研究活動情報

• Faecal microbiota and cytokine profiles of rural Cambodian infants linked to diet and diarrhoeal episodes.

  Matthew J Dalby, Raymond Kiu, Iliana R Serghiou, Asuka Miyazaki, Holly Acford-Palmer, Rathavy Tung, Shabhonam Caim, Sarah Phillips, Magdalena Kujawska, Mitsuaki Matsui, Azusa Iwamoto, Bunsreng Taking, Sharon E Cox, Lindsay J Hall

  The gut microbiota of infants in low- to middle-income countries is underrepresented in microbiome research. This study explored the faecal microbiota composition and faecal cytokine profiles in a cohort of infants in a rural province of Cambodia and investigated the impact of sample storage conditions and infant environment on microbiota composition. Faecal samples collected at three time points from 32 infants were analysed for microbiota composition using 16S rRNA amplicon sequencing and concentrations of faecal cytokines. Faecal bacterial isolates were subjected to whole genome sequencing and genomic analysis. We compared the effects of two sample collection methods due to the challenges of faecal sample collection in a rural location. Storage of faecal samples in a DNA preservation solution preserved Bacteroides abundance. Microbiota analysis of preserved samples showed that Bifidobacterium was the most abundant genus with Bifidobacterium longum the most abundant species, with higher abundance in breast-fed infants. Most infants had detectable pathogenic taxa, with Shigella and Klebsiella more abundant in infants with recent diarrhoeal illness. Neither antibiotics nor infant growth were associated with gut microbiota composition. Genomic analysis of isolates showed gene clusters encoding the ability to digest human milk oligosaccharides in B. longum and B. breve isolates. Antibiotic-resistant genes were present in both potentially pathogenic species and in Bifidobacterium. Faecal concentrations of Interlukin-1alpha and vascular endothelial growth factor were higher in breast-fed infants. This study provides insights into an underrepresented population of rural Cambodian infants, showing pathogen exposure and breastfeeding impact gut microbiota composition and faecal immune profiles.

  2024年09月, NPJ biofilms and microbiomes, 10(1) (1), 85 - 85, 英語, 国際誌

  [査読有り]

  研究論文（学術雑誌）


• Cardiotocography use for fetal assessment during labor in low‐ and middle‐income countries: A scoping review

  Mai Takeshita, Rie Toyomoto, Kanae Marui, Masami Ito, Hiromi Eto, Kenji Takehara, Mitsuaki Matsui

  Abstract Background The use of cardiotocography (CTG) to improve neonatal outcomes is controversial. The medical settings, subjects, utilizations, and interpretation guidelines of CTG are unclear for low‐ and middle‐income countries (LMICs). Objectives To assess and review CTG use for studies identified in LMICs and provide insights on the potential for effective use of CTG to improve maternal and neonatal outcomes. Search Strategy The databases Medline, CINAHL, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) were searched for published and unpublished literature through September 2023. Selection Criteria Publications were identified which were conducted in LMICs, based on the World Bank list of economies for 2019; targeting pregnant women in childbirth; and focusing on the utilization of CTG and neonatal outcomes. Data Collection and Analysis Publications were screened, and duplicates were removed. A scoping review was conducted using PRISMA‐ScR guidelines. Results The searches generated 1157 hits, of which 67 studies were included in the review. In the studies there was considerable variation and ambiguity regarding the study settings, target populations, utilizations, timing, frequency, and duration of CTG. While cesarean section rates were extensively investigated as an outcome of studies of CTG itself and the effect of additional techniques on CTG, other clinically significant outcomes, including neonatal mortality, were not well reported. Conclusions Variations and ambiguities were found in the use of CTG in LMICs. Due to the limited amount of evidence, studies are needed to examine CTG availability in the context of LMICs.

  Wiley, 2024年08月, International Journal of Gynecology and Obstetrics, 166(2) (2), 580 - 595

  [査読有り]

  研究論文（学術雑誌）

  神戸大学リポジトリ（Kernel）へのリンク


• A descriptive study of stroke types, risk factors, clinical features, and outcomes in a tertiary hospital in Myanmar.

  Thant Zin Tun, Su Myat Han, Kazuhiko Moji, Mitsuaki Matsui

  BACKGROUND: Stroke is a leading cause of death in the world, and the burden of stroke is higher in low- and middle-income countries. Understanding the risk factors, complications, and outcomes of stroke are useful for healthcare planning and resource allocation. Little information on stroke is available for many low- and middle-income Asian countries; including Myanmar, which is the focus of this study. METHODS: A review was conducted of medical records for stroke admissions during 2017 in a tertiary hospital in Myanmar. The final diagnoses, risk factors, clinical features, complications, and outcomes were systematically collected from computer- and paper-based medical records. RESULTS: Of 908 cases analysed, haemorrhagic stroke was the most common type (49%), followed by ischaemic stroke (43%). Unimproved cases were 32%. Identified risk factors of unimproved cases were 'haemorrhagic stroke' [adjusted odds ratio (aOR): 1.73], 'having fever during hospitalization' [aOR: 2.49], 'Glasgow Coma Scale (GCS) at the admission between 9 and 14' [aOR: 4.33], and GCS less than 9 [aOR: 42.86]. CONCLUSION: This study is based on hospital medical records to assess stroke types, risk factors, clinical features, and outcomes in a tertiary hospital, in Nay Pyi Daw, Myanmar. The findings indicated that early case admission, improved hospital care management, and increased awareness of the modifiable risk factors within populations are crucial for preventing stroke incidents.

  2024年03月, Tropical Medicine and Health, 52(1) (1), 26, 英語, 国内誌

  [査読有り]

  研究論文（学術雑誌）


• Stillbirth rates and their determinants in a national maternity hospital in Phnom Penh, Cambodia in 2017-2020: a cross-sectional assessment with a nested case-control study

  Aliki Christou, Jackline Mbishi, Mitsuaki Matsui, Lenka Beňová, Kim Rattana, Ayako Numazawa, Azusa Iwamoto, Sophearith Sokhan, Nary Ieng, Thérèse Delvaux

  Abstract Background In Cambodia, stillbirths and their underlying factors have not been systematically studied. This study aimed to assess the proportion and trends in stillbirths between 2017-2020 in a large maternity referral hospital in the country and identify their key determinants to inform future prevention efforts. Methods This was a retrospective cross-sectional analysis with a nested case-control study of women giving birth at the National Maternal and Child Health Centre (NMCHC) in Phnom Penh, 2017-2020. We calculated percentages of singleton births at ≥22 weeks’ gestation resulting in stillbirth and annual stillbirth rates by timing: intrapartum (fresh) or antepartum (macerated). Multivariable logistic regression was used to explore factors associated with stillbirth, where cases were all women who gave birth to a singleton stillborn baby in the four-year period. One singleton live birth immediately following each case served as an unmatched control. Multiple imputation was used to handle missing data for gestational age. Results Between 2017 and 2020, 3.2% of singleton births ended in stillbirth (938/29,742). The stillbirth rate increased from 24.8 per 1000 births in 2017 to 38.1 per 1000 births in 2020, largely due to an increase in intrapartum stillbirth rates which rose from 18.8 to 27.4 per 1000 births in the same period. The case-control study included 938 cases (stillbirth) and 938 controls (livebirths). Factors independently associated with stillbirth were maternal age ≥35 years compared to <20 years (aOR:1.82, 95%CI:1.39,2.38), extreme (aOR:3.29, 95%CI:2.37,4.55) or moderate (aOR:2.45, 95%CI:1.74,3.46) prematurity compared with full term, and small-for-gestational age (SGA)(aOR:2.32, 1.71,3.14) compared to average size-for-age. Breech/transverse births had nearly four times greater odds of stillbirth (aOR:3.84, 95%CI:2.78,5.29), while caesarean section reduced the odds by half compared with vaginal birth (aOR:0.50, 95%CI:0.39,0.64). A history of abnormal vaginal discharge increased odds of stillbirth (aOR:1.42, 95%CI:1.11,1.81) as did a history of stillbirth (aOR:3.08, 95%CI:1.5,6.5). Conclusions Stillbirth prevention in this maternity referral hospital in Cambodia requires strengthening preterm birth detection and management of SGA, intrapartum care, monitoring women with stillbirth history, management of breech births, and further investigation of high-risk referral cases. Plain English summary In Cambodia, there is very little information published on stillbirths to know precisely how many there are and to understand the underlying reasons they occur so they can be prevented in the future. Our study aimed to quantify the number of stillborn babies and identify some underlying risk factors from one of the largest maternity referral hospitals in the Phnom Penh, Cambodia. We examined data from almost 30,0000 health facility medical files of women who gave birth between 2017 and 2020 which included 938 stillbirths. We found that about 3.2% of births ended in a stillbirth and that this percentage increased between 2017 and 2020. Women who had preterm babies, or whose babies were small in weight for their gestational age, and babies that were born breech had a higher chance of being stillborn. Women who had abnormal vaginal discharge which can indicate a possible infection also had a higher odds of having a stillbirth. We also found that women who had a stillbirth previously had almost three times higher chance of having another stillborn baby. Having a caesarean section reduced the likelihood of having a stillborn baby by about half. These findings suggest that efforts are needed to better identify and manage women with preterm births and monitor fetal growth as well as ensure breech births are managed adequately.

  Cold Spring Harbor Laboratory, 2023年10月, Reproductive Health, 20, 157

  [査読有り]


• Length of stay and determinants of early discharge after facility-based childbirth in Cameroon: analysis of the 2018 Demographic and Health Survey.

