Faculty Profiles - YAMAMOTO Eiko

Papers - YAMAMOTO Eiko

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Factors associated with neonatal mortality in a tertiary hospital in Phnom Penh, Cambodia.

Ponloeu Leak, Eiko Yamamoto, Pisey Noy, Dane Keo, Sidonn Krang, Tetsuyoshi Kariya, Yu Mon Saw, Meng Siek, Nobuyuki Hamajima

Nagoya journal of medical science Vol. 83 ( 1 ) page： 113 - 124 2021.2

Language：English Publishing type：Research paper (scientific journal)

This study aimed to identify hospital neonatal mortality rate (NMR) and the causes of neonatal deaths, and to understand risk factors associated with neonatal mortality in a national tertiary hospital in Cambodia. The study included all newborn infants, aged 0-28 days old, hospitalized in the Pediatrics department of Khmer-Soviet Friendship Hospital between January 2016 and December 2017. In total, 925 infants were included in the study. The mean gestational age was 35.9 weeks (range, 24-42 weeks). Preterm infants and low birth weight accounted for 47.5% and 56.7%, respectively. With respect to payment methods, the government (53.5%) and non-governmental organizations (NGO) (13.7%) paid the fees as the families were not in a financial position to do so. The hospital NMR at the Pediatrics department was 9.3%. Respiratory distress syndrome (37.2%) was the main cause of deaths followed by hypoxic-ischemic encephalopathy (31.4%) and neonatal infection (21.0%). Factors associated with neonatal mortality were Apgar score at 5th minute <7 (adjusted odds ratio (AOR) = 3.57), payment by the government or NGO (AOR = 11.32), admission due to respiratory distress (AOR = 11.94), and hypothermia on admission (AOR = 9.41). The hospital NMR in the Pediatrics department was 9.3% (95% confidence interval 7.50-11.35) at Khmer-Soviet Friendship Hospital; prematurity and respiratory distress syndrome were the major causes of neonatal mortality. Introducing continuous positive airway pressure machine for respiratory distress syndrome and creating neonatal resuscitation guidelines and preventing hypothermia in delivery rooms are required to reduce the high NMR.

DOI： 10.18999/nagjms.83.1.113

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Assessment of nutritional status and risk factors for malnutrition among the elderly in Loikaw, Myanmar Reviewed International coauthorship

May Thet Nu Noe, Yu Mon Saw, Thu Nandar Saw, Yoon Pwint Kyaw, Poe Ei Zin, Su Myat Cho, Tetsuyoshi Kariya, Eiko Yamamoto, Hla Hla Win, Tin Wann, Nobuyuki Hamajima

Nutrition Vol. 79-80 page： 110933 - 110933 2020.11

Assessment of quality of life among elderly in urban and peri-urban areas, Yangon Region, Myanmar. Reviewed International coauthorship International journal

Poe Ei Zin, Yu Mon Saw, Thu Nandar Saw, Su Myat Cho, Su Su Hlaing, May Thet Nu Noe, Tetsuyoshi Kariya, Eiko Yamamoto, Kay Thi Lwin, Hla Hla Win, Nobuyuki Hamajima

PloS one Vol. 15 ( 10 ) page： e0241211 2020.10

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: In the context of an aging population, quality of life (QOL) is an important consideration for the well-being of the elderly. However, there is limited information on the QOL of the elderly in Myanmar. This study aimed to explore the risk factors for low QOL among the elderly in urban and peri-urban areas of the Yangon Region, Myanmar. METHODS: A community-based, cross-sectional study was conducted among the elderly aged 60 years or older in two urban and two peri-urban townships in the Yangon Region from July to September 2019. A multi-stage sampling method was used to recruit study participants using a pre-tested questionnaire. A total of 616 (305 males and 311 females) elderly people were interviewed using a face-to-face interview technique. Multiple linear regression analysis was performed on the four domains (physical health, psychological health, social relationship, and environment) of QOL measured with the WHOQOL-BREF. RESULTS: Income level and having intimate friends influenced the QOL scores of the elderly in all domains, while education level and marital status influenced psychological health, social relationship, and environment domains. Social interaction with neighbors increased the QOL scores for physical health, social relationship, and environment domains. Living in peri-urban areas was associated with lower QOL scores for physical health, psychological health, and environment, while participation in group activities increased QOL scores in these domains. Having comorbidities affected the QOL for psychological health and environment domains, while the frequency of going out affected physical health, and the frequency of religious performance affected social relationship. CONCLUSION: Residential location, education level, marital status, income, comorbidities, social interactions with neighbors and friends, participation in group activities, and frequencies of going out and religious activities should be considered in planning and implementing programs for the elderly in Myanmar. Peri-urban development, strengthening healthcare and social security systems, and encouraging social interaction and participation in group activities play critical roles in improving the QOL for elderly residing in Myanmar.

