence of ovarian endometriomas and to evaluate the end-points of follow-up after laparoscopic excision of ovarian endometriomas. Material and Methods We retrospectively reviewed 167 patients who underwent laparoscopic excision of ovarian endometriomas at our hospital between 2000 and 2009, and followed up the patients until 2010. Following surgery, patients chose to receive gonadotrophin-releasing hormone agonist, oral contraceptive pills (OCP), dienogest, or no medication and underwent regular ultrasonographic examinations. Potential risk factors for recurrence, including age at surgery, were assessed in the patients receiving no medication. Postoperative recurrence, defined as re-appearance of an ovarian endometrioma > 2 cm in size, was assessed for each treatment group. Results Age at surgery was the only significant risk factor for recurrence, at a cut-off of 32 years, obtained through receiver–operator curve analysis. In patients not receiving medication, the recurrence rate gradually increased up to 50% over 5 years; there was no recurrence 5 years after surgery. Although no recurrence was seen in patients during continuous treatment with OCP or dienogest, the disease recurred in 55.5% of patients after discontinuing OCP. Conclusions Although adjuvant therapy for all patients may represent overtreatment, the findings of the present study suggest that, in the interest of fertility preservation, continuous postoperative hormonal treatment should be administered, at least to patients younger than 32 years. In patients who decline hormonal treatment, we recommend that they undergo follow-up for recurrence until 5 years after surgery.

The recent emergence of laparoendoscopic single-site surgery (LESS) has had a great impact on gynecology. As LESS grows in popularity, attention has been paid to the procedure's cosmetic benefits. Although in theory LESS is an ideal approach that leaves no visible scars and improves patients' quality of life, the outcomes are not always ideal according to recently published data. Therefore, alternative approaches, such as mini-laparoscopy, are also becoming more popular. Herein, we review randomized trials studying the benefits of LESS in gynecology and discuss alternative approaches. Finally, we propose the mimic approach as the next generation for non-visible scar surgery.

Background In Japan, introduction of severe drunk-driving penalties and a lower blood alcohol concentration (BAC) limit in June 2002 was followed by a substantial reduction in fatal alcohol-related crashes. However, previous research suggests that this reduction started before the legal amendments. The causes of the decrease have not been studied in detail. Methods Monthly police data on fatal road traffic crashes from January 1995 to August 2006 were analyzed using a joinpoint regression model to identify change-points in the trends of the proportion of drunk-driving among drivers primarily responsible for fatal crashes. We analyzed the data by BAC level (≥0.5 or

While cervical cancer screening is useful for detecting and then treating the disease at an early stage, most women with screen-positive results are free from cervical cancer but nevertheless subject to the unnecessary worry entailed in receiving such results. The purpose of this study was to examine whether receiving a screen-positive result was actually related to psychological distress among Japanese women who underwent cervical cancer screening. We conducted a questionnaire survey at health facilities in a semiurban city of Ibaraki prefecture, involving 1744 women who underwent cervical cancer screening and 72 who received screen-positive results and then underwent further testing. We used the K6 scale to assess their psychological distress (K6 score ≥5) and performed multiple logistic regression analyses to estimate the relative effect of receiving screen-positive results on psychological distress. Psychological distress was more prevalent among women with screen-positive results (OR 2.22; 95 % CI 1.32–3.74), while it was also related to history of mental health consultation (OR 2.26; 95 % CI 1.69–3.01) and marital status (OR 1.32; 95 % CI 1.02–1.70). Receiving a positive cervical cancer screening result was associated with psychological distress. To alleviate this psychological impact, the current form of communicating the screening results should be reconsidered.

Objectives To quantitatively describe the recent longitudinal trend in road injuries involving school children while commuting to and from school in Japan and to identify groups or situations with particularly large or small decreasing trends. Methods Data on the number of children aged 6–15 years who sustained road injuries while commuting were obtained, stratified by year, demographic characteristics, mode of transport and other variables. The rates of killed or seriously injured (KSI) children were calculated from the number of KSI cases (the numerator) and the product of population and the proportion of each mode of transport estimated using the Person Trip Survey data (the denominator). We conducted descriptive analyses of the longitudinal trend in KSI rates stratified by the variables, and Poisson regression analyses were employed to quantify the annualised changes in the rates. Results During the study period, 166 children were killed and 8484 children were seriously injured; the KSI rate decreased approximately 30%. The KSI rate was almost 10 times higher among cyclists than pedestrians. In cyclists, the decrease in the KSI rate among children aged 12–15 years was smaller in boys than in girls (estimated change −14% vs −30%). The KSI rate of male pedestrians aged 6–7 years was larger than female and older pedestrians, with a large decrease of 48%. Conclusions Although the overall rate of road injuries among children while commuting was decreasing, cyclists were at a much greater risk than pedestrians, and the improvements for cyclists occurred at a slower pace.

