John I. Takayama

Admission, recruitment, and retention

As the country strives to produce larger numbers of generalist physicians, considerable controversy has arisen over whether or not generalist applicants can be identified, recruited, and influenced to keep a generalist-oriented commitment throughout medical training. The authors present new and existing data to show that: 1) preadmission (BA/MD or post-baccalaureate) programs can help to identify generalist-oriented students; 2) characteristics determinedat admission to medical school are predictive of future generalist career choice; 3) current inpatient-oriented training programs strongly push students away from a primary care career; 4) women are more likely than men to choose generalist careers, primarily because of those careers’ interpersonal orientation; and 5) residency training programs are able to select applicants likely to become generalists. Therefore, to produce more generalists, attempts should be made to encourage generalist-oriented students to enter medical schools and to revise curricula to focus on outpatient settings in which students can establish effective and satisfying relationships with patients. These strategies are most likely to be successful if enacted within the context of governmental and medical school-based changes that allow for more reimbursement and respect for the generalist disciplines.

BMI z-score is the optimal measure of annual adiposity change in elementary school children.

Background: BMI or BMI% adjusted for age has been identified as the optimal measure of short-term adiposity change in kindergarten children aged 29–68 months. The optimal measure of annual adiposity change in older age children, however, has not been determined. Aim: To identify the optimal measure of annual adiposity change for Japanese children aged 6–12 years. Subjects and methods: A cohort of 669 Japanese children in one private school in Tokyo in whom height and weight were measured annually between 6 and 12 years. Each childs annual variability in adiposity was summarized by the standard deviation (SD) of BMI and BMI% adjusted for age, BMI z-score and BMI centile. The SDs were compared in overweight and non-overweight children and correlated with each childs baseline BMI z-score. Results: The within-child BMI, BMI% and BMI centile SDs were significantly different in overweight and non-overweight children, while the BMI z-score SDs were similar in the two groups. Furthermore, the within-child BMI, BMI% and BMI centile SDs were inversely correlated with baseline BMI z-score, whereas BMI z-score SDs were not, with the exception of measurements for grade 1–2 children. Conclusion: The BMI z-score is the optimal measure of annual adiposity change for elementary school children.

Screening for maternal depression in primary care pediatrics.

Purpose of review An estimated 10–20% of mothers suffer from postpartum depression. Given its profound impact on both mother and infant and the availability of effective interventions, pediatricians can improve identification and referral of mothers with postpartum depression by screening regularly during well child visits. The purpose of this paper is to review and assess recently developed screening tools. Recent findings Since the development of the Edinburgh Postnatal Depression Scale in 1987, several shorter screening tools have been introduced. Although further innovation to optimize appropriate identification of postpartum depression is critical, these brief tools have been shown to be useful in improving pediatrician recognition of depression in mothers and referral to psychiatric specialists. Summary Recently developed brief screening tools are recommended for routine use by pediatricians during well child visits to identify mothers who need additional evaluation for depression. Screening should be conducted repeatedly during the first year of child rearing as symptoms of postpartum depression may appear at any time and its progression may help differentiate between mild and more severe forms of depression. Pediatricians can also provide appropriate follow-up of the family.

Official Japanese reports significantly underestimate prevalence of overweight in school children: Inappropriate definition of standard weight and calculation of excess weight

Background: The obesity epidemic in Japan continues to increase. However, the prevalence and trends of obesity have not explicitly been determined in Japanese children. Aim: The study estimated the trend and prevalence of overweight in Japanese school children, 1980–2001. Subjects and methods: The 2001 cross-sectional national survey on 334,939 boys and 335,204 girls, 5–18 years of age was studied, using the 1978–1981 references. Main outcome measures were proportion of children with BMI ≥95th centile and those with ≥ + 20% excess body weight. Results: The prevalence of overweight increased 2.6 times (5.0% to 12.9%) in Japanese boys and 2.5 times (5.0% to 12.5%) in Japanese girls during the last two decades as assessed by using BMI, whereas the Japanese Ministry of Education, Culture, Sports and Science and Technology reported a much smaller increment in prevalence (5.8% to 9.2% in boys, 5.6% to 8.0% in girls, respectively) using the same data but based on a cut-off value of ≥ + 20% excess body weight. Conclusion: Official governmental reports significantly underestimate the current epidemic of obesity in Japan.

Prevalence and trends of underweight and BMI distribution changes in Japanese teenagers based on the 2001 National Survey data.

