Faculty Profiles - NISHIGORI Hiroshi

Association between daily breakfast habit during pregnancy and neurodevelopment in 3-year-old offspring: The Japan Environment and Children’s Study Open Access

Imaizumi K., Murata T., Isogami H., Fukuda T., Kyozuka H., Yasuda S., Yamaguchi A., Sato A., Ogata Y., Shinoki K., Hosoya M., Yasumura S., Hashimoto K., Fujimori K., Nishigori H., Kamijima M., Yamazaki S., Ohya Y., Kishi R., Yaegashi N., Mori C., Ito S., Yamagata Z., Inadera H., Nakayama T., Sobue T., Shima M., Nakamura H., Suganuma N., Kusuhara K., Katoh T.

Scientific Reports Vol. 14 ( 1 ) 2024.12

Publisher：Scientific Reports

The association between daily breakfast habits during pregnancy and offspring neurodevelopment remains unknown. We evaluated the association between breakfast habits during pregnancy and offspring neurodevelopment. Data of 72,260 women with singleton deliveries at and after 37 weeks of gestation enrolled during 2011–2014 in the Japan Environment and Children’s Study were analysed. Offspring neurodevelopmental delays at 3 years of age were evaluated using the Ages and Stages Questionnaire, Third Edition (ASQ-3). Participants were stratified by tertiles of maternal daily energy intake (DEI) (Groups 1, 2, and 3:< 1400, 1400–1799, and ≥ 1800 kcal, respectively) during pregnancy and by offspring sex. The adjusted odds ratio (aOR) for abnormality in communication among participants with daily breakfast consumption habit was 0.87 (95% confidence interval, 0.80–0.96). A stratified analysis based on total DEI showed no significant differences in the neurodevelopment of Group 1 offspring. The aOR for abnormality in communication was 0.80 (95% confidence interval, 0.68–0.94) in Group 2. The aOR for abnormality in personal–social characteristics was 0.84 (95% confidence interval, 0.71–0.99) in Group 3. Maternal daily breakfast habits are associated with offspring neurodevelopment at 3 years of age, with the association influenced by maternal DEI and offspring sex.

DOI： 10.1038/s41598-024-55912-x

What can Japanese medical education contribute to the world?

Exploring yarigai: The meaning of working as a physician in teaching medical professionalism Reviewed Open Access

Nishigori, H; Shimazono, Y; Busari, J; Dornan, T

MEDICAL TEACHER Vol. 46 ( 11 ) page： 1486 - 1493 2024.11

Language：English Publisher：Medical Teacher

Introduction: The shift in medical professionalism now considers the well-being of physicians, given the prevalence of burnout and the importance of work-life balance. To reconsider the question ‘Why do doctors work for the patient?’ and explore the meaning of working as a physician, this study adopts the concept of ‘yarigai,’ which represents fulfillment and motivation in meaningful work. The authors’ research questions are: How do doctors recount experiences of yarigai in caring for patients? What kind of values are embodied in their stories about yarigai? Method: They adopted narrative inquiry as the methodology for this study. They interviewed 15 doctors who were recognized by their colleagues for their commitment to patient-centered care or had demonstrated yarigai in caring for patients. The semi-structured interviews were conducted face-to-face with each participant by the Japanese researchers, yielding 51 cases of patient-doctor interactions. After grouping the interview data, they translated the cases into English and identified four representative cases to present based on the set criteria. Results: From the 51 case studies, they constructed four representative narratives about the yarigai as a physician. Each of them spoke of (1) finding positive meaning in difficult situations, (2) receiving gifts embodying ikigai, (3) witnessing strength in a seemingly powerless human being, and (4) cultivating relationships that transcend temporal boundaries, as being rewarding in working as a physician. The main results of the study, which are the narratives, are described in the main body of the paper. Conclusion: The stories on yarigai gave intrinsic meanings to their occupational lives, which can be informative for students, residents, and young physicians when contemplating the meaning of their work as doctors. Rather than demanding selfless dedication from physicians towards patients, they believe it more important to foster yarigai, derived from the contribution to the well-being of others through patient care.