  Jovanny Tsuala Fouogue, Aline Semaan, Tom Smekens, Louise-Tina Day, Veronique Filippi, Matsui Mitsuaki, Florent Ymele Fouelifack, Bruno Kenfack, Jeanne Hortence Fouedjio, Thérèse Delvaux, Lenka Beňová

  BACKGROUND: A minimum length of stay following facility birth is a prerequisite for women and newborns to receive the recommended monitoring and package of postnatal care. The first postnatal care guidelines in Cameroon were issued in 1998 but adherence to minimum length of stay has not been assessed thus far. The objective of this study was to estimate the average length of stay and identify determinants of early discharge after facility birth. METHODS: We analyzed the Cameroon 2018 Demographic and Health Survey. We included 4,567 women who had a live birth in a heath facility between 2013 and 2018. We calculated their median length of stay in hours by mode of birth and the proportion discharged early (length of stay < 24 h after vaginal birth or < 5 days after caesarean section). We assessed the association between sociodemographic, context-related, facility-related, obstetric and need-related factors and early discharge using bivariate and multivariable logistic regression. RESULTS: The median length of stay (inter quartile range) was 36 (9-84) hours after vaginal birth (n = 4,290) and 252 (132-300) hours after caesarean section (n = 277). We found that 28.8% of all women who gave birth in health facilities were discharged too early (29.7% of women with vaginal birth and 15.1% after a caesarean section). Factors which significantly predicted early discharge in multivariable regression were: maternal age < 20 years (compared to 20-29 years, aOR: 1.44; 95%CI 1.13-1.82), unemployment (aOR: 0.78; 95%CI: 0.63-0.96), non-Christian religions (aOR: 1.65; 95CI: 1.21-2.24), and region of residence-Northern zone aOR:9.95 (95%CI:6.53-15.17) and Forest zone aOR:2.51 (95%CI:1.79-3.53) compared to the country's capital cities (Douala or Yaounde). None of the obstetric characteristics was associated with early discharge. CONCLUSIONS: More than 1 in 4 women who gave birth in facilities in Cameroon were discharged too early; this mostly affected women following vaginal birth. The reasons leading to lack of adherence to postnatal care guidelines should be better understood and addressed to reduce preventable complications and provide better support to women and newborns during this critical period.

  2023年08月, BMC pregnancy and childbirth, 23(1) (1), 575, 英語, 国際誌

  [査読有り]

  研究論文（学術雑誌）


• The association between complementary feeding practice and linear growth faltering among Cambodian children: an analysis of the 2014 Cambodia Demographic and Health Survey

  Asuka Miyazaki, Kerry Wong, Rattana Kim, Mitsuaki Matsui

  Background Inappropriate complementary feeding is a factor contributing to linear growth faltering in early childhood. We aimed to assess complementary feeding practice and investigate its association with linear growth faltering among children aged 6 to 23 months among children aged 6-23 months in Cambodia. Methods This study is a secondary data analysis of the 2014 Cambodia Demographic and Health Survey (CDHS). Multivariable linear regression analysis was used to investigate associations between complementary feeding practice and linear growth faltering as length-for-age z-scores (LAZ), adjusted for all covariates. Results This study included 1381 children aged 6 to 23 months. The prevalence of age-appropriate complementary feeding practice was low in Cambodia. Only 23% of the children met all three criteria of minimum dietary diversity, minimum meal frequency, and age-appropriate breastfeeding. Approximately 30% of children aged 6 to 11 months met the minimum dietary diversity requirements and less than 40% of children aged 18 to 23 months were provided breastfeeding after the introduction of complementary food. This study found that there is no relationship between food diversity and feeding frequency and child linear growth. However, the provision of both complementary food and breast milk was independently and negatively associated with linear growth (β-Coefficient=-0.38, 95% confidence interval, CI=-0.60, -0.16). Positive effects on child linear growth, after controlling for all covariates, included the richer (β-Coefficient=0.36, 95% CI=0.07, 0.66) and richest (β-Coefficient=0.50, 95% CI=0.20, 0.79) quintiles of households, as well as appropriate water treatment before drinking (β-Coefficient=0.22, 95% CI=0.05, 0.40). Conclusions Most Cambodian young children aged 6 to 23 months received inappropriate complementary feeding. This study suggests that from the time of conception there is a necessity to improve maternal and child nutrition educational intervention for mothers, including feeding and hygiene practices.

  Inishmore Laser Scientific Publishing Ltd, 2023年06月, Journal of Global Health Reports, 7

  [査読有り]

  研究論文（学術雑誌）


• Coinfections of malaria and sexually transmitted and reproductive tract infections in pregnancy in sub-Saharan Africa: a systematic review and individual participant data meta-analysis protocol

  Sumire Sorano, Georgia Gore-Langton, Charles Opondo, Chris Smith, Mitsuaki Matsui, Enesia Banda Chaponda, Daniel Chandramohan, R Matthew Chico

  Introduction Malaria infection and curable sexually transmitted infections and reproductive tract infections (STIs/RTIs) adversely impact pregnancy outcomes. In sub-Saharan Africa, the prevalence of malaria and curable STIs/RTIs is high and, where coinfection is common, combination interventions may be needed to improve pregnancy outcomes. The aim of this systematic review is to estimate the prevalence of malaria and curable STI/RTI coinfection during pregnancy, risk factors for coinfection and prevalence of associated adverse pregnancy outcomes. Methods and analysis We will use three electronic databases, PubMed, EMBASE and Malaria in Pregnancy Library to identify studies involving pregnant women attending routine antenatal care facilities in sub-Saharan Africa and reporting malaria and curable STI/RTI test results, published in any language since 2000. We will search databases in the second quarter of 2023 and repeat the search before completion of our analyses. The first two authors will screen titles and abstracts, selecting studies that meet inclusion criteria and qualify for full-text screening. If agreement on inclusion/exclusion cannot be reached, the last author will serve as arbiter. We will extract data from eligible publications for a study-level meta-analysis. We will contact research groups of included studies and request individual participant data for meta-analysis. The first two authors will conduct a quality appraisal of included studies using the GRADE system. The last author will adjudicate if the first two authors do not agree on any appraisals. We will conduct sensitivity analyses to test the robustness of effect estimates over time (by decade and half-decade periods), geography (East/Southern Africa vs West/Central Africa), gravidity (primigravidae, secundigravidae, multigravidae), treatment type and dosing frequency, and malaria transmission intensity. Ethics and dissemination We obtained ethics approval from the London School of Hygiene & Tropical Medicine (LSHTM Ethics Ref: 26167). Results of this study will be disseminated via peer-reviewed publication and presentation at scientific conferences. PROSPERO registration number CRD42021224294.

  BMJ, 2023年06月, BMJ Open, 13(6) (6), e074896

  [査読有り]

  研究論文（学術雑誌）


• Modern contraceptive use among adolescent girls and young women in Benin: a mixed-methods study.

  Noudéhouénou Crédo Adelphe Ahissou, Lenka Benova, Thérèse Delvaux, Charlotte Gryseels, Jean-Paul Dossou, Sourou Goufodji, Lydie Kanhonou, Christelle Boyi, Armelle Vigan, Koen Peeters, Miho Sato, Mitsuaki Matsui

  OBJECTIVES: The study aimed to assess the determinants of modern contraceptive method use among young women in Benin. DESIGN: A mixed-methods design. SETTING AND PARTICIPANTS: We used the Benin 2017-2018 Demographic and Health Survey datasets for quantitative analysis. Data collection was conducted using multiple-cluster sampling method and through household survey. Qualitative part was conducted in the city of Allada, one of the Fon cultural capitals in Benin. The participants were purposively selected. OUTCOMES: Contraceptive prevalence rate, unmet need for modern method and percentage of demand satisfied by a modern method for currently married and sexually active unmarried women were measured in the quantitative part. Access barriers and utilisation of modern methods were assessed in the qualitative part. RESULTS: Overall, 8.5% (95% CI 7.7% to 9.5%) among young women ages 15-24 were using modern contraceptives and 13% (12.1% to 14.0%) among women ages 25 or more. Women 15-24 had a higher unmet need, and a lower demand satisfied by modern contraceptive methods compared with women ages 25 or more. 60.8% (56.9% to 64.7%) of all unmarried young women had unmet need for modern contraceptives. Young women were more likely to use male condoms which they obtain mainly from for-profit outlets, pharmacies and relatives. The factors associated with demand satisfied by a modern method were literacy, being unmarried, knowing a greater number of modern contraceptive methods and experiencing barriers in access to health services. On the other hand, the qualitative study found that barriers to using modern methods include community norms about pre-marital sexual intercourse, perceptions about young women's fertility, spousal consent and the use of non-modern contraceptives. CONCLUSION: Contraceptive use is low among young women in Benin. The use of modern contraceptives is influenced by sociodemographic factors and social norms. Appropriate interventions might promote comprehensive sexuality education, increase community engagement, provide youth-friendly services and address gender inequalities.