DOI： 10.1371/journal.pone.0241211

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Geographic distribution and utilisation of CT and MRI services at public hospitals in Myanmar. Reviewed International coauthorship International journal

Moe Khaing, Yu Mon Saw, Thet Mon Than, Aye Myat Mon, Su Myat Cho, Thu Nandar Saw, Tetsuyoshi Kariya, Eiko Yamamoto, Nobuyuki Hamajima

BMC health services research Vol. 20 ( 1 ) page： 742 - 742 2020.8

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: Diagnosis by computed tomography (CT) and magnetic resonance imaging (MRI) is important for patient care. However, the geographic distribution and utilisation of these machines in countries with limited resources, such as Myanmar, have not been sufficiently studied. Therefore, this study aims to identify the geographic distribution and utilisation of CT and MRI services at public hospitals in Myanmar. METHODS: This nationwide, cross-sectional study was conducted at 43 public hospitals in Myanmar. Data were collected retrospectively using a prepared form from 1st January 2015 to 31st December 2017 at public hospitals in Myanmar. A descriptive analysis was performed to calculate the number of CT and MRI units per million population in each state and region of Myanmar. The distribution of CT and MRI units was assessed using the Lorenz curve and Gini coefficient, which are indicators of inequality in distribution. RESULTS: In total, 45 CT and 14 MRI units had been installed in public hospitals in Myanmar by 2017. In total, 205,570 CT examinations and 18,981 MRI examinations have been performed within the study period. CT units per million population in 2017 varied from 0.30 in Rakhine State to 3.22 in Kayah State. However, MRI units were available only in public hospitals in five states/regions. The Gini coefficient for CT and MRI was 0.35 and 0.69, respectively. An upward trend in the utilisation rate of CT and MRI was also observed during the study period, especially among patients aged between 36 and 65 years. CONCLUSIONS: Throughout Myanmar, CT units were more equally distributed than MRI units. CT and MRI units were mostly concentrated in the Yangon and Mandalay Regions, where the population density is higher. The geographic distribution and utilisation rate of CT and MRI units varied among states, regions, and patients' age group. However, the utilisation rates of CT and MRI increased annually in all states and regions during the review period. The Ministry of Health and Sports in Myanmar should consider the utilisation and population coverage of CT and MRI as an important factor when there will be procurement of those medical equipment in the future.

DOI： 10.1186/s12913-020-05610-x

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Determinants of diarrhea in children under the age of five in Afghanistan: a secondary analysis of the Afghanistan Demographic and Health Survey 2015. Reviewed International coauthorship

Ahmad Nasir Wasiq, Yu Mon Saw, Sultani Jawid, Tetsuyoshi Kariya, Eiko Yamamoto, Nobuyuki Hamajima

Nagoya journal of medical science Vol. 82 ( 3 ) page： 545 - 556 2020.8

Language：English Publishing type：Research paper (scientific journal)

Diarrhea is the second leading cause of under-five mortality and globally accounts for 526,000 child deaths every year. Afghanistan, with 33,000 child deaths in 2012, was ranked 8th among nations, with the highest under-five deaths being from pneumonia and diarrhea. This study aimed to identify the determinants of diarrhea in children under the age of five in Afghanistan. A secondary data analysis of the Afghanistan Demographic and Health Survey (AfDHS) 2015 was focused on diarrhea in children under the age of five. The dataset of the AfDHS 2015 was used for the analysis. The subjects for this study were 30,238 under-five children. A logistic regression model was applied to examine the determinants of childhood diarrhea. This study found that 7,921 (26.2%) out of 30,238 under-five children had diarrhea within the two weeks preceding the survey. Higher maternal education accompanied a lower risk of childhood diarrhea with an adjusted odds ratio (AOR) of 0.70 (P<0.01) than did no education. Flush toilets (AOR=0.84, P<0.01) and traditional dry vaults (AOR=0.83, P<0.001) were less likely associated with diarrhea compared with pit latrines. Tube wells, public taps, and unprotected wells and springs were sources of drinking water with a higher risk of diarrhea than piped water. This study identified that the type of toilet facility, source of drinking water, age of the child, and maternal education were important determinants of under-five diarrhea. Intervention programs concerning improved sanitation facilities, sources of drinking water, and raising women's level of education and health awareness are important.