DOI： 10.1080/0142159X.2024.2316227

錦織　宏　名古屋大学総合医学教育センター長・教授

錦織宏

医学教育 Vol. 55 ( 5 ) page： 374 - 376 2024.10

Nishigori, H; Haruta, J; Urushibara-Miyachi, Y

MEDICAL TEACHER Vol. 46 ( sup1 ) page： S1 - S3 2024.6

Medical education in Japan

Nishigori, H

MEDICAL TEACHER Vol. 46 ( sup1 ) page： S4 - S10 2024.6

Language：English Publisher：Medical Teacher

The Model Core Curriculum for Medical Education (MCC) currently, there are 82 medical schools in Japan. The combined enrollment capacity of medical schools nationwide stands at 9,217. Students are eligible to enter medical school upon graduation from senior high school. The standard undergraduate medical education curriculum in Japan spans six years. The Model Core Curriculum for Medical Education (MCC), developed by the Ministry of Education, Culture, Sports, Science and Technology (MEXT), serves as the guideline for all medical school curricula. The Common Achievement Tests Organization (CATO) conducts the Computer-Based Testing (CBT) and the Objective Structured Clinical Examination (OSCE) in all medical schools. The Japan Accreditation Council for Medical Education (JACME), formally recognized by the World Federation of Medical Education (WFME), is responsible for the accreditation of undergraduate medical education in Japan. The National Examination for Medical Practitioners, administered by the Ministry of Health, Labour and Welfare (MHLW) and held annually, is a paper-based examination in which examinees answer multiple-choice questions. After graduating from medical school and obtaining a medical license, individuals progress to a two-year basic postgraduate clinical training program. Upon completion, they advance to a three-to-five-year specialty training phase. The lifelong learning of physicians is overseen by the respective medical societies and the Japan Medical Association. Current issues facing medical education in Japan include bloated curricula, faculty members’ busy schedules and burdens, educational disparities and admission selection, and uneven distribution of specialties. The author believes that medical education should continue to evolve to reflect future changes in society.

DOI： 10.1080/0142159X.2024.2372108

Web of Science

Association of cesarean section and infectious outcomes among infants at 1 year of age: Logistic regression analysis using data of 104,065 records from the Japan Environment and Children's Study Open Access

PubMed

Maeda H., Hashimoto K., Iwasa H., Kyozuka H., Kume Y., Go H., Sato A., Ogata Y., Murata T., Fujimori K., Shinoki K., Nishigori H., Yasumura S., Hosoya M., Kamijima M., Yamazaki S., Ohya Y., Kishi R., Yaegashi N., Mori C., Ito S., Yamagata Z., Inadera H., Nakayama T., Iso H., Shima M., Kurozawa Y., Suganuma N., Kusuhara K., Katoh T.

PLoS ONE Vol. 19 ( 2 February ) 2024.2

Publisher：PLoS ONE

Background There has been a recent decrease in the prevalence of infectious diseases in children worldwide due to the usage of vaccines. However, the association between cesarean delivery and infectious diseases remains unclear. Here, we aimed to clarify the association between cesarean delivery and the development of infectious diseases. Methods This study is a cross-sectional study. We used data from the Japan Environment and Children's Study, which is a prospective, nationwide, government-funded birth cohort study. The data of 104,065 records were included. Information about the mode of delivery, central nervous system infection (CNSI), otitis media (OM), upper respiratory tract infection (URTI), lower respiratory tract infection (LRTI), gastrointestinal infection (GI), and urinary tract infection (UTI) was obtained from questionnaires and medical records transcripts. Multiple logistic regression analysis was used to assess the association between cesarean delivery and CNSI, OM, URTI, LRTI, GI, and UTI risk. Results We included a total of 74,477 subjects in this study, of which 18.4% underwent cesarean deliveries. After adjusting for the perinatal, socioeconomic, and postnatal confounding factors, children born by cesarean delivery did not have an increased risk of developing CNSI (95% confidence interval [CI] 0.46-1.35), OM (95% CI 0.99-1.12), URTI (95% CI 0.97-1.06), LRTI (95% CI 0.98-1.15), GI (95% CI 0.98-1.11), or UTI (95% CI 0.95-1.45). Conclusions This nationwide cohort study did not find an association between cesarean delivery and CNSI, OM, URTI, LRTI, GI, and UTI. However, further studies are needed to evaluate the role of cesarean delivery in the development of infectious diseases. Copyright:

