Cesarean section rates and local resources for perinatal care in Japan: A nationwide ecological study using the national database of health insurance claims

Maeda, Eri; Ishihara, Osamu; Tomio, Jun; Sato, Ayumu; Kobayashi, Yasuki; Murata, Katsuyuki

doi:10.1111/jog.13518

Cited by 42 publications

(35 citation statements)

References 35 publications

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“…For example, the ID1 cannot follow up on patients who change their jobs and ID2 cannot follow up on patients who change their family names. The NDB has been used in several studies (Maeda et al 2018 ; Okumura and Nishi 2017 ; Okumura et al 2017 ). Our study protocol was reviewed and approved by the institutional review board at the Institute of Health Economics and Policy.…”

Section: Methodsmentioning

confidence: 99%

Glucose and Prolactin Monitoring in Children and Adolescents Initiating Antipsychotic Therapy

Okumura

Usami

Okada

et al. 2018

Journal of Child and Adolescent Psychopharmacology

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Objective: We aimed to evaluate glucose and prolactin monitoring in children and adolescents initiating antipsychotic therapy using a nationwide claims database.Methods: A retrospective 15-month cohort study was conducted using the National Database of Health Insurance Claim Information and Specified Medical Checkups in Japan. Patients aged ≤18 years, who were newly prescribed antipsychotics between April 2014 and March 2015, were followed up for 450 days. Outcomes were the use of glucose and prolactin testing through 15 months after drug initiation (index date) with consideration of persistence with antipsychotic therapy. The incidence proportion of patients monitored was assessed within the following four time windows: baseline (between 30 days before the index date and the index date), at 1–3 months (between 1 and 90 days after the index date), at 4–9 months (between 91 and 270 days after the index date), and at 10–15 months (between 271 and 450 days after the index date).Results: Of 43,608 new users in 6620 medical institutions, the percentage of persistent antipsychotic users was 46.4% at 90 days, 29.7% at 270 days, and 23.8% at 450 days after the index date. The proportion of patients who received monitoring within the baseline period was 13.5% (95% confidence interval [CI], 13.2–13.8) for glucose and 0.6% (95% CI, 0.5–0.6) for prolactin, respectively. The proportion of patients who received glucose monitoring at all time windows decreased to 0.9%. The proportion of patients who received prolactin monitoring by the second time window decreased to 0.1%.Conclusions: Our study shows that monitoring for glucose and prolactin is infrequent in children and adolescents initiating antipsychotic therapy. Strategies for physicians, patients, and guardians are needed to overcome the barriers in glucose and prolactin monitoring.

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Section: Methodsmentioning

confidence: 99%

Glucose and Prolactin Monitoring in Children and Adolescents Initiating Antipsychotic Therapy

Okumura

Usami

Okada

et al. 2018

Journal of Child and Adolescent Psychopharmacology

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“…The spontaneous surge in catecholamine secretion caused by uterine contractions is particularly important for fetal alveolar fluid clearance,12 and previous studies found that elective caesarean section before the onset of labour is a significant risk factor for TTN 3 13 14. The number of elective caesarean sections has increased in Japan over the last decades, and the caesarean section rate reached 11.5% in 2013 15. The elective caesarean section rate is expected to continue to increase due to increased maternal age,16 multiple gestations after fertility treatment17 and maternal request 18.…”

Section: Introductionmentioning

confidence: 99%

Association between uterine contractions before elective caesarean section and transient tachypnoea of the newborn: a retrospective cohort study