DOI： 10.18999/nagjms.82.3.545

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Estimation of the unvaccinated among those aged less than 25 years according to aimag and its association with incidence of measles outbreak 2015-2016 in Mongolia. Reviewed International coauthorship

Enkhbold Sereenen, Yu Mon Saw, Ryenchindorj Erkhembayar, Baigal Volodya, Otgonbayar Dashpagma, Oyunchimeg Orsoo, Tetsuyoshi Kariya, Chimedsuren Ochir, Eiko Yamamoto, Nobuyuki Hamajima

Nagoya journal of medical science Vol. 82 ( 3 ) page： 437 - 447 2020.8

Language：English Publishing type：Research paper (scientific journal)

Mongolia had an epidemic of measles in 2015-2016, even though more than 90% of the population have been vaccinated since 1997. This study aimed to examine the associations between unvaccinated proportion and measles incidence according to aimag. Mongolia has 21 provinces (aimag) with Ulaanbaatar as the capital city. Vaccination coverage between 1991 and 2014 and measles incidence according to aimag were obtained from the National Center for Communicable Diseases of Mongolia database. Accumulated unvaccinated proportion (AUP) among those aged 1 to 24 years in 2015 was estimated from the unvaccinated at the 1st dose of 1991 to 2014. From 1991 to 2014, unvaccinated proportion among those aged 1 to 24 years in the whole country has been reducing from 28.0% in 1991 to 1.8% in 2014. The AUP in 2015 varied from 2.7% (Selenge) to 21.8% (Govisumber). The incidence was remarkably higher in only two aimags with a large density of the unvaccinated aged 1 to 24 years (Ulaanbaatar and Darkhan-Uul) than in the other aimags. The incidence had no significant correlation with the AUP, although the correlation between the incidence and the density of unvaccinated aged 1 to 24 years was significant when the two aimags were included. In conclusion, the AUP between 2.7% and 21.8% had no correlation with the incidence according to aimags in Mongolia measles epidemic 2015-2016.

DOI： 10.18999/nagjms.82.3.437

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Etiologic agents of acute diarrhea in sentinel surveillance sites in Vientiane Capital, Lao People's Democratic Republic, 2012-2015. Reviewed International coauthorship International journal

Souphatsone Houattongkham, Eiko Yamamoto, Noikaseumsy Sithivong, Souphalak Inthaphatha, Tetsuyoshi Kariya, Yu Mon Saw, Arounnapha Vongduangchanh, Onechanh Keosavanh, Nobuyuki Hamajima

European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology Vol. 39 ( 6 ) page： 1115 - 1122 2020.6

Language：English Publishing type：Research paper (scientific journal)

This study aims to identify the pathogens of diarrhea in Vientiane Capital, Lao People's Democratic Republic (Lao PDR). The data of 2482 patients who visited eight health facilities due to diarrhea in 2012-2015 were retrospectively reviewed. Stool or rectal swabs collected from all patients were tested for bacteria. Children who were under 5 years old were additionally tested for rotavirus. Of 2482 cases, 1566 cases were under 5 years old, and at least one enteropathogen was detected in 475 cases (19.1%). Salmonella species was the most commonly detected bacterial pathogen. Enteropathogenic Escherichia coli (EPEC) and Salmonella species was the major pathogen in the dry season and the wet season, respectively. Eighty-seven patients tested positive for multiple bacteria. Rotavirus was detected in 291 children under 5 years old (32.4%), mostly from October to April. The major bacteria of coinfection with rotavirus were EPEC followed by Salmonella species. Salmonella species was the predominant bacterial pathogen of diarrhea of all ages, and rotavirus was the predominant pathogen among children under 5 years old. Further studies examining other types of pathogens for diarrhea and the introduction of a rotavirus vaccine for children are needed in Lao PDR.