DOI： 10.1371/journal.pone.0298950

Prenatal folic acid supplement/dietary folate and cognitive development in 4-year-old offspring from the Japan Environment and Children’s Study Open Access

Nishigori H., Nishigori T., Obara T., Suzuki T., Mori M., Imaizumi K., Murata T., Kyozuka H., Ogata Y., Sato A., Shinoki K., Yasumura S., Hosoya M., Hashimoto K., Fujimori K., Kamijima M., Yamazaki S., Ohya Y., Kishi R., Yaegashi N., Mori C., Ito S., Yamagata Z., Inadera H., Nakayama T., Sofue T., Shima M., Nakamura H., Suganuma N., Kusuhara K., Katoh T.

Scientific Reports Vol. 13 ( 1 ) 2023.12

Publisher：Scientific Reports

We evaluated the association between maternal prenatal folic acid supplement use/dietary folate intake and cognitive development in 4-year-old offspring (N = 3445) using data from the Japan Environment and Children’s Study. Cognitive development was evaluated using the Kyoto Scale of Psychological Development 2001. Multiple regression analysis revealed that offspring of mothers who started using folic acid supplements pre-conception had a significantly higher language-social developmental quotient (DQ) (partial regression coefficient 1.981, 95% confidence interval 0.091 to 3.872) than offspring of mothers who did not use such supplements at any time throughout their pregnancy (non-users). Offspring of mothers who started using folic acid supplements within 12 weeks of gestation had a significantly higher cognitive-adaptive (1.489, 0.312 to 2.667) and language-social (1.873, 0.586 to 3.159) DQ than offspring of non-users. Regarding daily dietary folate intake from preconception to early pregnancy, multiple regression analysis revealed that there was no significant association with any DQ area in the 200 to < 400 µg and the ≥ 400 µg groups compared with the < 200 µg group. Maternal prenatal folic acid supplementation starting within 12 weeks of gestation (but not adequate dietary folate intake from preconception to early pregnancy) is positively associated with cognitive development in 4-year-old offspring.

DOI： 10.1038/s41598-023-36484-8

Association between gestational age at threatened preterm birth diagnosis and incidence of preterm birth: the Japan Environment and Children’s Study Open Access

Murata T., Isogami H., Imaizumi K., Fukuda T., Kyozuka H., Yasuda S., Yamaguchi A., Sato A., Ogata Y., Shinoki K., Hosoya M., Yasumura S., Hashimoto K., Nishigori H., Fujimori K., Kamijima M., Yamazaki S., Ohya Y., Kishi R., Yaegashi N., Mori C., Ito S., Yamagata Z., Inadera H., Nakayama T., Sobue T., Shima M., Nakamura H., Suganuma N., Kusuhara K., Katoh T.

Scientific Reports Vol. 13 ( 1 ) 2023.12

Publisher：Scientific Reports

We evaluated the association between gestational age at threatened preterm birth (TPTB) diagnosis and preterm birth (PTB) incidence using a nationwide birth cohort. Data of 94,236 women with singleton deliveries from the Japan Environment and Children’s Study (enrolled between 2011 and 2014) were analysed. Participants were divided based on parity and gestational age at TPTB diagnosis (22–24, 25–27, 28–30, 31–33, and 34–36 weeks). Multivariable logistic regression models were used to calculate the odds ratios (ORs) for PTB before 37 and 34 weeks in women from all groups, using participants without TPTB as the reference. The adjusted ORs for PTB before 37 weeks were the highest in the latest gestational age group in nulliparous and multiparous women without previous PTB, while those before 34 weeks were the highest in the earliest and latest gestational age group in multiparous women without previous PTB and in the earliest gestational age group in multiparous women with previous PTB. The association between gestational age at TPTB diagnosis and PTB incidence varies based on maternal parity and PTB before 37 or 34 weeks. Further studies with detailed clinical data and a unified TPTB diagnosis protocol are necessary to clarify this association.

