Abstract
Introduction : For stable patients, we actively performed a reverse introduction into peripheral medical institutions, but “the interinstitutional relations in medical treatment which a hospital doctor hopes for” were not promoted or established.
Aim : Our primary aims were to understand “the interinstitutional relations in the field of medical treatment that outpatients demand” and to obtain materials to promote and establish such relations. Another major aim was to substantially investigate the backgrounds of the patients, the coordinated medical institutions, and general hospitals by using structural equation modeling, and to identify latent factors promoting interinstitutional relations in medical treatment.
Method : We enrolled 471 outpatients as subjects and conducted a questionnaire survey.
Results : Both the hopes and expectations of patients for coordinated medical institutions were related to a “strong connection with the general hospital and with the specialists”. On the other hand, the issuing of a “long-term prescription” with the purpose of reducing the burden on the outpatient department was a strong factor that disturbed such relations.
Conclusions : Our study suggested that the strong relationships that exist among these three elements--patients, peripheral medical institutions, and general hospitals--are latent factors that satisfy the medical demands of the patients and are promoted by smooth interinstitutional medical cooperation.

BACKGROUND: Studies on the adverse effects of Asian dust (AD) on respiratory function in children are scarce. The objective of this study was to examine the association between AD and respiratory function by measuring peak expiratory flow rates (PEFRs) in asthmatic children. METHODS: The study was carried out from March to May from 2014 through 2016. One hundred ten children with bronchial asthma were recruited from four hospitals in the Goto Islands and south Nagasaki area in Nagasaki prefecture. The parents were asked to record their children's PEFRs every morning/evening and clinical symptoms in an asthma diary. AD was assessed from light detection and ranging data, and a linear mixed-effects model was used to estimate the effects of AD on daily PEFR. Time-stratified case-crossover analyses were performed to examine the association between AD and asthma attacks defined by reduction levels in PEFR. RESULTS: AD was detected on 11 days in the Goto Islands, and on 23 days in the south Nagasaki area. After adjusting for age, sex, temperature, and daily oxidants, we found a consistent association between AD and a 1.1% to 1.7% decrease in PEFR in the mornings and a 0.7% to 1.3% decrease in the evenings at a lag of 0 to 5 days. AD was not associated with the number of asthma attacks, respiratory symptoms, or other symptoms at any lag days examined. CONCLUSIONS Exposure to AD was associated with reduced PEFR, although the effects were not large enough to induce clinically apparent symptoms, in clinically well-controlled asthmatic children.

BACKGROUND: The Japan Environment and Children's Study (JECS) is a nation-wide birth cohort study investigating environmental effects on children's health and development. In this study, the exposure characteristics of the JECS participating mothers were summarized using two questionnaires administered during pregnancy. METHODS: Women were recruited during the early period of their pregnancy. We intended to administer the questionnaire during the first trimester (MT1) and the second/third trimester (MT2). The total number of registered pregnancies was 103,099. RESULTS: The response rates of the MT1 and MT2 questionnaires were 96.8% and 95.1%, respectively. The mean gestational ages (SDs) at the time of the MT1 and MT2 questionnaire responses were 16.4 (8.0) and 27.9 (6.5) weeks, respectively. The frequency of participants who reported "lifting something weighing more than 20 kg" during pregnancy was 5.3% for MT1 and 3.9% for MT2. The Cohen kappa scores ranged from 0.07 to 0.54 (median 0.31) about the occupational chemical use between MT1 and MT2 questionnaires. Most of the participants (80%) lived in either wooden detached houses or steel-frame collective housing. More than half of the questionnaire respondents answered that they had "mold growing somewhere in the house". Insect repellents and insecticides were used widely in households: about 60% used "moth repellent for clothes in the closet," whereas 32% applied "spray insecticide indoors" or "mosquito coil or an electric mosquito repellent mat." CONCLUSIONS We summarized the exposure characteristics of the JECS participants using two maternal questionnaires during pregnancy.
Adult ; Child Health ; Cohort Studies ; Female ; Gestational Age ; Humans ; Japan ; Maternal Exposure ; statistics & numerical data ; Mothers ; statistics & numerical data ; Pregnancy ; Surveys and Questionnaires ; Young Adult