2020

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ObjectiveWe evaluated the association between the presence of predelivery uterine contractions and transient tachypnoea of the newborn (TTN) in women undergoing an elective caesarean section.DesignA retrospective cohort study.SettingNational Hospital Organization Kofu National Hospital, which is a community hospital, between January 2011 and May 2019.ParticipantsThe study included 464 women who underwent elective caesarean section. The exclusion criteria were missing data, twin pregnancy, neonatal asphyxia, general anaesthesia and elective caesarean section before term.Primary and secondary outcome measuresPatients were grouped according to the presence or absence of uterine contractions on a 40-min cardiotocogram (CTG) performed within 6 hours before caesarean delivery. We performed a multivariable logistic regression analysis to examine the association between predelivery uterine contractions and TTN.ResultsThe incidence of TTN was 9.9% (46/464), and 38.4% (178/464) of patients had no uterine contraction. The absence of uterine contractions was significantly associated with an increased risk of TTN (adjusted OR 2.04; 95% CI 1.09 to 3.82) after controlling for gestational diabetes mellitus, small for gestational age, male sex and caesarean section at 37 weeks.ConclusionsAccurate risk stratification using a CTG could assist in the management of infants who are at risk of developing TTN.

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“…Similar to our previous report, the proportion of subjects born via CS in the R group of the present study was 25% (2 out of 8), while none were born via CS in the NR group (0%, n = 4) or the HC group (0%, n = 11). Although this difference did not reach statistical significance, the frequency of CS delivery in the R group was higher than that of general population in Japan [35]. Therefore, one reason for gut microbiota dysbiosis in the relapsing INS patients in the current study may relate to birth via CS.…”

Section: Discussionmentioning

confidence: 42%

Gut Microbiota Dysbiosis in Children with Relapsing Idiopathic Nephrotic Syndrome

et al. 2018

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Background: While the etiology of idiopathic nephrotic syndrome (idiopathic nephrotic syndrome [INS]; characterized by repeated relapses and comorbid allergic conditions) remains unknown, recent evidence suggests that dysfunction in regulatory T cells (Tregs) plays an important role in the development of INS as well as allergic diseases. We hypothesized that dysbiosis involving decreased butyric acid-producing gut microbiota leads to defective induction and differentiation of peripherally induced Tregs, resulting in INS relapse. Methods: Study subjects were 12 children with INS, 8 classified as relapsing (R group; median age: 3.0 years) and 4 as non-relapsing (NR group; median age: 4.3 years), and 11 healthy children (HC group; median age: 5.1 years) serving as normal controls. Measurement of microbiota was performed using 16S ribosomal RNA metagenomic analysis, and fecal butyric acid was measured using high performance liquid chromatography. Flow-cytometric analysis of Tregs and CD4-positive (CD4⁺) cells in peripheral blood was also performed. Results: Metagenomic analysis of gut microbiota using feces showed that the proportion of butyric acid-producing bacteria was significantly lower in R (median 6.36%) than HC (median 18.84%; p = 0.0013), but no different between NR (median 16.71%) and HC (p = 0.29). Fecal organic acid analysis revealed significantly lower butyric acid quantities in R than HC (medians: 0.48 vs. 0.99 mg/g, p = 0.042). Circulating Tregs as a proportion of CD4⁺ cells were decreased in 75% of R and NR. Conclusion: Pediatric relapsing INS patients show gut microbiota dysbiosis, characterized by a decreased proportion of butyric acid-producing bacteria and lower fecal butyric acid quantities, concomitant with reduced circulatory Tregs.

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Cesarean section rates and local resources for perinatal care in Japan: A nationwide ecological study using the national database of health insurance claims

Abstract: Higher elective CS rates might be associated with limited or unconsolidated medical resources. Policymakers should be aware of regional differences and the possible effects of perinatal care resources on CS rates.

Cited by 42 publications

References 35 publications

Glucose and Prolactin Monitoring in Children and Adolescents Initiating Antipsychotic Therapy

Glucose and Prolactin Monitoring in Children and Adolescents Initiating Antipsychotic Therapy

Association between uterine contractions before elective caesarean section and transient tachypnoea of the newborn: a retrospective cohort study

Gut Microbiota Dysbiosis in Children with Relapsing Idiopathic Nephrotic Syndrome

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