DOI： 10.1038/s41598-023-38524-9

Deconstructing the masculinized assumption of the medical profession: narratives of Japanese physician fathers Reviewed Open Access

Kamihiro, N; Taga, F; Miyachi, J; Matsui, T; Nishigori, H

BMC MEDICAL EDUCATION Vol. 23 ( 1 ) page： 857 2023.11

Language：English Publisher：BMC Medical Education

Background: Gender studies in the medical profession have revealed gender biases associated with being a doctor, a profession often regarded as more suitable for men. The path to gender equality inevitably involves deconstructing this masculinized assumption. Despite the decades-long expectation that ikumen–men who actively participate in childcare in Japan–would contribute to a change toward gender equality, Japanese society is still male dominated, and women suffer from a large gender gap. With the aim of exploring implicit gendered assumptions concerning being a caregiver and a doctor, the authors focused on the experience of individuals juggling the binary roles of a professional and a caregiver. Methods: The authors conducted subjectivist inductive research, recruited ten Japanese physician fathers through purposive sampling, and collected data through one-to-one semi-structured interviews between October 2017 and December 2018. The authors recorded and transcribed the narrative data, and extracted themes and representative narratives. Results: The study identified three themes about the reproduction and potential change of the gender gap: maintaining gendered assumptions of the medical profession without experiencing conflict, maintaining gendered assumptions of the medical profession while experiencing conflict, and deconstructing gendered assumptions of the medical profession through conflict. The authors found that these negotiations interplayed with the gendered division of labor between male doctors and their wives as well as the patriarchal family structure. Conclusions: The study revealed how gendered assumptions of the medical profession, as well as gender stereotypes and gendered division of household labor, were reproduced in the course of male doctors’ negotiations when they became fathers. For male doctors to question their unconscious gender bias, the authors emphasize the importance of men gaining knowledge about gender stereotypes, and propose that educators create such opportunities. Moreover, the authors assert that increasing doctors’ awareness of how masculinized assumptions implicitly interact with ideas of being a doctor—an aspect rarely discussed among medical professionals—is crucial for deconstructing the gendered normativity in the medical field.

DOI： 10.1186/s12909-023-04855-4

宮地純一郎, 錦織宏

月刊地域医学 Vol. 37 ( 9 ) page： 65 2023.9

Report on Workshops at the 55th Annual Conference Reviewed

Takeda Yuko, Tsuchiya Shizuma, Saiki Takuya, Maeno Takami, Imafuku Rintaro, Matsuyama Yasushi, Yagi Machiko, Kikukawa Makoto, Obara Haruo, Shiibashi Michio, Nakamura Mariko, Takamura Akiteru, Nagasaki Kazuya, Kobayashi Shizuko, Tsuruta Jun, Miyachi Yuka, Nishigori Hiroshi

Igaku Kyoiku / Medical Education (Japan) Vol. 54 ( 4 ) page： 406 - 409 2023.8

Narrative Review of Feedback -From Definition to Recent Discussion- Reviewed

Kimura Takeshi, Nishigori Hiroshi

Igaku Kyoiku / Medical Education (Japan) Vol. 54 ( 3 ) page： 255 - 265 2023.6

Language：Japanese Publisher：Japan Society for Medical Education

Feedback is an educational activity that occurs in a variety of settings in medical education and has been widely discussed since 2008, when Ridder et al. defined it as "Specific information about the comparison between a trainee's observed performance and a standard, given with the intent to improve the trainee's performance." (Ridder et al., 2008, p.3). Since then, discussions on effective feedback have shifted from a behaviorist, instructor-centered approach to a more multifaceted approach that focuses on relationship and the learner as recipient of feedback, or the learner's potential ability to make use of feedback (self-regulated learning, feedback literacy).

DOI： 10.11307/mededjapan.54.3_255

Reflection on Interprofessional Collaboration Based on Uncomfortable Experiences Reviewed

Sano Itsuki, Morishita Mariko, Nishigori Hiroshi

Igaku Kyoiku / Medical Education (Japan) Vol. 54 ( 3 ) page： 281 - 287 2023.6

Language：Japanese Publisher：Japan Society for Medical Education

The first author set up a study group with other members in 2014, aiming to improve multidisciplinary collaboration through reflection and discussions on discomfort ( “Moyatto” in Japanese) while focusing on group members’ experiences at work. One-hour online sessions were conducted monthly with multidisciplinary professionals from several institutions. We reflected on interprofessional collaboration based on Moyatto. This paper describes the history of the study group’s inception and development, the learning process of each session, and the theory as a framework. It also reports on the practice and changes in our study group, concluding that interprofessional collaboration requires first-order reflection within a same-profession group and second-order reflection among diverse professionals.