  2022年01月, BMJ open, 12(1) (1), e054188, 英語, 国際誌

  [査読有り]

  研究論文（学術雑誌）


• Factors affecting the choice of delivery place in a rural area in Laos: A qualitative analysis

  Yoshiko Kawaguchi, Ahmad M. Sayed, Alliya Shafi, Sengchanh Kounnavong, Tiengkham Pongvongsa, Angkhana Lasaphonh, Khamsamay Xaylovong, Miho Sato, Mitsuaki Matsui, Atsuko Imoto, Nguyen Tien Huy, Kazuhiko Moji

  Home delivery (HD) without skilled birth attendants (SBAs) are considered crucial risk factors increasing maternal and child mortality rates in Loa PDR. While a few studies in the literature discuss the choice of delivery in remote areas of minority ethnic groups; our work aims to identify factors that indicated their delivery place, at home or in the health facilities. A community-based qualitative study was conducted between February and March 2020. Three types of interviews were implemented, In-depth interviews with 16 women of eight rural villages who delivered in the last 12 months in Xepon District, Savannakhet Province, Lao PDR. Also, three focus group discussions (FGDs) with nine HCPs and key-informant interviews of ten VHVs were managed. Factors affecting the choice of the delivery place were categorized according to the social-ecological model. Our sample included five Tri women and two Mangkong women in the HD group, while the FD group included three Tri women, two Mangkong women, one Phoutai woman, two Laolung women and one Vietnamese. Our investigation inside the targeted minority showed that both positive perceptions of home delivery (HD) and low-risk perception minorities were the main reasons for the choice of HD, on the individual level. On the other hand, fear of complication, the experience of stillbirth, and prolonged labour pain during HD were reasons for facility-based delivery (FD). Notably, the women in our minority reported no link between their preference and their language, while the HCPs dated the low knowledge to the language barrier. On the interpersonal level, the FD women had better communication with their families, and better preparation for delivery compared to the HD group. The FD family prepared cash and transportation using their social network. At the community level, the trend of the delivery place had shifted from HD to FD. Improved accessibility and increased knowledge through community health education were the factors of the trend. At the societal (national policy) level, the free delivery policy and limitation of HCPs’ assisted childbirth only in health facilities were the factors of increasing FD, while the absence of other incentives like transportation and food allowance was the factor of remaining of HD. Based on the main findings of this study, we urge the enhancement of family communication on birth preparedness and birthplace. Furthermore, our findings support the need to educate mothers, especially those of younger ages, about their best options regarding the place of delivery. We propose implementing secondary services of HD to minimize the emergency risks of HD. We encourage local authorities to be aware of the medical needs of the community especially those of pregnant females and their right for a free delivery policy.

  Public Library of Science (PLoS), 2021年08月, PLOS ONE, 16(8) (8), e0255193

  [査読有り]

  研究論文（学術雑誌）


• Knowledge on intrapartum care practices among skilled birth attendants in Cambodia-a cross-sectional study.

  Mitsuaki Matsui, Yuko Saito, Rithy Po, Bunsreng Taing, Chamnan Nhek, Rathavy Tung, Yoko Masaki, Azusa Iwamoto

  BACKGROUND: Delivery is a critical moment for pregnant women and babies, and careful monitoring is essential throughout the delivery process. The partograph is a useful tool for monitoring and assessing labour progress as well as maternal and foetal conditions; however, it is often used inaccurately or inappropriately. A gap between practices and evidence-based guidelines has been reported in Cambodia, perhaps due to a lack of evidence-based knowledge in maternity care. This study aims to address to what extent skilled birth attendants in the first-line health services in Cambodia have knowledge on the management of normal delivery, and what factors are associated with their level of knowledge. METHODS: Midwives and nurses were recruited working in maternity in first-line public health facilities in Phnom Penh municipality, Kampong Cham and Svay Rieng provinces. Two self-administered questionnaires were applied. The first consisted of three sections with questions on monitoring aspects of the partograph: progress of labour, foetal, and maternal conditions. The second consisted of questions on diagnostic criteria, normal ranges, and standard intervals of monitoring during labour. A multiple linear regression analysis was performed to identify relationships between characteristics of the participants and the questionnaire scores. RESULTS: Of 542 eligible midwives and nurses, 523 (96%) participated. The overall mean score was 58%. Only 3% got scores of more than 90%. Multivariate analysis revealed that 'Kampong Cham province', 'younger age', and 'higher qualification' were significantly associated with higher scores. Previous training experience was not associated with the score. Substantial proportions of misclassification of monitoring items during labour were found; for example, 61% answered uterine contraction as a foetal condition, and 44% answered foetal head descent and 26% answered foetal heart rate as a maternal condition. CONCLUSION: This study found that knowledge was low on delivery management among skilled birth attendants. Previous training experience did not influence the knowledge level. A lack of understanding of physiology and anatomy was implied. Further experimental approaches should be attempted to improve the knowledge and quality of maternity services in Cambodia.

  2021年06月, Reproductive Health, 18(1) (1), 115, 英語, 国際誌

  [査読有り]

  研究論文（学術雑誌）


• "Why did our baby die soon after birth?"-Lessons on neonatal death in rural Cambodia from the perspective of caregivers.

  Ayako Suzuki, Mitsuaki Matsui, Rathavy Tung, Azusa Iwamoto

  INTRODUCTION: Neonatal deaths represent around half the deaths of children less than five-years old in Cambodia. The process from live birth to neonatal death has not been well described. This study aimed to identify problems in health care service which hamper the reduction of preventable neonatal deaths in rural Cambodia. METHODS: This study adopted a method of qualitative case study design using narrative data from the verbal autopsy standard. Eighty and forty villages were randomly selected from Kampong Cham and Svay Rieng provinces, respectively. All households in the target villages were visited between January and February 2017. Family caregivers were asked to describe their experiences on births and neonatal deaths between 2015 and 2016. Information on the process from birth to death was extracted with open coding, categorized, and summarized into several groups which represent potential problems in health services. RESULTS: Among a total of 4,142 children born in 2015 and 2016, 35 neonatal deaths were identified. Of these deaths, 74% occurred within one week of birth, and 57% were due to low-birth weight. Narrative data showed that three factors should be improved, 1) the unavailability of a health-care professional, 2) barriers in the referral system, and 3) lack of knowledge and skill to manage major causes of neonatal deaths. CONCLUSION: The current health system has limitations to achieve further reduction of neonatal deaths in rural Cambodia. The mere deployment of midwives at fixed service points such as health centers could not solve the problems occurring in rural communities. Community engagement revisiting the principle of primary health care, as well as health system transformation, is the key to the solution and potential breakthrough for the future.

  2021年06月, PLoS one, 16(6) (6), e0252663, 英語, 国際誌

  [査読有り]

  研究論文（学術雑誌）


• A Consensus-Based Checklist for Reporting of Survey Studies (CROSS).

  Akash Sharma, Nguyen Tran Minh Duc, Tai Luu Lam Thang, Nguyen Hai Nam, Sze Jia Ng, Kirellos Said Abbas, Nguyen Tien Huy, Ana Marušić, Christine L Paul, Janette Kwok, Juntra Karbwang, Chiara de Waure, Frances J Drummond, Yoshiyuki Kizawa, Erik Taal, Joeri Vermeulen, Gillian H M Lee, Adam Gyedu, Kien Gia To, Martin L Verra, Évelyne M Jacqz-Aigrain, Wouter K G Leclercq, Simo T Salminen, Cathy Donald Sherbourne, Barbara Mintzes, Sergi Lozano, Ulrich S Tran, Mitsuaki Matsui, Mohammad Karamouzian

  2021年04月, Journal of general internal medicine, 36(10) (10), 3179 - 3187, 英語, 国際誌

  [査読有り]

  研究論文（学術雑誌）


• Changes over time in HIV testing and counselling uptake and associated factors among youth in Zambia: a cross-sectional analysis of demographic and health surveys from 2007 to 2018.

  Aimé Bitakuya Heri, Francesca L Cavallaro, Nurilign Ahmed, Maurice Mubuyaeta Musheke, Mitsuaki Matsui

  INTRODUCTION: Zambia is among the countries with the highest HIV burden and where youth remain disproportionally affected. Access to HIV testing and counselling (HTC) is a crucial step to ensure the reduction of HIV transmission. This study examines the changes that occurred between 2007 and 2018 in access to HTC, inequities in testing uptake, and determinants of HTC uptake among youth. METHODS: We carried out repeated cross-sectional analyses using three Zambian Demographic and Health Surveys (2007, 2013-14, and 2018). We calculated the percentage of women and men ages 15-24 years old who were tested for HIV in the last 12 months. We analysed inequity in HTC coverage using indicators of absolute inequality. We performed bivariate and multivariate logistic regression analyses to identify predictors of HTC uptake in the last 12 months. RESULTS: HIV testing uptake increased between 2007 and 2018, from 45 to 92% among pregnant women, 10 to 58% among non-pregnant women, and from 10 to 49% among men. By 2018 roughly 60% of youth tested in the past 12 months used a government health centre. Mobile clinics were the second most common source reaching up to 32% among adolescent boys by 2018. Multivariate analysis conducted among men and non-pregnant women showed higher odds of testing among 20-24 year-olds than adolescents (aOR = 1.55 [95%CI:1.30-1.84], among men; and aOR = 1.74 [1.40-2.15] among women). Among men, being circumcised (aOR = 1.57 [1.32-1.88]) and in a union (aOR = 2.44 [1.83-3.25]) were associated with increased odds of testing. For women greater odds of testing were associated with higher levels of education (aOR = 6.97 [2.82-17.19]). Education-based inequity was considerably widened among women than men by 2018. CONCLUSION: HTC uptake among Zambian youth improved considerably by 2018 and reached 65 and 49% tested in the last 12 months for women and men, respectively. However, achieving the goal of 95% envisioned by 2020 will require sustaining the success gained through government health centres, and scaling up the community-led approaches that have proven acceptable and effective in reaching young men and adolescent girls who are less easy to reach through the government facilities.

  2021年03月, BMC Public Health, 21(1) (1), 456, 英語, 国際誌

  [査読有り]

  研究論文（学術雑誌）


• Awareness and preparedness of healthcare workers against the first wave of the COVID-19 pandemic: A cross-sectional survey across 57 countries.

