{"created":"2023-06-19T11:23:31.330552+00:00","id":4080,"links":{},"metadata":{"_buckets":{"deposit":"3cfd2b35-a109-41ff-8821-0cc90b24cc28"},"_deposit":{"created_by":3,"id":"4080","owners":[3],"pid":{"revision_id":0,"type":"depid","value":"4080"},"status":"published"},"_oai":{"id":"oai:asahikawa-med.repo.nii.ac.jp:00004080","sets":["7","7:23"]},"author_link":["12471","12472","12473","12474","12475"],"item_5_biblio_info_21":{"attribute_name":"書誌情報","attribute_value_mlt":[{"bibliographicIssueDates":{"bibliographicIssueDate":"2011-07-01","bibliographicIssueDateType":"Issued"},"bibliographicIssueNumber":"7","bibliographicPageEnd":"5","bibliographicPageStart":"1","bibliographicVolumeNumber":"58","bibliographic_titles":[{"bibliographic_title":"厚生の指標"}]}]},"item_5_description_33":{"attribute_name":"抄録","attribute_value_mlt":[{"subitem_description":"目的 北海道内の各市町村から産婦人科・小児科救急拠点病院へのアクセス時間について地理情報システム(Geographic Information System,以下,GIS)ソフトウエアを用いて推定し,それらの周産期アウトカムの影響を検討することを目的としている。方法 市町村ごとの平成15〜19年の乳児死亡数,新生児死亡数,周産期死亡数から,5年間平均の乳児死亡率,新生児死亡率(出生千対),周産期死亡率(出産千対)を計算した。産婦人科医と小児科医の常勤医がそれぞれ2名以上勤務する28施設を今回の産婦人科・小児科拠点病院とした。各市町村から28産婦人科・小児科拠点病院のうち直近の施設への乗用車でのアクセス時間を推定するためArcGIS9.3(ESRI,NYC)のNetwork analyst解析を用いた。各市町村からのアクセス時間を説明変数として乳児死亡率の第4四分位,新生児死亡率の第3三分位,周産期死亡率の第4四分位となるオッズ比についてロジスティック回帰分析を用いて算出した(新生児死亡率のみ分布が低値に偏っているため四分位に適さず,三分位とした)。結果 対象医療機関への到達時間の中央値は48.4分,平均値57.3分(標準偏差39.0),最小値,0.3分,最大値は181.0分で,90分以上の市町村は40(22.7%)に認め,そのうち13市町村(7.4%)が120分以上となっていた。ロジスティック回帰分析では,乳児死亡率ではアクセス時間による有意な差を認めなかった。新生児死亡率については,アクセス時間が60分以上90分未満の群が30分未満の群に比べて有意に減少していた(オッズ比(OR)=0.22,95%信頼区間(CI):0.07-0.73,P=0.013)。また,90分以上の群では上昇する傾向を認めた(OR=4.33,95%CI:0.17-1.09,P=0.076)。また,周産期死亡率はアクセス時間が30分以上60分未満の群において有意の上昇を認めた(OR=2.61,95%CI:1.04-6.58,P=0.041)。結論 新生児死亡率では60分以上90分未満で有意にオッズ比の低下を認めたが,90分以上でオッズ比の上昇傾向を認めた。しかし,周産期死亡率では,30分以上60分未満でオッズ比の上昇を認めた。都市部の未受診妊婦の増加などの影響も考えられ,アクセス時間は単純にはアウトカムに関係しなかったと考えられるが,90分以上のアクセス時間は問題である可能性もあり,今後も検討を重ね,道路やドクターヘリの整備,医療機関の効率的な配置などを考えていく必要がある。","subitem_description_language":"ja","subitem_description_type":"Abstract"}]},"item_5_description_36":{"attribute_name":"注記","attribute_value_mlt":[{"subitem_description":"雑誌掲載版","subitem_description_type":"Other"}]},"item_5_description_37":{"attribute_name":"資源タイプ","attribute_value_mlt":[{"subitem_description":"text","subitem_description_type":"Other"}]},"item_5_description_41":{"attribute_name":"フォーマット","attribute_value_mlt":[{"subitem_description":"application/pdf","subitem_description_type":"Other"}]},"item_5_source_id_22":{"attribute_name":"ISSN","attribute_value_mlt":[{"subitem_source_identifier":"0452-6104","subitem_source_identifier_type":"PISSN"}]},"item_5_text_44":{"attribute_name":"ID(XooNIps)","attribute_value_mlt":[{"subitem_text_value":"2011324359"}]},"item_5_text_54":{"attribute_name":"閲覧数(XooNIps)","attribute_value_mlt":[{"subitem_text_value":"1020"}]},"item_5_text_55":{"attribute_name":"ダウンロード数(XooNIps)","attribute_value_mlt":[{"subitem_text_value":"1267"}]},"item_5_text_7":{"attribute_name":"著者 