DOI： 10.11307/mededjapan.54.3_281

2. A Newly Established Quality/Competency "Taking a Multi-Systemic View towards a Patient as a Living Person" Reviewed

Haruta Junji, Ando Takayuki, Endo Amane, Kaneko Makoto, Shikino Kiyoshi, Nagamine Yuiko, Nishigori Hiroshi, Fujikawa Hirohisa, Yamanashi Hirotomo

Igaku Kyoiku / Medical Education (Japan) Vol. 54 ( 2 ) page： 142 - 148 2023.4

Language：Japanese Publisher：Japan Society for Medical Education

Based on the social context of an aging society and surveys conducted since 2020, the need for comprehensive perspectives and approaches that consider patients'psychosocial background and a cross-organ perspective has been identified. As a result, a new quality and ability, namely comprehensive attitudes toward patients, has been established as part of the core curriculum for medical education in FY2022. Specific learning objectives include "holistic perspectives and approaches," "community perspectives and approaches," "life perspectives and approaches," and "social perspectives and approaches". An educational design that draws on multiple learning theories to enable reflection on one's own way of being has been proposed to integrate abstract and concrete, conceptual and experiential, and self and others perspectives. It is expected that this medical education will lead to improvement in the well-being of individuals, families, and communities.

DOI： 10.11307/mededjapan.54.2_142

7. Educational Strategies and Good Practice (1) Reviewed

Matsushima Kayoko, Asada Yoshikazu, Nomura Osamu, Haruta Junji, Yamaguchi Kumiko, Kondo Takeshi, Nishigori Hiroshi, Konishi Yasuhiko

Igaku Kyoiku / Medical Education (Japan) Vol. 54 ( 2 ) page： 177 - 181 2023.4

Language：Japanese Publisher：Japan Society for Medical Education

In the 2022 revision of the Model Core Curriculum, a new "Educational Strategies and Assessment" section was added as a further development in outcome-based education. By adding a chapter on strategies and evaluation, which is an important element of the curriculum, and linking it to qualities and abilities, we have devised a way for learners and instructors to make use of the Core Curriculum more easily. In addition, 11 example of strategy and assessment cases are included as Good Practice to encourage practical application. However, since these are only examples, we hope this chapter will be further developed as universities create strategies and evaluations that make the most of their unique characteristics.

DOI： 10.11307/mededjapan.54.2_177

Forword　In Featuring the Special Topics Reviewed

Nishigori Hiroshi, Konishi Yasuhiko

Igaku Kyoiku / Medical Education (Japan) Vol. 54 ( 2 ) page： 133 - 133 2023.4

Summary　Outline of the 2022 Revision of the Model Core Curriculum for Medical Education in Japan Oversight of the Revision : Evidence-Based Medical Education Reviewed

Nishigori Hiroshi

Igaku Kyoiku / Medical Education (Japan) Vol. 54 ( 2 ) page： 199 - 202 2023.4

Language：Japanese Publisher：Japan Society for Medical Education

The 2022 revision of the Model Core Curriculum for Medical Education by the Japan Society for Medical Education was based on several data sets including academic papers and survey results. It is recommended that the formation of a team consisting of diverse attributes, sufficient discussion using a web conference system, smooth communication between the government and academic societies, and dialogue with organizations related to medical education be continued in the next revision. On the other hand, collaboration and communication with academic societies in specialized fields is an issue for the future.　Although the revised Model Core Curriculum for Medical Education is the product of the collective wisdom of experts in medical education in Japan in the early 2020s, it is by no means a legal mandate imposed by the state, nor does it force faculty members of each university to follow it blindly. We hope that those involved in medical education will use this Model Core Curriculum, which was prepared with an eye to society 20 years from now, as a reference guide, and at the same time, we hope that those involved in education in the field will implement the updated guidelines while sometimes questioning them.