  Nguyen Tien Huy, R Matthew Chico, Vuong Thanh Huan, Hosam Waleed Shaikhkhalil, Vuong Ngoc Thao Uyen, Ahmad Taysir Atieh Qarawi, Shamael Thabit Mohammed Alhady, Nguyen Lam Vuong, Le Van Truong, Mai Ngoc Luu, Shyam Prakash Dumre, Atsuko Imoto, Peter N Lee, Dao Ngoc Hien Tam, Sze Jia Ng, Mohammad Rashidul Hashan, Mitsuaki Matsui, Nguyen Tran Minh Duc, Sedighe Karimzadeh, Nut Koonrungsesomboon, Chris Smith, Sharon Cox, Kazuhiko Moji, Kenji Hirayama, Le Khac Linh, Kirellos Said Abbas, Tran Nu Thuy Dung, Tareq Mohammed Ali Al-Ahdal, Emmanuel Oluwadare Balogun, Nguyen The Duy, Mennatullah Mohamed Eltaras, Trang Huynh, Nguyen Thi Linh Hue, Bui Diem Khue, Abdelrahman Gad, Gehad Mohamed Tawfik, Kazumi Kubota, Hoang-Minh Nguyen, Dmytro Pavlenko, Vu Thi Thu Trang, Le Thuong Vu, Tran Hai Yen, Nguyen Thi Yen-Xuan, Luong Thi Trang, Vinh Dong, Akash Sharma, Vu Quoc Dat, Mohammed Soliman, Jeza Abdul Aziz, Jaffer Shah, Pham Dinh Long Hung, Yap Siang Jee, Dang Thuy Ha Phuong, Tran Thuy Huong Quynh, Hoang Thi Nam Giang, Vy Thi Nhat Huynh, Nguyen Anh Thi, Nacir Dhouibi, Truc Phan, Vincent Duru, Nguyen Hai Nam, Sherief Ghozy

  BACKGROUND: Since the COVID-19 pandemic began, there have been concerns related to the preparedness of healthcare workers (HCWs). This study aimed to describe the level of awareness and preparedness of hospital HCWs at the time of the first wave. METHODS: This multinational, multicenter, cross-sectional survey was conducted among hospital HCWs from February to May 2020. We used a hierarchical logistic regression multivariate analysis to adjust the influence of variables based on awareness and preparedness. We then used association rule mining to identify relationships between HCW confidence in handling suspected COVID-19 patients and prior COVID-19 case-management training. RESULTS: We surveyed 24,653 HCWs from 371 hospitals across 57 countries and received 17,302 responses from 70.2% HCWs overall. The median COVID-19 preparedness score was 11.0 (interquartile range [IQR] = 6.0-14.0) and the median awareness score was 29.6 (IQR = 26.6-32.6). HCWs at COVID-19 designated facilities with previous outbreak experience, or HCWs who were trained for dealing with the SARS-CoV-2 outbreak, had significantly higher levels of preparedness and awareness (p<0.001). Association rule mining suggests that nurses and doctors who had a 'great-extent-of-confidence' in handling suspected COVID-19 patients had participated in COVID-19 training courses. Male participants (mean difference = 0.34; 95% CI = 0.22, 0.46; p<0.001) and nurses (mean difference = 0.67; 95% CI = 0.53, 0.81; p<0.001) had higher preparedness scores compared to women participants and doctors. INTERPRETATION: There was an unsurprising high level of awareness and preparedness among HCWs who participated in COVID-19 training courses. However, disparity existed along the lines of gender and type of HCW. It is unknown whether the difference in COVID-19 preparedness that we detected early in the pandemic may have translated into disproportionate SARS-CoV-2 burden of disease by gender or HCW type.

  2021年, PloS one, 16(12) (12), e0258348, 英語, 国際誌

  [査読有り]

  研究論文（学術雑誌）


• Perspectives of health care workers and village health volunteers on community-based Integrated Management of Childhood Illness in Madagascar.

  Tomomi Kitamura, Pamela Fergusson, Arison Nirina Ravalomanda, Florentine Soanarenina, Angeline Thérése Raveloarivony, René Rasamoelisolonjatovo, Raymond Rakotoarimanana, Mitsuaki Matsui

  The Ministry of Health and Family Planning of Madagascar introduced Integrated Management of Childhood Illness (IMCI) strategy in 2006, and community-based IMCI (c-IMCI), in Mahajanga II District in 2007. Following the 2009 political crisis, foreign organisations' suspension of development aid until 2012 significantly affected the implementation of c-IMCI. This study aimed to elucidate the perspectives of village health volunteers (VHVs) and public health officers (PHO) on c-IMCI. Semi-structured in-depth interviews with all VHVs working in three communes and PHOs working at central, district, and health centre levels were conducted in 2013. Textual data, created from transcripts, were translated into English and French. Data management involved analysis of sections of translated transcripts, which were marked, coded, and linked with similar experiences, challenges, and opinions; these were categorised into words and phrases to discover meaningful relationships between emerging themes. From all interviews of 30 VHV in three Mahajanga II communes and 4 PHOs, 3 themes emerged: 1) benefits of c-IMCI to the community and for VHVs, 2) challenges to continue c-IMCI, and 3) motivation to continue c-IMCI. Although all respondents considered c-IMCI as beneficial, they stated it was difficult to continue. The health system and implementation of c-IMCI should be strengthened to enable programme survival beyond the initial phase, especially during times of political instability.

  Elsevier {BV}, 2020年11月, Heliyon, 6(11) (11), e05326, 英語, 国際誌

  [査読有り]

  研究論文（学術雑誌）


• Voices from the frontline: findings from a thematic analysis of a rapid online global survey of maternal and newborn health professionals facing the COVID-19 pandemic.

  Aline Semaan, Constance Audet, Elise Huysmans, Bosede Afolabi, Bouchra Assarag, Aduragbemi Banke-Thomas, Hannah Blencowe, Séverine Caluwaerts, Oona Maeve Renee Campbell, Francesca L Cavallaro, Leonardo Chavane, Louise Tina Day, Alexandre Delamou, Therese Delvaux, Wendy Jane Graham, Giorgia Gon, Peter Kascak, Mitsuaki Matsui, Sarah Moxon, Annettee Nakimuli, Andrea Pembe, Emma Radovich, Thomas van den Akker, Lenka Benova

  INTRODUCTION: The COVID-19 pandemic has substantially impacted maternity care provision worldwide. Studies based on modelling estimated large indirect effects of the pandemic on services and health outcomes. The objective of this study was to prospectively document experiences of frontline maternal and newborn healthcare providers. METHODS: We conducted a global, cross-sectional study of maternal and newborn health professionals via an online survey disseminated through professional networks and social media in 12 languages. Information was collected between 24 March and 10 April 2020 on respondents' background, preparedness for and response to COVID-19 and their experience during the pandemic. An optional module sought information on adaptations to 17 care processes. Descriptive statistics and qualitative thematic analysis were used to analyse responses, disaggregating by low-income and middle-income countries (LMICs) and high-income countries (HICs). RESULTS: We analysed responses from 714 maternal and newborn health professionals. Only one-third received training on COVID-19 from their health facility and nearly all searched for information themselves. Half of respondents in LMICs received updated guidelines for care provision compared with 82% in HICs. Overall, 47% of participants in LMICs and 69% in HICs felt mostly or completely knowledgeable in how to care for COVID-19 maternity patients. Facility-level responses to COVID-19 (signage, screening, testing and isolation rooms) were more common in HICs than LMICs. Globally, 90% of respondents reported somewhat or substantially higher levels of stress. There was a widespread perception of reduced use of routine maternity care services, and of modification in care processes, some of which were not evidence-based practices. CONCLUSIONS: Substantial knowledge gaps exist in guidance on management of maternity cases with or without COVID-19. Formal information-sharing channels for providers must be established and mental health support provided. Surveys of maternity care providers can help track the situation, capture innovations and support rapid development of effective responses.

  BMJ, 2020年06月, BMJ Global Health, 5(6) (6), e002967, 英語, 国際誌

  [査読有り]

  研究論文（学術雑誌）


• Frequent unregulated use of antibiotics in rural Cambodian infants.

  Asuka Miyazaki, Rathavy Tung, Bunsreng Taing, Mitsuaki Matsui, Azusa Iwamoto, Sharon E Cox

  BACKGROUND: Despite a high prevalence of antibiotic resistance in Cambodia, few studies have assessed health-seeking behaviour and the use of antibiotics by caregivers of young children in Cambodia. METHODS: We conducted a cross-sectional survey of infants <12 months of age and their caregivers, assessing the frequency of reported illness, common symptoms and associated health-seeking behaviour through structured questionnaires administered by trained fieldworkers at a home visit. In a subset of these participants, ages 4-8 months with no acute malnutrition, we conducted a 3-month surveillance with fortnightly home visits. RESULTS: Of 149 infants (ages 1-11 months, 54.4% male) enrolled in the cross-sectional study, 76 (51.4%) reported symptoms of diarrhoea, fever or cough in the previous 14 d, with associated use of antibiotics reported in 22 (14.8%) infants. In 47 infants enrolled in the longitudinal surveillance, there were 141 reported episodes of illness in 44 (94%) infants with 21 infants (45%) reported to have received antibiotics in 32/141 (22.7%) episodes. Amoxicillin was the most commonly reported antibiotic in both surveys (68% [40/59 episodes reporting the use of antibiotics]). CONCLUSIONS: Antibiotic usage is high in this population and appears to be occurring largely outside of the formal healthcare system.

  2020年06月, Transactions of the Royal Society of Tropical Medicine and Hygiene, 114(6) (6), 401 - 407, 英語, 国際誌

  [査読有り]

  研究論文（学術雑誌）


• Determinants of growth measurements in rural Cambodian infants: a cross-sectional study

  Asuka Miyazaki, Mitsuaki Matsui, Rathavy Tung, Bunsreng Taing, Laura V White, Azusa Iwamoto, Sharon E Cox

  Abstract Background Inappropriate feeding and hygiene practices and poor environment are associated with malnutrition. We aimed to investigate the contributions of feeding, hygiene practices and recent illness to the nutritional status of rural Cambodian infants and any sex-specific differences. Methods In a cross-sectional study, nested within an ongoing birth cohort, trained fieldworkers conducted anthropometry and collected information from the main caregiver during home visits. Multivariable linear regression was used to investigate associations with nutritional status as length-for-age z-scores (LAZ) and weight-for-length z-scores (WLZ). Results A total of 156 children, 87 (55.8%) male, ages 0–11 months were enrolled. The prevalence of acute malnutrition (WLZ &lt;−2) in males and females was 2.3% (2/87) and 5.8% (4/69), respectively, and 23.0% (20/87) of males and 14.5% (10/69) of females were stunted (LAZ &lt;−2). WLZ but not LAZ decreased with age. WLZ was independently negatively associated with increasing age (β-coefficient −0.14 [95% confidence interval {CI} −0.20 to −0.08], p&lt;0.001), and regular use of feeding bottles (β-coefficient −0.46 [95% CI −0.83 to −0.10], p=0.014), and positively with handwashing with soap (β-coefficient 0.40 [95% CI 0.05 to 0.75), p=0.027). Conclusions The prevalence of acute malnutrition was low, but stunting was prevalent without evidence of a sex difference. Non-linear growth faltering was associated with increasing age and hygiene/feeding practices.