Abdominal sacrocolpopexy is the gold standard for treating pelvic organ prolapse (POP) because of safety and durable good results. More recently laparoscopic sacrocolpopexy (LSC), a less invasive approach, has become popular. Although these surgeries are versatile and can treat almost all patients with POP, these techniques have shortcomings. Specifically, reinforcement of lateral vaginal defects are not very strong, thus patients with POP and a severe paravaginal defect are not good candidates for abdominal or laparoscopic sacrocolpopexy. To overcome this problem, we developed a novel type of LSC, which can reinforce severe paravaginal defects by using a reversed T-shaped anterior mesh combining the advantage of transvaginal mesh surgery. We refer to this novel surgery as 'hybrid LSC'. Thus far, eight patients have successfully undergone this surgery. Hybrid LSC is a simple and secure method, and is an alternative treatment for POP with a severe paravaginal defect.

ACADEMIC EMERGENCY MEDICINE 2012; 19:782–792 © 2012 by the Society for Academic Emergency Medicine Abstract Objectives: This study aimed to investigate whether early epinephrine administration in out-of-hospital cardiopulmonary arrest (OHCA) patients was associated with improved outcomes and to address the selection bias inherent in observational studies (more severe cases are more likely to receive epinephrine). Methods: This was a retrospective analysis of prospectively collected population-based data of adult bystander-witnessed OHCA patients from a nationwide Japanese registry between January 2007 and December 2008. To address selection bias, those who attained early return of spontaneous circulation (ROSC) without epinephrine administration were excluded, leaving 49,165 patients in the analysis. The outcomes were intact neurologic survival, defined as survival with cerebral performance category score 1or 2, and any survival at 1 month or at discharge (whichever was earlier). The primary predictor was the time from the start of cardiopulmonary resuscitation (CPR) by emergency medical services (EMS) to first epinephrine administration, with early epinephrine defined as within 10 minutes. Results: Multivariate logistic regression analysis showed that cardiac origin OHCA patients who received early epinephrine (≤10 minutes) had significantly higher rates of intact neurologic survival (odds ratio [OR] = 1.39, 95% confidence interval [CI] = 1.08 to 1.78) and any survival (OR = 1.73, 95% CI = 1.46 to 2.04) than those who did not receive early epinephrine, after adjusting for potential confounders. Results for noncardiac OHCA patients were similar. Conclusions: Early epinephrine administration may be associated with higher rates of intact neurologic survival and any survival in adult bystander-witnessed OHCA patients. This article provides a potential method to address the selection bias inherent in observational studies that examine the effects of drug administration in OHCA patients.

Introduction: The purpose of this study was to elucidate the feasibility of gasless laparoscopically assisted myomectomy (LAM) using a wound retraction system. This method treats symptomatic uterine myomas by combining laparoscopy with a mini-laparotomy to enucleate myoma nodules and to close the uterine myometrium. Methods: This study includes 275 patients who underwent gasless LAM. For patients with fewer than three myoma nodules, the location of the largest nodule was classified as anterior, fundal, or posterior. The operative outcomes, intraoperative and postoperative courses, and complications were examined. Results: All operations were performed satisfactorily, and no conversions to laparotomy were required. None of the patients developed serious complications. The mean blood loss and operating time were 190.3 mL and 152.2 minutes, respectively. The mean myoma size was 8.9 cm, and the mean number of myomas per patient was 2.8. The average postoperative hospital stay was 5.7 days. There were no significant differences in resected myoma size, blood loss, and surgical duration with respect to the location of the largest nodule. Conclusion: Gasless LAM with a wound retractor is feasible and allows surgeons to perform myomectomy safely and cost-effectively, without requiring advanced laparoscopic surgical skills and while maintaining minimum invasiveness.

Objectives We examined road safety policies and trends in road traffic injuries (RTIs) in Japan between 1970 and 2008 from the viewpoints of population and high-risk-individual approaches to see what lessons can be learned from the example of a country that experienced a decline in RTIs following comprehensive road safety policies. Methods We reviewed research papers and policy documents, obtained from relevant ministries, decade by decade. We obtained data on RTIs from police and from vital statistics. Results Japan started the Fundamental Traffic Safety Program to combat the increase in RTIs, and succeeded in reducing both RTI mortality and morbidity rates in the 1970s by implementing vast road safety improvements, using population approaches with a particular focus on protecting the most vulnerable population groups at that time. However, RTIs increased again in the 1980s because of increasing traffic volume. In the 1990s and 2000s, safety policies targeted at high-risk driving behaviors succeeded in reducing RTI mortality rates but failed to change morbidity rates. Conclusions To achieve a safer road environment, more emphasis is required on population approaches that reduce risk among the whole population, with a balance between population and high-risk-individual approaches.