DOI： 10.11307/mededjapan.54.2_199

Association of labour duration in spontaneous deliveries with low neonatal Apgar scores and foetal acidosis: the Japan Environment and Children’s Study Open Access

Murata T., Yasuda S., Imaizumi K., Isogami H., Fukuda T., Kyozuka H., Yamaguchi A., Sato A., Ogata Y., Shinoki K., Hosoya M., Yasumura S., Hashimoto K., Nishigori H., Fujimori K., Kamijima M., Yamazaki S., Ohya Y., Kishi R., Yaegashi N., Mori C., Ito S., Yamagata Z., Inadera H., Nakayama T., Iso H., Shima M., Nakamura H., Suganuma N., Kusuhara K., Katoh T.

Scientific Reports Vol. 12 ( 1 ) 2022.12

Publisher：Scientific Reports

This study evaluated the association between labour duration (LD) and incidence of low neonatal Apgar scores and foetal acidosis. Data of 37,682 women with full-term singleton spontaneous vaginal deliveries from the Japan Environment and Children’s Study were analysed. Women were classified according to the median LD as nulliparous (< 10 or ≥ 10 h) or multiparous (< 5 or ≥ 5 h) and further into five subcategories: nulliparous (< 10.0, 10.0–12.9, 13.0–15.9, 16.0–18.9, and ≥ 19 h) and multiparous (< 5.0, 5.0–7.9, 8.0–10.9, 11.0–13.9, and ≥ 14.0 h). Multiple logistic regression models were used to determine odds ratios (ORs) for outcomes in women with over-median LD. Over-median LD exhibited no statistically significant association with low neonatal Apgar scores. The adjusted ORs for both umbilical artery (UmA-pH) < 7.2 and < 7.1 were increased in nulliparous women with over-median LD, whereas only the adjusted OR for UmA-pH < 7.2 was increased in multiparous women with over-median LD. Moreover, this association manifested as a plateau in nulliparous women with LD ≥ 13 h and without dose-dependent association in multiparous women.

DOI： 10.1038/s41598-022-24359-3

Association of Chlamydia trachomatis infection with pregnancy outcomes among Japanese pregnant women: The Japan environment and children’s study Open Access

Yasuda S., Kyozuka H., Endo Y., Kanno A., Murata T., Fukusda T., Yamaguchi A., Sato A., Ogata Y., Kuse M., Hosoya M., Yasumura S., Hashimoto K., Nishigori H., Fujimori K., Kamijima M., Yamazaki S., Ohya Y., Kishi R., Yaegashi N., Mori C., Ito S., Yamagata Z., Inadera H., Nakayama T., Iso H., Shima M., Kurozawa Y., Suganuma N., Kusuhara K., Katoh T.

PLoS ONE Vol. 17 ( 11 November ) 2022.11

Publisher：PLoS ONE

This study aimed to investigate the impact of Chlamydia trachomatis (CT) infection on pregnancy outcome in pregnant Japanese women. We utilized the data from a nationwide birth cohort study, the Japan Environment and Children’s Study (JECS), for this study. We enrolled 26,385 individuals who could refer to data on pregnancy outcomes and confounding factors, with data on CT. Binominal logistic regression models were used to determine whether pregnant women with CT positivity were at more risk of experiencing adverse pregnancy outcomes, preterm birth (PTB), preterm prelabor rupture of membrane (pPROM), low birth weight (LBW) infants, small for gestational age (SGA) births, or hypertensive disorders of pregnancy (HDP). After adjusting for maternal age, parity, marital status, smoking status, and education status, there were no significantly increased risks of PTB, pPROM, LBW infants, SGA, and HDP in the odds ratios. No significant increase in the risk of adverse pregnancy outcomes was observed in any of the subgroup analyses, which were limited to the pregnancy women in Fukushima prefecture, where CT screening could be confirmed at 28-30 weeks of gestation. We believe that the results of this study will make a significant contribution to the future of medical care for pregnant women in Japan. Our findings are important for medical practitioners to contribute to the future medical treatment of Japanese pregnant women, and also to contribute to pre-conception care for Japanese society as a whole, including pregnant women.

DOI： 10.1371/journal.pone.0275573