DOI： 10.1007/s10096-020-03827-6

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Evaluation of a routine second curettage for hydatidiform mole: a cohort study. Reviewed

Eiko Yamamoto, Kimihiro Nishino, Kaoru Niimi, Eri Watanabe, Yukari Oda, Kazuhiko Ino, Fumitaka Kikkawa

International journal of clinical oncology Vol. 25 ( 6 ) page： 1178 - 1186 2020.6

Language：English Publishing type：Research paper (scientific journal)

OBJECTIVE: The aim of this study was to evaluate routine second curettage for hydatidiform mole (HM) by comparing the characteristics and outcomes of developing gestational trophoblastic neoplasia (GTN). STUDY DESIGN: This was a cohort study including 173 patients diagnosed with HM between January 2002 and August 2019 who were followed up at Nagoya University Hospital, Japan. After an evacuation, 105 and 68 patients were managed with the routine method (routine group) and elective method (elective group) for a second curettage, respectively. The routine second curettage was performed around 7 days after the first evacuation. Patients in the elective group underwent a second curettage if there was ultrasonographic evidence of molar remnants in the uterine cavity. Socio-clinical factors were retrospectively compared between the routine and elective groups, and between patients showing regression and those who developed GTN. RESULTS: The incidence of GTN was 15.2% in the routine group and 20.6% in the elective group, and the difference was not significant (P = 0.364). The median GTN risk score was significantly higher in the routine group than in the elective group (P = 0.033). Presence of a complete HM, gestational age, and a pre-treatment human chorionic gonadotropin level of ≥ 200,000 mIU/mL were independent risk factors for GTN in molar patients. CONCLUSION: The incidence of GTN was unchanged but the risk score of GTN was higher in the routine group than in the elective group. Routine second curettage may not be necessary, but further study will be needed to confirm this.

DOI： 10.1007/s10147-020-01640-x

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Prevalence of alcohol consumption and its risk factors among university students: A cross-sectional study across six universities in Myanmar. Reviewed International coauthorship International journal

Hein Htet, Yu Mon Saw, Thu Nandar Saw, Nang Mie Mie Htun, Khaing Lay Mon, Su Myat Cho, Thinzar Thike, Aye Thazin Khine, Tetsuyoshi Kariya, Eiko Yamamoto, Nobuyuki Hamajima

PloS one Vol. 15 ( 2 ) page： e0229329 2020.2

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: Globally, alcohol consumption is a significant public health concern and it is one of the most important risk behaviours among university students. Alcohol consumption can lead to poor academic performance, injuries, fights, use of other substances, and risky sexual behaviours among students. However, the study explored the prevalence of alcohol consumption and the associated risk factors among university students since these have not been fully examined in previous research. Therefore, the aim of this study was to explore the prevalence of alcohol consumption and the associated risk factors among university students in Myanmar. METHODS: The present cross-sectional study was conducted using a sample of 15-24-year-old university students who were selected from six universities in Mandalay, Myanmar, in August 2018. In total, 3,456 students (males: 1,301 and females: 2,155) were recruited and asked to respond to a self-administered questionnaire. Multiple logistic regression analysis was used to estimate the adjusted odds ratio (AOR) and 95% confidence interval (CI) for alcohol consumption among university students. RESULTS: The prevalence of alcohol consumption in the previous 30 days was 20.3% (males: 36.0%, females: 10.8%). The alcohol consumption was significantly higher among males (AOR = 2.3, 95% CI; 1.9-2.9), truant students (AOR = 2.1, 95% CI; 1.3-3.3), smokers (AOR = 7.0, 95% CI; 5.1-9.7), students who reported feeling of hopelessness or sadness (AOR = 1.4, 95% CI; 1.2-1.8), peers' alcohol consumption (AOR = 7.5, 95% CI; 4.8-11.7). CONCLUSION: The present study revealed that males, smokers, peer alcohol consumption, and truant students had higher odds of alcohol consumption among the students. Therefore, effective campus-based counselling, peer education, and national surveillance systems that can monitor risky drinking behaviours among university students should be implemented. Further, government regulations that control the production, sale, promotion, advertising, and restriction of alcohol should be well developed and strengthened, as in the case of other Southeast Asian countries.

