研究者詳細 - 錦織　宏

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 14 巻 ( 1 ) 2024年12月

出版者・発行元：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 査読有り Open Access

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

MEDICAL TEACHER 46 巻 ( 11 ) 頁： 1486 - 1493 2024年11月

記述言語：英語出版者・発行元：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 55 巻 ( 5 ) 頁： 374 - 376 2024年10月

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

MEDICAL TEACHER 46 巻 ( sup1 ) 頁： S1 - S3 2024年6月

Medical education in Japan

Nishigori, H

MEDICAL TEACHER 46 巻 ( sup1 ) 頁： S4 - S10 2024年6月

記述言語：英語出版者・発行元：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 19 巻 ( 2 February ) 2024年2月

出版者・発行元：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 13 巻 ( 1 ) 2023年12月

出版者・発行元：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 13 巻 ( 1 ) 2023年12月

出版者・発行元：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 査読有り Open Access

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

BMC MEDICAL EDUCATION 23 巻 ( 1 ) 頁： 857 2023年11月

記述言語：英語出版者・発行元：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 37 巻 ( 9 ) 頁： 65 2023年9月

第55回学会大会における査読ワークショップ開催報告査読有り

武田裕子, 土屋静馬, 西城卓也, 前野貴美, 今福輪太郎, 松山泰, 八木街子, 菊川誠, 尾原晴雄, 椎橋実智男, 中村真理子, 高村昭輝, 長崎一哉, 小林志津子, 鶴田潤, 宮地由佳, 錦織宏

医学教育 54 巻 ( 4 ) 頁： 406 - 409 2023年8月

フィードバック　定義から近年の議論まで査読有り

木村武司, 錦織宏

医学教育 54 巻 ( 3 ) 頁： 255 - 265 2023年6月

記述言語：日本語出版者・発行元：日本医学教育学会

フィードバックは医学教育の様々な場面で行われる教育活動であり, これまで盛んに議論されてきた. 2008年にRidderらが「学修者パフォーマンスの改善を意図した, 学修者に見られたパフォーマンスと到達点 (コンピテンシー) との比較についての情報」と定義し, 以後は効果的なフィードバックについて, 指導者を中心とした行動主義的なアプローチから受容者である学修者を中心に据えた関係性や, 学修者に潜在するフィードバックを活かす能力 (自己調整学修, フィードバックリテラシー) などへと, より多面的に捉えるように議論が展開されてきている. 本稿ではその変遷をナラティブ・レビューの形で概説し, 今後の教育実践や医学教育研究に貢献する.

DOI： 10.11307/mededjapan.54.3_255

職種横断的な内省を通して思いのすれ違いを連携に活かす査読有り

佐野樹, 森下真理子, 錦織宏

医学教育 54 巻 ( 3 ) 頁： 281 - 287 2023年6月

記述言語：日本語出版者・発行元：日本医学教育学会

専門職間で起こる思いのすれ違いを「モヤっと」と名づけ, それを医療/教育現場での連携に活かすため, 2014年から研究会を立ち上げた. 多施設の多職種で月1回1時間のオンライン研究会を行い, モヤっとした経験について内省を行った. 本稿では研究会について振り返る中で, 会の発足と歩み, 会の中で起きている学習プロセスや根拠となっている理論について述べる. さらに研究会での実践とその変化について共有しつつ, 多職種連携 (教育) での内省には, 専門領域内でする一次内省と, 領域の外から自らの専門を見つめる二次内省の両輪が必要であることを示す.

DOI： 10.11307/mededjapan.54.3_281

2. 資質・能力に新設された総合的に患者・生活者をみる姿勢について査読有り

春田淳志, 安藤崇之, 遠藤周, 金子惇, 鋪野紀好, 長嶺由衣子, 錦織宏, 藤川裕恭, 山梨啓友

医学教育 54 巻 ( 2 ) 頁： 142 - 148 2023年4月

記述言語：日本語出版者・発行元：日本医学教育学会

少子高齢化社会の背景と令和2年度からの調査を踏まえ, 患者の抱える問題を臓器横断的に捉えた上で, 心理社会的背景も踏まえた総合的な視点とアプローチの必要性が示され, 医学教育モデル・コア・カリキュラム (令和4年改訂版) に総合的に患者・生活者をみる姿勢が資質・能力に新設された. 下位目標として「全人的な視点とアプローチ」「地域の視点とアプローチ」「人生の視点とアプローチ」「社会の視点とアプローチ」が位置づけられた. 抽象と具体, 概念と経験, 自己と他者等の視点を統合し, 自己の在り方を省察できるような複数の学習理論を踏まえた教育方法が提案された. このような医学教育を通じて, 患者・生活者のウェルビーイングが向上することを期待する.

DOI： 10.11307/mededjapan.54.2_142

総括　医学教育モデル・コア・カリキュラム (令和4年度版) 改訂の統括 : 根拠に基づいた医学教育査読有り

錦織宏

医学教育 54 巻 ( 2 ) 頁： 199 - 202 2023年4月

記述言語：日本語出版者・発行元：日本医学教育学会

日本医学教育学会による医学教育モデル・コア・カリキュラム (以下, コアカリ) の令和4年度改訂にあたっての素案作成は, 学術論文や調査結果など多くの根拠に基づいて行った. 多様な属性からなるチーム編成, Web会議システムを活用した十分な検討, 行政と学会の円滑なコミュニケーション, 医学教育に関連のある組織との丁寧な対話は, 次回改訂でも継続することを推奨する. 一方で, 専門領域の学会との連携・コミュニケーションは今後の課題である. 　今回改訂されたコアカリは, 2020年代前半に本邦の医学教育学分野の有識者が叡智を結集した産物ではあるが, 決して国家が押し付ける正義ではなく, そしてこれに盲目的に従うことを各大学の教員に強要するものでもない. 現場で教育に携わる方には, 20年後の社会を見据えて作成したこのコアカリを, 大いに参考にしつつ, また時に疑いながら, 教育を展開することを期待する.

DOI： 10.11307/mededjapan.54.2_199

序文 : 特集　Making of医学教育モデル・コア・カリキュラムを企画するにあたって査読有り

錦織宏, 小西靖彦

医学教育 54 巻 ( 2 ) 頁： 133 - 133 2023年4月

7. 方略とGood Practice (1) 査読有り

松島加代子, 淺田義和, 野村理, 春田淳志, 山口久美子, 近藤猛, 錦織宏, 小西靖彦

医学教育 54 巻 ( 2 ) 頁： 177 - 181 2023年4月

記述言語：日本語出版者・発行元：日本医学教育学会

令和4年改訂版医学教育モデル・コア・カリキュラム (以下, コアカリ) では, アウトカム基盤型教育において, さらなる展開として, 新たに『学修方略・評価』の章が追加された. カリキュラムの重要な要素である方略・評価の章を加え, 資質・能力に紐づけることで, 学修者や指導者にコアカリを活用していただけるよう工夫した. また, 教育現場ですぐに実践していただけるように11の方略・評価事例をGood Practiceとして紹介した. ただし, これらのGood Practiceは, 各施設での実施を必須とするものではなく, あくまで参考例として掲載している. 各大学の特徴を生かした独自の方略・評価が策定され, 本章がさらに発展していくことを期待する.

DOI： 10.11307/mededjapan.54.2_177

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 12 巻 ( 1 ) 2022年12月

出版者・発行元：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 17 巻 ( 11 November ) 2022年11月

出版者・発行元：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