  Oxford University Press ({OUP}), 2020年05月, International Health, 英語

  [査読有り]

  研究論文（学術雑誌）


• Evidence-based intrapartum practice and its associated factors at a tertiary teaching hospital in the Philippines, a descriptive mixed-methods study

  Chisato Masuda, Shirley Kristine Ferolin, Ken Masuda, Chris Smith, Mitsuaki Matsui

  Springer Science and Business Media LLC, 2020年02月, BMC Pregnancy and Childbirth, 20(1) (1), 78, 英語

  [査読有り]

  研究論文（学術雑誌）


• Satisfaction of Pregnant Women with Antenatal Care Services at Women and Children Hospital in South Okkalapa, Myanmar: A Facility-Based Cross-Sectional Study Triangulated with Qualitative Study.

  Nang Mon Hsai, Mitsuaki Matsui, Chris Fook Sheng Ng, Cho Thet Khaing, Atsuko Imoto, Ahmed M Sayed, Nguyen Tien Huy, Yasuhiko Kamiya, Kazuhiko Moji

  Background: While patients' satisfaction is a barometer for healthcare quality, Myanmar did not do enough to assess the antenatal care (ANC) satisfaction. Objective: In this study, we aim to assess the satisfaction level of pregnant women with ANC services provided by a public hospital in Myanmar. Methods: A cross-sectional study was conducted with 125 women in the quantitative and 27 in the qualitative study at South Okkalapa Women and Children Hospital in Myanmar. Satisfaction was measured by using a five-point Likert scale with 25-item services. Statistical software SPSS version 16 was used for quantitative data analysis. Qualitative data were manually analyzed by thematic analysis. Results: The proportion of pregnant women who were satisfied with healthcare services ranged from 18% to 35%. Provider's service yielded satisfaction ranging between 25% and 35%; meanwhile, facilities in the waiting area had the lowest mean score (2.78) for satisfaction. Laboratory service and waiting time at the antenatal clinic were major sources of dissatisfaction. Overall, 48% of the pregnant women were in high satisfaction with ANC services. Out of 25 items, cleanliness of ANC clinic, the process of ANC procedure, drug supply by the hospital, ventilation, and lighting in the waiting area, waiting time to see doctors, and working hours (availability of services) showed significant association with overall satisfaction. Conclusion: Nearly half of the pregnant women in the study were very satisfied with the total healthcare services they received. Facilities in the waiting area, laboratory service, and waiting time to see doctors were dissatisfied services and need to be upgraded.

  2020年, Patient preference and adherence, 14, 2489 - 2499, 英語, 国際誌

  [査読有り]

  研究論文（学術雑誌）


• カンボジアの農村部における子どもの低栄養に関連する要因 大規模な洪水発生直後の緊急調査結果より

  宮崎 あすか, 岩本 あづさ, Tung Rathavy, 松井 三明

  長崎大学医学部保健学科, 2019年09月, 保健学研究, 32, 35 - 42, 日本語

  [査読有り]

  研究論文（学術雑誌）


• Discrepancy between the national protocol and healthcare providers' knowledge, attitude, and practice regarding induction and augmentation of labor with oxytocin in Cambodia

  Sasagawa E, Tung R, Horikoshi Y, Takehara K, Noguchi M, Osanai Y, Kita K, Matsui M

  目的

    本研究は、カンボジアにおいて医師・助産師がオキシトシンをどのように捉え、利用しているかを、国家産科プロトコールのオキシトシン使用基準と比較し、knowledge（知識）、attitude（態度）、practice（実践）の観点から把握することを目的としている。

  方法

    カンボジアの首都プノンペンにある国立の産科病院において、直接観察と個別インタビューによる質的研究を2013年1～2月に実施した。直接観察はオキシトシンを用いて陣痛誘発・促進された産婦を対象とし、オキシトシン使用開始から分娩終了までの観察を通じて、陣痛誘発・促進の適応や産婦の分娩経過、医師・助産師のオキシトシン使用管理方法を確認した。個別インタビューは、直接観察で得られた情報を補完し、医療従事者のオキシトシンの捉え方、意思決定プロセス、使用管理に関する知識を確認するため、分娩を担当した医師・助産師を対象に行った。

    結果

    調査期間中、産婦10名の分娩経過を直接観察し、医師3名、助産師9名に対して個別インタビューを行った。陣痛誘発・促進開始の判断根拠となった医療従事者の知識は、10名中9名の産婦に対して妥当性があると評価できた。しかし、陣痛誘発・促進のためのオキシトシン使用管理については、国家産科プロトコールと医療従事者の知識・態度・実践との間に相違が見られた。例えば、医療従事者12名のうち、11名が陣痛誘発・促進方法について記載されている国家産科プロトコールを見たことがなく、正しい知識へのアクセスが限られていることが明らかとなった。また、分娩進行効果が認められる有効陣痛が発来している状態においても、「子宮口全開大後には点滴を増量しても問題ない」という誤った認識が広がっていることも分かった。臨床においては、オキシトシン点滴静脈注射の初回投与量は統一されておらず、最大投与量（安全限界）を越えた過剰投与も確認された。また、6名の産婦に対し、オキシトシン点滴開始後2時間以上、モニタリングがなされていなかった。

  結論

    本調査を通じ、陣痛誘発・促進を目的としたオキシトシン点滴管理に関する国家産科プロトコールと、医療従事者の知識・態度・実際の使用方法との間に大きなギャップが確認された。出産の安全性を確保し、治療効果を最大限とするために、国家産科プロトコールの普及とオキシトシン管理に関する研修の充実の必要性が示唆された。

  日本国際保健医療学会, 2016年12月, Journal of International Health, 31(4) (4), 289 - 298, 英語

  [査読有り]


• Prevalence of Perineal Lacerations in Women Giving Birth at Midwife-Led Birth Centers in Japan: A Retrospective Descriptive Study

  Maiko Suto, Kenji Takehara, Chizuru Misago, Mitsuaki Matsui

  2015年07月, Journal of Midwifery & Women's Health, 60(4) (4), 419 - 427, 英語

  [査読有り]

  研究論文（学術雑誌）


• Affordability of emergency obstetric and neonatal care at public hospitals in Madagascar

  Ayako Honda, Pierana Gabriel Randaoharison, Mitsuaki Matsui

  2011年05月, Reproductive Health Matters, 19(37) (37), 10 - 20, 英語, 国際誌

  [査読有り]

  研究論文（学術雑誌）


• マダガスカルの地域における妊産婦・新生児ケア

  松井 三明, 岩本 あづさ

  国際小児保健研究会, 2011年01月, JICHAジャーナル, 1(1) (1), 5 - 14, 日本語

  [査読有り]


• セネガル国タンバクンダ州におけるUnmet Obstetric Need指標を用いた重症産科合併症による妊産婦死亡の推計

  松井 三明, 池田 憲昭

  目的 母性保健の分野では、妊産婦死亡率が課題の把握や対策策定に用いられる。しかし、その算出は推計によることが大半であり、誤差範囲が広いことなどから、比較的小規模の人口集団を対象としたプログラムのモニタリングや地域間の比較に用いることはできないことも知られている。本研究では、セネガル国タンバクンダ州において、De Brouwereによって提唱された"unmet obstetric need"指標を用い、重症産科合併症に起因する妊産婦死亡の推計を行い、同指標の妊産婦死亡削減対策における利用可能性について考察することを目的とした。方法 2005年にタンバクンダ州および隣接するカオラック州の7医療施設で実施された帝王切開について、その適応と患者居住地を調査し、タンバクンダ州居住者に対して実施された帝王切開数および率を求めた。また帝王切開を実施しなくては死亡に至る可能性が高い「絶対的母体適応」という重症産科合併症群を定義し、それに対して必要な手術数をタンバクンダ州内各保健管区について推計し、実際に提供された手術数との差を求めた。この差が、重症産科合併症を発症したにもかかわらず病院で適切な医療サービスを受けることなしに妊産婦死亡に至った症例数と仮定し、各保健管区ごとに絶対的母体適応に起因する妊産婦死亡率を推計した。結果 タンバクンダ州内の6保健管区における帝王切開率は、全適応に対しては0.3-2.0%、絶対的母体適応に対しては0.1-0.9%に分布した。タンバクンダ州の絶対的母体適応に起因する妊産婦死亡率は651(95%CI 554-761)、また保健管区ごとでは、クンペントゥム966(741-1239)、グディリ877(588-1260)に対し、ケドゥグ249(119-457)、バケル296(128-584)と、統計学的有意差がみられた。結語 本調査から、"unmet obstetric need"指標を用いて、州内保健管区の絶対的母体適応に起因する妊産婦死亡の違いを明らかにすることが可能であった。この手法を適用することで、妊産婦死亡の現状を把握し対策策定に用いることができるだけでなく、地域間の比較、トレンドのモニタリング、プログラムの評価に用いることができる可能性が示唆された。(著者抄録)

  日本国際保健医療学会, 2010年06月, 国際保健医療, 25(2) (2), 69 - 78, 日本語

  [査読有り]