DOI： 10.1371/journal.pone.0229329

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Association between body mass index and ready-to-eat food consumption among sedentary staff in Nay Pyi Taw union territory, Myanmar. Reviewed International coauthorship International journal

Thin Zar Thike, Yu Mon Saw, Htin Lin, Khin Chit, Aung Ba Tun, Hein Htet, Su Myat Cho, Aye Thazin Khine, Thu Nandar Saw, Tetsuyoshi Kariya, Eiko Yamamoto, Nobuyuki Hamajima

BMC public health Vol. 20 ( 1 ) page： 206 - 206 2020.2

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: Ready-to-eat (RTE) food consumption has become popular in the working community with the increase in full-time jobs and the limited time to prepare food. Although RTE food is essential for this community, its consumption causes obesity. In Myanmar, obesity is a modifiable risk factor for non-communicable diseases, causing increases in morbidity and mortality. This study aimed to identify the association between body mass index (BMI) and RTE food consumption among sedentary staff in Nay Pyi Taw Union Territory, Myanmar. METHODS: A cross-sectional study was conducted in 2018, in which 400 respondents participated in face-to-face interviews. The study area was selected using simple random sampling and drawing method. Measuring tape and digital weighing scale were used to measure the height and weight of the respondents. BMI was calculated by dividing the weight by height squared (kg/m2). Overweight and obesity were categorized by World Health Organization cut-off points. The collected data were analyzed using multiple logistic regression to estimate the adjusted odds ratio (AOR), and the 95% confidence interval (CI). RESULTS: This study revealed that sedentary staff who consumed RTE food once or more per month were nearly five times more likely to be overweight and obese (AOR = 4.78, 95% CI 1.44-15.85) than those who consumed RTE food less frequently. In addition, five factors namely being older than 32 years (AOR = 3.97, 95% CI 1.82-8.69), preference for RTE food (AOR = 8.93, 95% CI 2.54-31.37), light-intensity of physical exercise (AOR = 3.55, 95% CI 1.63-7.73), sedentary leisure activities (AOR = 3.32, 95% CI 1.22-9.03), and smoking (AOR = 5.62, 95% CI 1.06-29.90) were positively associated with overweight and obesity. CONCLUSION: Frequent consumers of RTE food and less physically active sedentary staff were more likely to be overweight and obese. This study highlights the urgent need to raise awareness regarding healthy lifestyle behaviors among the working community to reduce the burden of obesity-related chronic diseases. Moreover, sedentary workers should be aware of the food-based dietary guidelines of the country. Policy makers should strictly enforce nutritional labeling of RTE food, and strictly prohibit over-branding of RTE food.

DOI： 10.1186/s12889-020-8308-6

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Cross-sectional study on tobacco advertising, promotion and sponsorship (TAPS) and violations of tobacco sale regulations in Myanmar: do these factors affect current tobacco use among Myanmar high school students? Reviewed International coauthorship International journal

Su Myat Cho, Yu Mon Saw, Nyi Nyi Latt, Thu Nandar Saw, Hein Htet, Moe Khaing, Thet Mon Than, Ei Mon Win, Zaw Zaw Aung, Tetsuyoshi Kariya, Eiko Yamamoto, Nobuyuki Hamajima

BMJ open Vol. 10 ( 2 ) page： e031933 2020.2

Language：English Publishing type：Research paper (scientific journal)

OBJECTIVES: To examine the associations of current tobacco use with tobacco advertising, promotion and sponsorship (TAPS), and illicit tobacco sales exposures among Myanmar high school students. DESIGN: A quantitative, cross-sectional study. SETTING: Seven high schools from both urban and rural areas of four states and regions in Myanmar. PARTICIPANTS: In total, 1174 high school students (482 males and 692 females) were interviewed using a self-administered questionnaire. MAIN OUTCOME MEASURE: Current tobacco use of participants, defined as using any kind of smoked or smokeless tobacco product at least one occasion within the past 30 days. RESULTS: The prevalence of TAPS exposure was 90.9% among high school students in Myanmar. Current tobacco use was positively associated with being over 14 years old (adjusted OR (AOR) 9.81; 95% CI 4.54 to 21.19), being male (AOR 28.06; 95% CI 13.29 to 59.25), exposure to any kind of TAPS (AOR 6.59; 95% CI 2.33 to 18.64), having seen any smoked tobacco product for sale inside or within 100 feet of the school premises (AOR 4.17; 95% CI 1.65 to 10.58), having seen the sale or gifting of any smoked tobacco product to minors (AOR 6.46; 95% CI 2.18 to 19.12) and having seen the sale or distribution of any smoked tobacco product by minors (AOR 2.42; 95% CI 1.42 to 4.10). Having ever received health education about tobacco use (AOR 0.45; 95% CI 0.27 to 0.78), or having a higher perception score of tobacco use (AOR 0.17; 95% CI 0.10 to 0.30) were negatively associated with current tobacco use. CONCLUSIONS: There was an alarming prevalence of TAPS exposure among Myanmar high school students. TAPS exposure and violations of tobacco sale regulations were strong risk factors for current tobacco use among Myanmar high school students, while health education about tobacco products was reported as an effective protective factor. Specific smokeless tobacco sale regulations for minors are needed immediately in Myanmar.