Objects Laparoendoscopic single-site surgery (LESS) is an ideal approach for gynecologic surgery and yields better cosmetic results. However, a standard umbilical approach with LESS is not appropriate for gynecologic surgery requiring intra-abdominal suturing and dissection requiring traction. Therefore, we have developed a new multitrocar access system for gynecologic LESS. The purpose of this study was to evaluate the efficacy of gynecologic LESS using this access system. Methods This access system consists of one 12-mm trocar, two 5-mm trocars, and a 5-mm flexible laparoscope. Two 5-mm trocars with small port heads were inserted cross-wise on opposite sides of the sleeve of the centrally positioned 12-mm trocar to maintain triangulation. Thirty-eight patients with various gynecologic conditions underwent LESS with this access system. The results of these surgeries were retrospectively compared to those of conventional laparoscopic procedures. Results Of the 38 LESS procedures performed with this access system, none was up-converted, converted to an open laparotomy, or required blood transfusion. The Salpingo-oophorectomy with LESS had several benefits, such as no extension of the skin incision of the trocar site and no leakage of the contents of the ovarian cyst into the peritoneal cavity, over that with conventional laparoscopy. A comparison of LESS (11 patients) and conventional laparoscopy (16 patients) for total hysterectomy showed no significant difference in total blood loss (234.0 mL vs. 221.6 mL) or the weight of the resected uterus (276.0 g vs. 285.0 g), although the mean total operative time was greater with LESS (199.0 min vs. 168.5 min). Conclusion Our multitrocar access system is safe and secure, and can be adapted for various gynecologic surgeries involving complicated procedures. LESS with this access system achieves results comparable to those of conventional laparoscopy with 4 ports, although the operative time is longer.

Japanese road traffic law was amended in 2002 and 2007 to increase the penalties for drink-driving in response to media coverage, publicity campaigns, and debates following high-profile alcohol-related motor-vehicle crashes in 1999 and 2006.To test the hypothesis that the proportion of crashes involving drink-driving started to decline before the law amendments, because of changes in social norms and driver behaviour after the high-profile crashes.In order to assess the impact of the cases in 1999 and 2006, time-series analyses were used to examine the trends in the proportion of crashes involving drink-driving, and whether there were abrupt changes in the level or slope at the expected time points, using monthly police data for the period between January 1995 and December 2008.In 1999, the proportion of alcohol-related fatal crashes in which the driver had a blood alcohol concentration (BAC) ≥0.5 mg/ml started to decline with a slope change of -0.09 percentage points per month (95% CI -0.15 to -0.03) but no level change, whereas there were no changes for drivers with a BAC0.5. In 2006, the trends for drivers with a BAC ≥0.5 or0.5 showed significant level declines of -3.1 (-5.0 to -1.2) and -1.7 (-2.5 to -0.9) percentage points, respectively, but no slope changes.Media coverage of high-profile crashes, and subsequent publicity campaigns and debates might have altered social norms and driver behaviour, reducing the proportion of alcohol-related crashes before the introduction of more severe penalties for drink-driving.

Objectives We examined (1) whether attending out-of-home day care centres (DCCs) has differential effects on improvement of child nutrition and facilitation of maternal employment depending on availability of non-institutionalised childcare support and (2) whether attendance increases infectious diseases. Methods In a prospective before–after comparison study at public DCCs in Pokhara, Nepal, we compared weight-for-age Z -score (WAZ) and height-for-age Z -score (HAZ) among children attending DCCs between at admission, after 6 months, and after 1 year and determined differential changes in these measures between those with and without appropriate childcare support. We used repeated measures analysis of variance with interaction terms between support availability and DCC attendance. We compared maternal income and incidence of diarrhoea and fever in children between the periods of waiting and attending. Results After 6 months, neither WAZ nor HAZ significantly changed. After 1 year, WAZ significantly improved, but HAZ did not change among all participants. Those without appropriate childcare support showed greater improvement in both WAZ and HAZ than those with support. While children were attending, income increased only among those mothers who were already working without any childcare support at baseline. Neither diarrhoea nor fever increased. Conclusions DCCs can be more beneficial for child nutrition and working mothers in households lacking childcare support than in those with support.

This longitudinal observational study evaluated whether admission priorities given to children on waiting lists for out‐of‐home day‐care centres (DCCs), determined as being either an early or late admission to DCCs, are determined by actual childcare needs and are assigned to children of disadvantaged families, in public DCCs in Pokhara, Nepal, between November 2003 and February 2006. Multivariate logistic regression analysis showed high caste, low household weekly income, and father’s absence from the home were associated with children’s early admission to DCCs; but maternal employment and availability of childcare support were not associated with admission priorities. Priorities given to children on DCC waiting lists were not fully based on deprivation and childcare need; caste/ethnicity may influence the prioritisation. Policies should explicitly prioritise those most in need and most deprived, possibly with regulations to reserve seats for those from low‐caste/ethnic groups.