• 日本語によるコミュニケーションが困難な外国人妊産婦の周産期医療上の問題点と支援に関する研究 一医療機関における12年間の分娩事例の分析より

  井上 千尋, 松井 三明, 李 節子, 中村 安秀, 箕浦 茂樹, 牛島 廣治

  本研究は,東京都心の医療機関における,1990年から2001年まで12年間の外国人分娩事例のうち,日本語によるコミュニケーションが困難な事例について検討することにより,言語の問題に伴う在日外国人の周産期医療上の課題を明らかにし,その対策について考察した.日本語によるコミュニケーションが困難なことにより,医療従事者と妊産婦との適切な意思伝達の阻害,保健・医療・福祉に関する情報不足,の2点が特有の問題として挙げられた.特に意思伝達の阻害は,病歴や自覚症状の確認困難,相互信頼関係形成と精神的支援の阻害,医療従事者の負担の増大を引き起こし,さらにインフォームドコンセントに基づく医療サービス提供の妨げになっていた.外国人妊産婦に対して,日本人と同じようにインフォームドコンセントに基づいた医療を提供するには,医療通訳制度を整えることが急務の課題であると考えられた(著者抄録)

  日本国際保健医療学会, 2006年03月, 国際保健医療, 21(1) (1), 25 - 32, 日本語

  [査読有り]


• 外国人妊産婦の「飛び込み分娩」に関する実態調査 医療機関における12年間の分娩事例の分析

  井上 千尋, 李 節子, 松井 三明, 中村 安秀, 箕浦 茂樹, 牛島 廣治

  外国人の分娩を多く取り扱う東京都心の医療機関において,1990年から12年間の外国人分娩のうち,「飛び込み分娩」事例について検討することにより,その妊娠・出産の現状と問題点を明らかにし,外国人特有の背景と支援のあり方について考察した.対象期間の外国人の分娩は656例で,飛び込み分娩事例は21例であった.飛び込み分娩の外国人妊産婦は,社会的・経済的に不安定な状態で,母子両面からハイリスクであることが確認され,医療機関へのアクセス,保健福祉制度の利用が著しく悪いことを示唆していた.外国人妊産婦が適切に医療にアクセスできるように,妊娠前からの情報と知識の提供,啓発が大きな課題である.経済的に困窮している外国人ハイリスク妊産婦に対しては,母子保健法や児童福祉法等による法的な保護が必要である

  日本小児保健協会, 2005年07月, 小児保健研究, 64(4) (4), 534 - 541, 日本語

  [査読有り]


• Antenatal care in the capital city of Cambodia: Current situation and impact on obstetric outcome

  Noriko Fujita, Mitsuaki Matsui, Sopha Srey, Chin Samuth Po, Sokhan Uong, Kanal Koum

  2005年04月, Journal of Obstetrics and Gynaecology Research, 31(2) (2), 133 - 139, 英語, 国際誌

  [査読有り]

  研究論文（学術雑誌）


• Characteristics of antepartum and intrapartum eclampsia in the National Maternal and Child Health Center in Cambodia

  Kanal Koum, Soryaphea Hy, Say Tiv, Tharith Sieng, Hiromi Obara, Mitsuaki Matsui, Noriko Fujita

  2004年04月, Journal of Obstetrics and Gynaecology Research, 30(2) (2), 74 - 79, 英語, 国際誌

  [査読有り]

  研究論文（学術雑誌）


• Dioxin-like potencies and extractable organohalogens (EOX) in medical, municipal and domestic waste incinerator ashes in Japan

  M Matsui, Y Kashima, M Kawano, M Matsuda, K Ambe, T Wakimoto, R Doi

  2003年12月, Chemosphere, 53(8) (8), 971 - 980, 英語, 国際誌

  [査読有り]

  研究論文（学術雑誌）


• Maternal death cases in the top referral hospital in Cambodia

  Kanal Koum, Say Tiv, Chan Soeung Sann, Mitsuaki Matsui, Hiromi Obara, Yoshiko Kudo, Noriko Fujita

  2002年, Journal of Obstetrics and Gynaecology Research, 28(1) (1), 13 - 18

  [査読有り]

  研究論文（学術雑誌）


• 東京湾とその周辺海域における魚の水銀濃度

  張 瑞軍, 鹿島 勇治, 松井 三明, 岡部 とし子, 土井 陸雄

  半閉鎖型の東京湾,開放型の相模湾及び外洋に接する銚子海域を対象海域として,食性の異なる3魚種412尾の魚肉中総水銀濃度を測定し,地理的環境,食性及び水質環境中の水銀濃度が魚の水銀蓄積に与える影響を検討した.その結果,魚の総水銀濃度は全て国の規制値範囲内であり,現在のレベルでは人の健康に害はないと考えられた.魚の食性は魚類や総水銀濃度に影響し,甲殻類食性の魚は多毛類食性やプランクトン食の魚より高い総水銀濃度が見られた.又,地理環境による魚の総水銀濃度に差が見られた.以上より,閉鎖型ないし半閉鎖型内湾は外湾や外洋より水質管理を一層強化し,より厳格な汚染クリーニングが必要と考えられた

  2001年07月, 日本衛生学雑誌, 56(2) (2), 492 - 499, 日本語

  [査読有り]


• Ovarian leiomyosarcoma: An autopsy case report

  Michiyo Nasu, Jun Inoue, Mitsuaki Matsui, Shigeki Minoura, Osamu Matsubara

  2000年, Pathology International, 50(2) (2), 162 - 165

  [査読有り]

  研究論文（学術雑誌）


• Roles of three histidine kinase genes in hyphal development and virulence of the pathogenic fungus Candida albicans

  Toshiko Yamada-Okabe, Toshiyuki Mio, Naomi Ono, Yuji Kashima, Mitsuaki Matsui, Mikio Arisawa, Hisafumi Yamada-Okabe

  1999年12月, Journal of Bacteriology, 181(23) (23), 7243 - 7247

  [査読有り]

  研究論文（学術雑誌）


• The Candida albicans gene for mRNA 5-cap methyltransferase: identification of additional residues essential for catalysis.

  Toshiko Yamada-Okabe, Toshiyuki Mio, Yuji Kashima, Mitsuaki Matsui, Mikio Arisawa, Hisafumi Yamada-Okabe

  The 5'-cap structure of eukaryotic mRNA is methylated at the terminal guanosine by RNA (guanine-N7-)-methyltransferase (cap MTase). Saccharomyces cerevisiae ABD1 (ScABD1) and human hMet (also called CMT1) genes are responsible for this enzyme. The ABD1 homologue was cloned from the pathogenic fungus Candida albicans and named C. albicans ABD1 (CaABD1). When expressed as a fusion with glutathione S-transferase (GST), CaAbd1p displayed cap MTase activity in vitro and rescued S. cerevisiae abd1delta null mutants, indicating that CaABD1 specifies an active cap MTase. Although the human cap MTase binds to the human capping enzyme (Hce1p), which possesses both mRNA guanylyltransferase (mRNA GTase) and mRNA 5'-triphosphatase (mRNA TPase) activities, yeast two-hybrid analysis demonstrated that in yeast neither mRNA GTase nor mRNA TPase physically interacted with the Abd1 protein. Comparison of the amino acid sequences of known and putative cap MTases revealed a highly conserved amino acid sequence motif, Phe/Val-Leu-Asp/Glu-Leu/Met-Xaa-Cys-Gly-Lys-Gly-Gly-Asp-Leu-Xaa-Lys, which encompasses the sequence motif characteristic of divergent methyltransferases. Mutations in CaAbd1p of leucine at the second and the twelfth positions (so far uncharacterized) to alanine severely diminished the enzyme activity and the functionality in vivo, whereas those of leucine at the fourth, cysteine at the sixth, lysine at the eighth, and glycine at the tenth positions did not. Furthermore, valine substitution for the twelfth, but not for the second, leucine in that motif abolished the activity and functionality of CaAbd1p. Thus, it appears that leucine at the second and the twelfth positions in the motif, together with a previously identified acidic residue in the third, glycine at the sixth and glutamic acid at the eleventh positions, play important roles in the catalysis, and that side chain length is crucial for the activity at the twelfth position in the motif.

  1999年11月, Microbiology (Reading, England), 145 ( Pt 11), 3023 - 3033, 英語, 国際誌

  [査読有り]

  研究論文（学術雑誌）


• Extractable organohalogens (EOX) in sediment and biota collected at an estuarine marsh near a former chloralkali facility

  Kurunthachalam Kannan, Masahide Kawano, Yuji Kashima, Mitsuaki Matsui, John P. Giesy

  1999年04月, Environmental Science and Technology, 33(7) (7), 1004 - 1008

  [査読有り]

  研究論文（学術雑誌）


• 当院における在日アジア系外国人の分娩及び新生児異常に関する臨床統計

  中江 華子, 長田 佳世, 五味淵 秀人, 宮澤 廣文, 粂川 好男, 松井 三明, 箕浦 茂樹

  185例を対象に,産科的背景,新生児異常,母体背景について診療録より調べた.1992年には29例7.1%だったアジア系外国人の分娩が,1996年には60例13.6%と倍増しており,帝王切開分娩の割合が有意に高かった.又,感染症を合併した妊婦が多かった.異常新生児は30.3%に認められ,その内訳は,高ビリルビン血症,巨大児,胎便吸引症候群,感染症の順に多かった.アジア系外国人は妊婦健診受診率が低く,医療保険未加入者が22.7%を占めていた

  1998年12月, 日本新生児学会雑誌, 34(4) (4), 804 - 809, 日本語

  [査読有り]


• Isolation and characterization of the Candida albicans gene for mRNA 5'-triphosphatase: Association of mRNA 5'-triphosphatase and mRNA 5'-guanylyltransferase activities is essential for the function of mRNA 5'-capping enzyme in vivo

  Toshiko Yamada-Okabe, Toshiyuki Mio, Mitsuaki Matsui, Yuji Kashima, Mikio Arisawa, Hisafumi Yamada-Okabe