DOI： 10.1136/bmjopen-2019-031933

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Disease frequency among inpatients at a tertiary general hospital in Lao PDR. Reviewed International coauthorship

Viengsakhone Louangpradith, Bounfeng Phoummalaysith, Tetsuyoshi Kariya, Yu Mon Saw, Eiko Yamamoto, Nobuyuki Hamajima

Nagoya journal of medical science Vol. 82 ( 1 ) page： 113 - 121 2020.2

Language：English Publishing type：Research paper (scientific journal)

In Lao People's Democratic Republic (Lao PDR), reports on disease frequency are very limited. This study aimed to report frequencies of the main cause of admission among inpatients of a tertiary general hospital (Mittaphab Hospital) in Vientiane. Subjects were inpatients who were admitted from January 3 to February 2 in 2017. The dataset were made as a pilot run to establish hospital statistics. The data on sex, age, address (province), dates of admission and discharge, and main diagnosis were collected from paper-based medical charts. International Classification of Diseases 10 was applied for classifying the main diagnosis. During the 1-month period, 1,201 inpatients (637 males and 564 females) were admitted, including 171 (14.2%) aged <20 years and 254 (21.1%) aged ≥60 years. About 20% patients were from outside of Vientiane. Among them, 67.5% (62.5% in males and 73.8% in females) were admitted within 7 days. The main causes with more than 10% in males were injury and poisoning S00-T98 (49.8%), while those in females were injury and poisoning S00-T98 (25.2%), pregnancy and childbirth O00-O99 (19.0%), and diseases of genitourinary system N00-N99 (13.7%). Injury and poisoning S00-T98 among inpatients aged <20 years was 81.8% in males and 59.0% in females. Among those aged 20-59 years, it was 49.9% and 22.4%, and among those aged ≥60 years it was 22.3% and 16.9%, respectively. This is the first report on the frequencies of main diseases among inpatients in Lao PDR. Injury was the first main cause of admission at the tertiary hospital.

DOI： 10.18999/nagjms.82.1.113

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Estimating cost of hospitalization for childbirth at a tertiary hospital in Mongolia. Reviewed International coauthorship

Bolorchimeg Taazan, Eiko Yamamoto, Bayart Baatar, Avirmed Amgalanbaatar, Tetsuyoshi Kariya, Yu Mon Saw, Nobuyuki Hamajima

Nagoya journal of medical science Vol. 82 ( 1 ) page： 47 - 57 2020.2

Language：English Publishing type：Research paper (scientific journal)

Health services for pregnancy and delivery at public health facilities are fully subsidized by the government in Mongolia. However, it has been reported that health financing, budget planning, and implementation processes are weak. Therefore, this study aims to estimate the costs per inpatient of vaginal delivery and cesarean section (C-section) by using data gathered from a tertiary hospital in Ulaanbaatar. Inpatient and financial data were collected from the Statistics and Finance, Economics Department of National Center for Maternal and Child Health. A top-down method was used for the calculation of unit costs. The total number of deliveries in 2016 were 11,033, including 7,777 vaginal deliveries and 3,256 C-sections. The cost per inpatient stay for vaginal delivery and C-section were USD 255 and USD 592, respectively. The average cost per bed-day of the six departments of the obstetrics and gynecology hospital was USD 80. The percentage that represents employees' salary in the cost per inpatient was as low as 12.4% for vaginal delivery and 18.5% for C-section, although the cost for salaries accounted for 51.2% of the total expenditure of the hospital. Results show that the cost per inpatient of C-section was two times higher than that of vaginal delivery. The cost of childbirths may account for approximately 9% of total health expenditure of the country. These results may be advantageous to the government in instituting a policy and controlling the health care budget to improve cost-effectiveness and equal access to all in health care services in Mongolia.