ローマ字","attribute_value_mlt":[{"subitem_text_value":"Nakagi, Yoshihiko"},{"subitem_text_language":"en","subitem_text_value":"Ito, Toshihiro"},{"subitem_text_language":"en","subitem_text_value":"Sugioka, Yoshihiko"},{"subitem_text_language":"en","subitem_text_value":"Yoshida, Takahiko"},{"subitem_text_language":"en"}]},"item_5_version_type_38":{"attribute_name":"著者版フラグ","attribute_value_mlt":[{"subitem_version_resource":"http://purl.org/coar/version/c_970fb48d4fbd8a85","subitem_version_type":"VoR"}]},"item_creator":{"attribute_name":"著者","attribute_type":"creator","attribute_value_mlt":[{"creatorNames":[{"creatorName":"西條, 泰明","creatorNameLang":"ja"},{"creatorName":"サイジョウ, ヤスアキ","creatorNameLang":"ja-Kana"}],"nameIdentifiers":[{"nameIdentifier":"12471","nameIdentifierScheme":"WEKO"}]},{"creatorNames":[{"creatorName":"中木, 良彦","creatorNameLang":"ja"},{"creatorName":"ナカギ, ヨシヒコ","creatorNameLang":"ja-Kana"}],"nameIdentifiers":[{"nameIdentifier":"12472","nameIdentifierScheme":"WEKO"}]},{"creatorNames":[{"creatorName":"伊藤, 俊弘","creatorNameLang":"ja"},{"creatorName":"イトウ, トシヒロ","creatorNameLang":"ja-Kana"}],"nameIdentifiers":[{"nameIdentifier":"12473","nameIdentifierScheme":"WEKO"}]},{"creatorNames":[{"creatorName":"杉岡, 良彦","creatorNameLang":"ja"},{"creatorName":"スギオカ, ヨシヒコ","creatorNameLang":"ja-Kana"}],"nameIdentifiers":[{"nameIdentifier":"12474","nameIdentifierScheme":"WEKO"}]},{"creatorNames":[{"creatorName":"吉田, 貴彦","creatorNameLang":"ja"},{"creatorName":"ヨシダ, タカヒコ","creatorNameLang":"ja-Kana"}],"nameIdentifiers":[{"nameIdentifier":"12475","nameIdentifierScheme":"WEKO"}]}]},"item_files":{"attribute_name":"ファイル情報","attribute_type":"file","attribute_value_mlt":[{"accessrole":"open_date","date":[{"dateType":"Available","dateValue":"2021-07-06"}],"displaytype":"detail","filename":"4796.pdf","filesize":[{"value":"4.3 MB"}],"format":"application/pdf","licensetype":"license_note","mimetype":"application/pdf","url":{"label":"4796.pdf","url":"https://asahikawa-med.repo.nii.ac.jp/record/4080/files/4796.pdf"},"version_id":"d3e30628-6e30-4792-ac29-5cfc3669635d"}]},"item_keyword":{"attribute_name":"キーワード","attribute_value_mlt":[{"subitem_subject":"乳児死亡率","subitem_subject_language":"ja","subitem_subject_scheme":"Other"},{"subitem_subject":"新生児死亡率","subitem_subject_language":"ja","subitem_subject_scheme":"Other"},{"subitem_subject":"周産期死亡率","subitem_subject_language":"ja","subitem_subject_scheme":"Other"},{"subitem_subject":"拠点病院","subitem_subject_language":"ja","subitem_subject_scheme":"Other"},{"subitem_subject":"地理情報システム（GIS)","subitem_subject_language":"ja","subitem_subject_scheme":"Other"},{"subitem_subject":"到達時間","subitem_subject_language":"ja","subitem_subject_scheme":"Other"}]},"item_language":{"attribute_name":"言語","attribute_value_mlt":[{"subitem_language":"jpn"}]},"item_resource_type":{"attribute_name":"資源タイプ","attribute_value_mlt":[{"resourcetype":"journal 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