  1998年09月, FEBS Letters, 435(1) (1), 49 - 54

  [査読有り]

  研究論文（学術雑誌）


• 在日外国人の分娩 国立国際医療センターでの経験から

  松井 三明, 中江 華子, 井上 潤

  1990年以降に外国人の分娩数,割合共に増加していることが確認された.その大半はアジア地域の出身者であり,7割強が新宿区に生活の拠点を持っていた.新宿区内在住の外国人登録数(1997年9月末現在)は19,591人,うちアジア地域が16,970人,86.9%であり,ほぼ地域の居住者分布を反映していると考えられる.しかし国籍別に区内登録者と当科での分娩者とを比較すると,フィリピンでは3.1%に対し13.9%,タイでは1.7%に対し10.5%と大きな隔たりが認められた

  1998年02月, 周産期医学, 28(2) (2), 253 - 257, 日本語

  [査読有り]

• 妊産婦の健康

  松井 三明

  2023年04月14日, 目で見るWHO, 84

  [招待有り]


• 新興・再興感染症,輸入感染症とは (特集 新興・再興感染症,輸入感染症と周産期医学)

  松井 三明, 岩本 あづさ

  東京医学社, 2021年03月, 周産期医学, 51(3) (3), 297 - 300, 日本語


• 長崎大学大学院(熱帯医学・グローバルヘルス研究科)のMPH教育

  松井 三明, 井本 敦子, 佐藤 美穂, 神谷 保彦, 門司 和彦, 北 潔

  医学書院, 2020年11月, 公衆衛生, 84(11) (11), 736 - 742, 日本語

  記事・総説・解説・論説等（商業誌、新聞、ウェブメディア）


• Challenges to neonatal care in Cambodia amid the COVID-19 pandemic

  Azusa Iwamoto, Rathavy Tung, Tomomi Ota, Shinichi Hosokawa, Mitsuaki Matsui

  National Center for Global Health and Medicine (JST), 2020年04月30日, Global Health & Medicine, 2(2) (2), 142 - 144, 英語

  [査読有り]

  速報，短報，研究ノート等（学術雑誌）


• 【教科書には載っていない分娩進行のアセスメント 開業助産師の"ここで分かる"をエビデンスで解説】 間歇時の眠り

  小長井 祥子, 松井 三明

  メディカ出版, 2017年09月, ペリネイタルケア, 36(9) (9), 878 - 881, 日本語


• 【教科書には載っていない分娩進行のアセスメント 開業助産師の"ここで分かる"をエビデンスで解説】 総論 分娩進行を判断・予測するために

  竹原 健二, 松井 三明

  メディカ出版, 2017年09月, ペリネイタルケア, 36(9) (9), 855 - 857, 日本語


• 【教科書には載っていない分娩進行のアセスメント 開業助産師の"ここで分かる"をエビデンスで解説】 座談会 開業助産師のワザとは

  江藤 宏美, 松井 三明, 野間田 真紀子, 信友 智子, 信友 浩一

  メディカ出版, 2017年09月, ペリネイタルケア, 36(9) (9), 844 - 854, 日本語


• 【現代帝王切開学】 母性の立場から 文献からみた諸外国の帝王切開の変遷

  松井 三明

  東京医学社, 2016年09月, 周産期医学, 46(9) (9), 1065 - 1070, 日本語


• 優れたSBA(Skilled Birth Attendant、熟練した分娩介助者) 日本の助産師の経験知を調査する 助産師がいう"お産が進む"とは何か? 開業助産師48名を対象にした聞き取り調査から(第17回)(最終回) まとめ

  竹原 健二, 井冨 由佳, 田山 美穂, 岡 潤子, 松井 三明

  メディカ出版, 2016年02月, ペリネイタルケア, 35(2) (2), 178 - 180, 日本語


• 優れたSBA(Skilled Birth Attendant、熟練した分娩介助者) 日本の助産師の経験知を調査する 助産師がいう"お産が進む"とは何か? 開業助産師48名を対象にした聞き取り調査から(第16回) 今回の着目点その他

  竹原 健二, 井冨 由佳, 田山 美穂, 岡 潤子, 松井 三明

  メディカ出版, 2016年01月, ペリネイタルケア, 35(1) (1), 93 - 95, 日本語


• 【出生前診断と生命倫理-染色体異常を中心として】 出生前診断・人工妊娠中絶の世界の潮流

  松井 三明

  東京医学社, 2015年05月, 周産期医学, 45(5) (5), 601 - 607, 日本語


• 優れたSBA(Skilled Birth Attendant、熟練した分娩介助者) 日本の助産師の経験知を調査する 助産師がいう"お産が進む"とは何か?(第1回) 助産師の観察と、"お産が進む"という判断

  竹原 健二, 井冨 由佳, 田山 美穂, 岡 潤子, 松井 三明

  メディカ出版, 2014年10月, ペリネイタルケア, 33(10) (10), 1026 - 1028, 日本語


• 技術情報 廃棄物焼却灰の有機態ハロゲン,ダイオキシン様およびエストロジェン様作用

  鹿島 勇治, 松井 三明, 岡部 とし子

  日本環境測定分析協会, 1999年10月, 環境と測定技術, 26(10) (10), 122 - 126, 日本語


• 日本に存在する焼却灰中の抽出可能な有機ハロゲン化合物(EOX:Cl,Br,およびI)ポ1 フタレンおよびポリ塩化ジベンゾ-p-ダイオキシンおよびジベンゾフラン

  Kawano Masahide, Ueda Morio, Matsui Mitsuaki

  廃棄物研究財団, 1998年, ダイオキシン海外調査報告書, (1998) (1998), 300 - 302, 日本語


• <座談会>カンボジアの保健医療・環境調査を始めて (特集 カンボジア復興と環境問題)

  鹿島 勇治, 松井 三明, 渡辺 直子

  〔月刊水情報〕, 1997年01月, 水情報, 17(1) (1), 3 - 8, 日本語


• 産科婦人科症状・診断・治療'95〜'96 婦人科 貧血

  箕浦 茂樹, 松井 三明, 立花 聡司

  1995年10月, 産婦人科の実際, 44(11) (11), 1483 - 1488, 日本語


• 母体疾患の周産期ケア 脳・脊髄・末梢神経疾患 閉塞性脳血管障害

  松井 三明, 箕浦 茂樹, 大木 康史

  1994年11月, 周産期医学, 24(増刊) (増刊), 485 - 487, 日本語


• CPDと帝王切開

  箕浦 茂樹, 松井 三明

  1994年03月, 産婦人科の実際, 43(4) (4), 475 - 478, 日本語

• アジア旅行者のための感染症対策

  本田, 徹, 金子, 明

  連合出版, 2003年11月, 日本語, ISBN: 4897721881


• ピル博士のピルブック

  Guillebaud, John, 早乙女, 智子

  メディカルトリビューン, 2001年, 日本語, ISBN: 489589231X

• カンボジアの地域における新生児死亡の実際 Verbal Autopsy36例の記述結果より

  岩本 あづさ, 鈴木 絢子, 松井 三明, 国際協力機構(JICA)カンボジア国「分娩時及び新生児期を中心とした母子継続ケア改善プロジェクト」

  日本公衆衛生学会総会抄録集, 2018年10月, 日本語, 日本公衆衛生学会


• カンボジアの第1次医療施設で出生する新生児の健康に影響を与える要因と対策

  松井 三明, 岩本 あづさ

  日本公衆衛生学会総会抄録集, 2016年10月, 日本語, 日本公衆衛生学会


• カンボジアで出生する児の臍帯動脈血検査結果から考えられる今後の周産期管理のあり方

  松井 三明, 岩本 あづさ

  日本公衆衛生学会総会抄録集, 2015年10月, 日本語, 日本公衆衛生学会

• カンボジア農村部に住む乳幼児の腸管病原微生物と環境性腸機能障害の関連

  宮崎 あすか, 松井 三明

  日本学術振興会, 科学研究費助成事業 基盤研究(C), 基盤研究(C), 長崎大学, 2023年04月 - 2026年03月


• イスラームを国教とするバングラデシュにおける女性の性機能障害の実態と障害への対処

  井本 敦子, 松井 三明, 本田 純久

  日本学術振興会, 科学研究費助成事業 基盤研究(C), 基盤研究(C), 長崎大学, 2021年04月01日 - 2024年03月31日

  本研究の目的は、バングラデシュ都市部の女性を対象に、質問紙調査および質的インタビュー調査を用いて、性機能障害の有症状況、障害の種類・重症度の実態を明らかにするとともに、障害に対する対処行動についても検証する。本研究により、性機能障害の有症者がどの程度存在し、どのような障害を抱え、どのように障害に対処したかが明らかになり、障害を持つ女性本人、また医療従事者や保健医療政策策定者が問題を意識化し、適切な施策を促進することができると考える。 本年度は、量的調査の準備を行うため、現地協力機関の協力を得て、現地の当該分野に関わる医療体制や保健政策、保健医療サービスについて情報収集を行い、研究計画の詳細を協議する予定であった。しかしながら、新型コロナウイルス感染症の影響により、現地への渡航が難しく、また協力機関においても新型コロナウイルス感染症の関連業務が増えたこともあり、調査協力を求めにくい状況に陥った。このため、インターネット検索等によって、女性の性機能障害の有症率や障害に対する対処行動等について文献レビューを行い、現地での研究業務は翌年に順延することとした。


• カンボジア農村部の小児に対する抗菌薬使用が薬剤耐性と低栄養に与える影響の研究

  松井 三明, 宮崎 あすか, 岩本 あづさ, コックス シャーロン

  日本学術振興会, 科学研究費助成事業 国際共同研究加速基金(国際共同研究強化(B)), 国際共同研究加速基金(国際共同研究強化(B)), 長崎大学, 2020年10月27日 - 2024年03月31日