DOI： 10.18999/nagjms.82.1.47

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Assessing risk factors and impact of cyberbullying victimization among university students in Myanmar: A cross-sectional study. Reviewed International coauthorship International journal

Aye Thazin Khine, Yu Mon Saw, Zaw Ye Htut, Cho Thet Khaing, Htin Zaw Soe, Kyu Kyu Swe, Thinzar Thike, Hein Htet, Thu Nandar Saw, Su Myat Cho, Tetsuyoshi Kariya, Eiko Yamamoto, Nobuyuki Hamajima

PloS one Vol. 15 ( 1 ) page： e0227051 2020.1

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: Cyberbullying is a global public health concern with tremendous negative impacts, not only on the physical and mental health of students but also on their well-being and academic performance. However, there are very few studies on cyberbullying among university students, especially in Myanmar. This study aims to determine the percentage of university students who suffered cyberbullying victimization in the last 12 months, and the association between students' socio-demographic characteristics, adverse events following cyberbullying and cyberbullying victimization. METHODS: A cross-sectional study was conducted among university students aged 18 years and older at one medical university in Magway, Myanmar. A total of 412 students (277 males and 135 females) participated in the study. Data were collected from August to September, 2018 using a self-administered questionnaire. Multiple logistic regression analyses (models I and II) were performed to estimate the unadjusted (UOR) and adjusted odds ratios (AOR), and 95% confidence intervals (CI). RESULTS: In total, 40.8% of males and 51.1% of females in the study had suffered cyberbullying victimization in the past 12 months. In model I, students who had been studying at the university for 3 years or less (AOR = 1.81; 95% CI 1.14-2.85), and who had witnessed psychological, physical or sexual violence, or cyberbullying in their neighborhoods, (AOR = 2.95; 95% CI 1.48-5.91) were more likely to have suffered cyberbullying victimization in the past 12 months. In model II, being a victim of cyberbullying was associated with difficulties in concentrating and understanding lectures (AOR = 3.96; 95% CI 1.72-9.11), and substance abuse (AOR = 2.37; 95% CI 1.02-5.49). Non-resident students were at a higher risk of being cyberbullying victims than their resident peers (AOR = 1.86; 95% CI 1.04-3.34). CONCLUSION: Two out of five students had suffered cyberbullying victimization in the past 12 months, and only half of the victims discussed their experience(s) with someone else. Students who suffered cyberbullying victimization faced academic difficulties and started or increased smoking, betel chewing or alcohol drinking. Counter measures to prevent and mitigate the adverse events related to cyberbullying victimization are urgently needed among university students in Myanmar. Periodic screening for cyberbullying, counseling services, cyber-safety educational programs, and awareness raising campaigns should be implemented.

DOI： 10.1371/journal.pone.0227051

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Dengue fever during pregnancy

Trinh Tien Dat, Kotani Tomomi, Yamamoto Eiko, Shibata Kiyosumi, Moriyama Yoshinori, Tsuda Hiroyuki, Yamashita Mamoru, Kajiyama Hiroaki, Dien Duc Thien Minh, Le Quang Thanh, Kikkawa Fumitaka

NAGOYA JOURNAL OF MEDICAL SCIENCE Vol. 80 ( 2 ) page： 241 - 247 2018.5

Establishment and characterization of cell lines derived from complete hydatidiform mole. Reviewed

Yamamoto E, Niimi K, Kiyono T, Yamamoto T, Nishino K, Nakamura K, Kotani T, Kajiyama H, Shibata K, Kikkawa F

International Journal of Molecular Medicine Vol. 40 ( 3 ) page： 614-622 2017.9

Authorship：Lead author Language：English Publishing type：Research paper (scientific journal)