Background: Excessive thinness has been glamorized among Japanese adolescent girls, and unhealthy dieting to lose weight has become a popular practice among them. The prevalence of underweight in contemporary Japanese girls in comparison with that of boys, however, remains to be studied. Aim: The purpose of this study was to determine the prevalence and trends of underweight in contemporary Japanese teenagers of both sexes using nationally representative cross-sectional data. Subjects and methods: Underweight was defined as BMI < 3rd percentile by age and sex of the 1978–1981 reference population as previously reported. These reference values were compared with BMIs of the contemporary population based on the 2001 Cross-sectional National Survey data of Japanese teenagers (215 972 boys and 216 496 girls). Results: The prevalence of underweight was approximately 2–3% in junior high school students of both sexes, 12.5–14.5 years of age, approximately 3% in senior high school students of both sexes, 15.5–16.5 years of age, and approximately 4% in senior high school students of both sexes, 17.5 years of age. Conclusion: The prevalence of underweight decreased among Japanese teenage students of both sexes during the past decades. Female preponderance in the prevalence of underweight was not confirmed.

Trends in thin body stature among Japanese female adolescents, 2003–2012

Abstract Background: The past decades have witnessed a steady increase in thin body stature associated with unhealthy dieting among Japanese female adolescents. The most recent trends in thinness, however, have not been reported. Aim: To describe changes in the distribution of body mass index (BMI) of Japanese female adolescents, from 2003–2012. Subjects and methods: This study examined BMI distribution changes in 2541 relatively affluent Japanese girls, aged 12.5–17.5 years, during 2003–2012. The 2003 and 2004 data were combined and compared to the combined 2011 and 2012 data. Tukey mean-difference plots were used to study the direction and magnitude of shifts in BMI distributions. Results: Prevalence of thinness (BMI <5th percentile of the 1978–1981 references) has progressively increased from 2.0–5.7% in 2003–2004 to 3.5–7.8% in 2011–2012 in Japanese girls. The downward shift in BMI was larger in 12.5–14.5 year olds than in 15.5–17.5 year olds and more prominent in the lower BMI spectrum. Conclusion: The trend towards thinness has continued in Japanese girls during the past decade. The distribution of BMI suggests thinner and younger sub-groups of girls are more susceptible to this trend.

Waist circumference centiles by age and sex for Japanese children based on the 1978–1981 cross-sectional national survey data

Abstract Aim: The aim of this study was to establish reference values for waist circumference among Japanese youths using the 1978–1981 nationally representative data. Subject and methods: Growth charts were derived using Cole’s LMS method, which adjusts the waist circumference distribution for skewness and allows waist circumference to be expressed as centile or standard deviation score. The sample population consisted of 19 233 children aged 6–18 years. Waist circumference was measured at the level of maximum waist narrowing in girls and at the level of the top of the iliac crest in boys. Results: Comparison was made between the 1978–1981 and 1992–1994 waist circumference charts, showing a large increase in waist circumference over time; the mean difference was 1.1 and 0.5 SD score units in boys and girls, respectively. Defining cut-offs for central fatness as the 90th and 95th centiles of the 1978–1981 reference, the prevalences in 1992–1994 were, respectively, 42.3% and 25.2% in boys and 19.1% and 10.9% in girls. The corresponding prevalences in 1978–1981 were 10% and 5% by definition. Conclusion: This study showed increasing trends in waist circumference, particularly in boys during the period of the two surveys and that the 1978–1981 charts serve as better baseline references for waist circumference among Japanese youth.

Tracking of BMI in Japanese children from 6 to 18 years of age: Reference values for annual BMI incremental change and proposal for size of increment indicative of risk for obesity

Background: A large incremental increase in BMI indicates excess fat deposition in most children, but the reference values for identifying those at risk for developing obesity have not been defined. Aim: To determine the mean and SD of annual incremental change (ΔSDS) in BMI for Japanese school children. Subjects and methods: A cohort of 669 Japanese children in one private school in Tokyo in whom height and weight were measured annually between 6–17 years of age. Each childs BMI was converted to SDS as based on the 1978–1981 Japanese references for the 12 annual measurements to derive the correlation coefficient, r, between two successive measurements. Using the formula, SD of Δ, the mean and SD of ΔSDS were obtained. Results: Excess BMI gain was defined in terms of ΔSDS in Japanese children. Annual incremental increase greater than 2 SD of ΔSDS, equivalent to 1–2 BMI units/year for younger children and 2–3 BMI units/year for older children, respectively, indicates rapid increase in body fat in Japanese children. Conclusion: Based on analysis of incremental change in BMI in this cohort, a cut-off has been identified that can be used to identify children at risk for developing obesity.

Can pediatricians accurately identify maternal depression at well-child visits?

Background:  The feasibility of a two‐item screening tool for maternal depression in a pediatric setting was recently reported. We assessed whether the accuracy of pediatrician recognition of maternal depression during the one‐month well‐child visit could be improved by an educational intervention using the two‐item screening tool.

Maternal childrearing anxiety reflects childrearing burden and quality of life.

Background:  The government of Japan has recently initiated public programs to allay maternal childrearing anxiety. The aim of the present study was to determine the prevalence of childrearing anxiety and describe its relationships with perceived childrearing burden and maternal quality of life (QOL).