  本研究では、低中所得国における子どもの低栄養の発生に関して、世界の動向とこれまでの研究成果を踏まえて、以下の学術的問いを設定し、これを検証することを目的として実施している。 1 生後1歳まで投与される抗菌薬によって、カンボジア農村部の子どもの腸内細菌叢が変化し、腸管慢性炎症が増加する。これを、抗菌薬を投与された子どもから便を採取し、便に含まれる炎症マーカーを測定することで確認する。 2 カンボジア農村部においても、すでにAMRを獲得した細菌が存在し、それが子どもの下痢症発生と関連している。これを、便に含まれる薬剤耐性遺伝子を同定し、さらに疾病エピソード発生との関連を検証することで確認する。 3 腸管慢性炎症とAMR獲得細菌の存在が、離乳期以降に子どもの低栄養を悪化させる要因である。これを子どもを定期的に追跡して身体計測を行い、慢性炎症、AMR、その他の要因との関連を疫学的に解析することで確認する。 2021年度においても、新型コロナウイルス感染症の蔓延のためにカンボジア国内での地方部訪問がままならず、計画していたコホートの形成が実施できなかったため研究本体の開始が遅延している。その遅れを取り戻すために、2021年度は研究で焦点を当てる低栄養の低中所得国における調査手法、および腸管慢性炎症と薬剤耐性のバイオマーカー確認手法に関するスコーピングレビューを開始するにとどまった。 併行して、カンボジアでの調査再開ができることを念頭に置いて、現地で雇用する研究スーパーバイズ担当者、およびリサーチアシスタントの雇用について、現地関係者との協議を行い、その方針を決定した。


• カンボジアにおける分娩監視装置導入と、その死産・新生児死亡の減少効果に関する研究開発

  松井 三明, 海野 信也, 江藤 宏美, 竹原 健二

  日本医療研究開発機構, 地球規模保健課題解決推進のための研究事業, 長崎大学, 2020年07月 - 2024年03月, 研究代表者


• 助産師を中心とする地域での妊娠・出産ケア提供体制構築可能性の研究

  松井 三明, 江藤 宏美

  日本学術振興会, 科学研究費助成事業 挑戦的萌芽研究, 挑戦的萌芽研究, 長崎大学, 2016年04月01日 - 2019年03月31日

  長崎県の離島を除く6保健所（長崎、佐世保、西彼、県北、県央、県南）管内の出生を出生個票と出生小票から取得した。その数は平成26年 10608件、平成27年 10344件、平成28年 10199件であり、これを解析の対象とした。出生千対の勤務助産師は、長崎市を100%とすると県北25%、県南50%と2～4倍の格差があった。粗出生率は最小は東彼杵町5.59、最大は大村市10.48と1.87倍の開きがあった。市町別に、勤務助産師の出生千対数と粗出生率を比較したところ、長崎市では医療施設と従事者との偏在が多いことが示唆された。また他の地域では医療従事者密度と粗出生率との間に相関があることが確認された。


• カンボジアにおける「科学的根拠に基づく助産ケア」が母児に及ぼす影響の研究

  松井 三明, 野口 真貴子, 竹原 健二

  日本学術振興会, 科学研究費助成事業 基盤研究(B), 基盤研究(B), 長崎大学, 2015年04月01日 - 2018年03月31日

  カンボジアで助産師・看護師の知識を測定し、欠如が大きいと同定された項目（胎児心音、分娩監視）に関する研修を実施し、研修前後での新生児の状態を比較検討した。 検討は首都プノンペン市の公立第1次医療施設6カ所で行った。研修実施前123例、実施後98例の臍帯動脈血液ガス測定を行った。pH平均値は7.23（前）、7.22（後）、pH 7.20未満の割合アシドーシスは37.4%（前）、32.7%（後）であり、有意な差は認められなかった。単に分娩監視を強化するだけでは改善につながらず、胎児に負荷をかける要因を同定しその対策を行うことが必須と考えた。


• 内分泌かく乱物質が引き起こす生物雌性化現象へのUDP-GlcNAc生合成の関与

  岡部 とし子, 鹿島 勇治, 松井 三明

  日本学術振興会, 科学研究費助成事業 基盤研究(C), 基盤研究(C), 横浜市立大学, 1999年 - 2001年

  ヒト及び動物において男性生殖機能の退行が危倶されているが、その原因として内分泌撹乱物質による性ホルモン受容体への作用が示唆されている。一方、ヒトのN-アセチルグルコサミン-1-リン酸(GlcNAc-1-P)ウリジル転移酵素(UAP1)は精巣及び精子尾部、特にouter dense fiberで発現が極めて高く生殖機能に重要な役割を果たしていると推察されている。また、UAP1は男性不妊症患者の血中に検出される抗体の抗原タンパク質であることから、男性不妊症との関連も示唆されている。そこで、本研究では不妊外来を訪れた男性不妊症患者の精液を用いて、その精漿中のUAP1に対する抗体の有無をELISA法により検討した結果、精子運動率の著しく低下した集団ではUAP1に対する抗体を有する割合が有意に高いことを示した。さらにUAP1の一次構造を比較すると数種類の精子表面タンパク質と部分的に相同性を有することから、UAP1に対する抗体を有することにより、他の精子表面タンパク質の機能を阻害することになり、結果として精子の機能に影響を及ぼす可能性が示唆された。さらに内分泌撹乱物質がUAP1の酵素活性に影響を及ぼすか否かについても検討した。 また、UAP1が関与することが知られている真核生物のUDP-GlcNAc生合成に関与する酵素遺伝子であるGNA1、AGM1を同定し、これら酵素の機能を明らかにした。さらにN-アセチルグルコサミン(GlcNAc)の異化作用に関与する酵素であるGlcNAc kinase及びGlcNAc-phosphate deacetylaseを同定し、これら酵素の機能ならびに染色体上にクラスターとして存在することを明らかにした。加えて、同一クラスターに存在する他の遺伝子産物の機能についても明らかにした。


• 核内ホルモンレセプターを用いた内分泌かく乱物質の人体へのリスク評価系の開発

  土井 陸雄, 岡部 とし子, 鹿島 勇治, 松井 三明

  日本学術振興会, 科学研究費助成事業 基盤研究(C), 基盤研究(C), 横浜市立大学, 1999年 - 2001年

  内分泌攪乱物質はエストロゲン様作用、アンドロゲン様作用等を有することによる生殖系への影響が報告されている。近年は内分泌攪乱物質を蓄積した野生生物の研究から、免疫系や甲状腺ホルモン系を介した神経系への影響も危惧されているがこれらの影響を評価する実験系が確立されていない。本研究では内分泌攪乱物質によるよる甲状腺ホルモン系への影響を評価するために、ヒト甲状腺ホルモン受容体α1を高発現した細胞株HeLaTR細胞を作成した。甲状腺ホルモンレスポンスエレメント(DR4)をエンハンサーとして有するレポーター遺伝子を導入する際に甲状腺ホルモンT3を添加すると、レポーター活性は数倍上昇した。しかしながら、類似の配列を有するが関連のないエンハンサー(DR0)を用いた場合にはレポーター活性を変化させなかった。さらに、甲状腺ホルモン結合タンパク質であるtransthretinへの結合が報告されている水酸化PCBはT3と共に添加するとレポーター活性を抑制した。また、ダイオキシンはT3によるレポーター活性をさらに増加させたが、エストロゲン受容体への結合が報告されているビスフェノールAやフタル酸を添加してもT3の作用に影響しなかった。以上の結果から、HeLaTR細胞へ甲状腺ホルモンレスポンスエレメントを有するレポーター遺伝子を導入し、レポーター活性を測定することにより、(抗)甲状腺ホルモン様作用を調べることが可能になった。


• 残留性有機汚染物質の内分泌撹乱作用および免疫系への作用

  松井 三明

  日本学術振興会, 科学研究費助成事業 奨励研究(A), 奨励研究(A), 横浜市立大学, 1999年 - 2000年

  ゴミ焼却に伴って発生し、環境中に長期間安定な形で残留する残留性有機汚染物質を念頭において、ゴミ焼却灰を材料として、以下の検討を行った。1)ダイオキシン反応エレメント(Dioxin responsive element)を介した遺伝子活性に及ぼす影響、2) 1)から得られたダイオキシン類毒性計数(biological toxic equivalent factor:生物学的TEQ)の推定、3)化学分析による毒性物質の定量およびダイオキシン類毒性計数(TEQ)の算出、4)2)および3)から得られた数値の比較検討、5)女性ホルモンの遺伝子転写活性に及ぼす影響。 複数の焼却灰試料抽出液を用いた検討では、生物学的TEQ値が、ダイオキシン類および多環芳香族化合物分析から得られたTEQ値を上回る試料が多かった。 また培養細胞による女性ホルモン依存性タンパク量の変化を検討したところ、抽出液の曝露によってタンパク量が増加する試料が認められた。このことから、抗エストロジェン作用を示すダイオキシン類が多量に存在していても、なおエストロジェン様作用をもつ化学物質を含有することが示唆された。 結果から、焼却灰中には、化学分析で同定・定量可能なダイオキシン類異性体・同族体の他に、同様の生物作用を示す物質が存在しているか、あるいは複数の物質が生物学的に相乗効果を示す可能性が示唆された。一方で、化学分析によって、多環芳香族化合物の関与は低いことが推定された。 女性ホルモン作用を示す物質の同定は困難であるが、原因物質としてはPCB類、有機塩素化合物などが考えられる。ダイオキシン類との複合影響を考慮した上で、環境中での挙動を踏まえながら、排出を管理することが重要であると思われた。 生物学的TEQ値の測定は有用と考えられるが、これのみでダイオキシン類の毒性評価を行うことは不可能であり、その毒性発現機構の詳細な解明と、それに基づく評価手法の開発が必要である。