Gestational trophoblastic diseases (GTDs) are a group of diseases characterized by abnormal cellular proliferation of atypical trophoblasts. A hydatidiform mole is an abnormal pregnancy caused by genetic fertilization disorders, and it can be classified as a complete hydatidiform mole (CHM) or a partial hydatidiform mole. The aim of this study was to establish cell lines from CHMs and to characterize the cells for future studies concerning GTD. HMol1-2C, HMol1-3B, HMol1-8 and HMol3-1B were established from primary cultures of CHM explants following the introduction of different combinations of genes including human telomerase reverse transcriptase (hTERT), a mutant form of CDK (CDK4R24C), cyclin D1, p53C234, MYC and HRAS. HMol1-2C, HMol1-3B, and HMol3-1B were confirmed to originate from trophoblasts of androgenic, homozygous CHMs. These three cell lines exhibited low human chorionic gonadotropin secretion, low migration and invasion abilities, and the potential to differentiate into syncytiotrophoblastic cells via forskolin treatment. These results suggest that these cells exhibit characteristics of trophoblastic cells, especially cytotrophoblastic cells. HMol1-8 was found to consist of diploid cells and originated from maternal cells, suggesting that they were derived from decidual cells. In conclusion, we successfully established three cell lines from CHMs by introduction of hTERT and other genes. Analysis revealed that the genetic origin of each cell line was identical with that of the original molar tissue, and the cell lines exhibited characteristics of trophoblastic cells, which are similar to undifferentiated cytotrophoblasts.

DOI： 10.3892/ijmm.2017.3067.

Inhibition of ZEB1 leads to inversion of metastatic characteristics and restoration of paclitaxel sensitivity of chronic chemoresistant ovarian carcinoma cells. Reviewed

Sakata J, Utsumi F, Suzuki S, Niimi K, Yamamoto E, Shibata K, Senga T, Kikkawa F, Kajiyama H.

Oncotarget Vol. 8 ( 59 ) page： 99482-99494 2017.8

Spontaneous regression of gestational trophoblastic neoplasia. Reviewed

Niimi K, Yamamoto E, Nishino K, Fujiwara S, Ino K, Kikkawa F.

Gynecolgic Oncology Reports Vol. 25 ( 21 ) page： 98-100 2017.7

N-acetylglucosaminyltransferase IVa promotes invasion of choriocarcinoma. Reviewed

Nishino K, Yamamoto E, Niimi K, Sekiya Y, Yamashita Y, Kikkawa F.

Oncology reports Vol. 38 ( 1 ) page： 440-448 2017.7

c-Rel Promotes Invasion of Choriocarcinoma Cells via PI3K/AKT Signaling. Reviewed

Sekiya Y, Yamamoto E, Niimi K, Nishino K, Nakamura K, Kotani T, Kajiyama H, Shibata K, Kikkawa F.

Oncology Vol. 92 ( 5 ) page： 299-310 2017.3

Language：English Publishing type：Research paper (scientific journal)

OBJECTIVE:
Choriocarcinoma is the most common epithelial cancer among gestational trophoblastic diseases (GTDs); the mechanism of trophoblastic carcinogenesis is unknown. This study aimed to examine the expression of NF-κB family proteins in GTDs and placental tissues as well as the roles of c-Rel in choriocarcinoma.
METHODS:
We examined the expression of NF-κB family proteins in normal placenta and hydatidiform mole tissues as well as extravillous trophoblast (EVT) and choriocarcinoma cell lines by Western blot and immunohistochemistry. Immunoprecipitation was performed to determine which proteins can bind with c-Rel in choriocarcinoma cells. To investigate the roles of c-Rel in choriocarcinoma, we examined the effects of c-Rel knockdown and overexpression on cell proliferation, migration, and invasion using small interfering RNAs and gene activation plasmid.
RESULTS:
The expression of c-Rel was strong in choriocarcinoma and EVTs, but very weak in villi of normal placenta and hydatidiform mole. Immunoprecipitation suggested that c-Rel heterodimerizes with p65 in choriocarcinoma. c-Rel knockdown reduced invasion, migration, and AKT phosphorylation in choriocarcinoma cells. c-Rel overexpression in choriocarcinoma increased migratory and invasive abilities, and the effect on invasion was inhibited by a PI3K inhibitor.
CONCLUSION:
These findings suggest that c-Rel might play a role in promoting the invasion of choriocarcinoma cells through PI3K/AKT signaling.

DOI： 10.1159/000458529.

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