We explored the factors influencing voluntary counseling and testing (VCT) utilization among tuberculosis patients attending two referral hospitals in Cambodia. We conducted face-to-face interviews using a structured questionnaire. We compared HIV/AIDS knowledge, HIV testing attitudes, risks for exposure to HIV, and AIDS stigma between VCT users and non-users. Compared to VCT non-users, VCT users had significantly higher risks for HIV and were more likely to have used condoms. Regarding stigma, VCT non-users demonstrated significantly greater AIDS stigmatizing beliefs compared to VCT users. To increase VCT utilization among TB patients, we need effective strategies to reduce AIDS stigma among them. Moreover, initiation of routine HIV testing in TB facilities might be another effective solution.

The aim of this study was to evaluate the available resources for trauma care at health centers (HCs) and referral hospitals (RHs) in rural Cambodia and to examine whether the resources at HCs are allocated on the basis of actual need based on the referral distance and number of severely injured patients referred to RHs. We conducted a cross-sectional facility survey by phone interview or mail using structured questionnaires at nationally representative samples of 85 HCs and 17 RHs from December 2006 to April 2007. The questionnaire included a modified checklist of the guidelines for essential trauma care as well as questions on distance for referral and the number of injured patients received and referred during the last 3 months. We analyzed the association between resource availability at HCs and their need using multivariate linear regression. Median (interquartile range) numbers of available resources at HCs and RHs were 25.5 (22.0–27.5) and 35 (28–41) among 37 and 62 essential items, respectively. Basic equipment, including both consumable supplies and durable devices and life-saving knowledge/skills, were not satisfactory at either HCs or RHs. A longer distance to the RH was associated with more knowledge/skills but not with equipment supplies; the number of referred patients was not associated with equipment or knowledge/skills. Staff training emphasizing life-saving knowledge/skills and better organization and planning to supply physical resources are needed. There is a gap between resource allocation and need, which should be addressed through clear policies to prioritize remote areas and to allocate resources based on reliable injury data.

The hydrogen adsorption properties and uptake capacities of three-dimensional microporous materials of lantern-type dinuclear M(BDC)(DABCO) 1/2 (M = Co II , Cull, and Zn II ; BDC = 1,4-benzenedicarboxylate, DABCO = 1,4-diazabicyclo[2.2.2]octane; Co(BDC)(DABCO) 1/2 (1), Cu(BDC)(DABCO) 1/2 (2), Zn(BDC)(DABCO) 1/2 (3)) were investigated at various temperatures of 77-333 K and pressures up to 10 MPa using a PCT automatic measuring system (Sievert-type apparatus). The results indicated that uptake to 4.11, 2.70, and 3.17wt% of hydrogen can be stored on 1, 2, and 3, respectively, at 77 K. The amounts of hydrogen are adsorbed by all complexes at around room temperature (293 K) and high-pressures are much lower (

In an attempt to address rapidly increasing injuries in low-income and middle-income countries (LMICs), the Essential Trauma Care Project was started with the goal of standardizing trauma care systems. This project, although part of "vertical" essential health services, has the potential to strengthen the health care system as a whole and to empower communities. Improved diagnosis, triage, referral, communication, and transport benefit the integrated health care systems weakened by vertical approaches. This project mobilizes existing resources, including lay people, to establish a "local model of prehospital care," which can raise community capability and foster trust in health systems. This article describes how this project can be an intersection between vertical and horizontal approaches.

To investigate the perception and actual use of mobile phones among Japanese high school students while riding their bicycles, and their experience of bicycle crash/near-crash.A questionnaire survey was carried out at high schools that were, at the time of the survey, commissioned by the National Agency for the Advancement of Sports and Health to conduct school safety research.In the survey, we found that mobile phone use while riding a bicycle was quite common among the students during their commute, but those who have a higher perception of danger in this practice, and those who perceived that this practice is prohibited, were less likely to engage in this practice. Male students and students commuting to school by bicycle only were more likely to have used phones while riding. There was a significant relationship between phone usage while riding a bicycle and the experience of bicycle crash/near-crash, although its causality was not established. Bicycle crash/near-crash experienced while using a phone was less prevalent among the students who had a higher perception of danger in phone usage while riding, students who perceived that this practice is prohibited, and students with a shorter travel time by bicycle during the commute.Since mobile phone use while riding a bicycle potentially increases crash risk among cyclists, student bicycle commuters should be made aware of this risk. Moreover, they should be informed that cyclists' phone usage while riding is prohibited according to the road traffic law.