Maternity leave policies for medical students in Japan / 医学教育

1) Although maternity leave can facilitate the professional success of female students.The extent to which maternity leave is implemented remains unknown.A cross-sectional questionnaire survey of all Japanese medical schools and postgraduate schools in medicine (N=81) was performed.Responses were received from 55 medical schools and postgraduate medical schools (response rate=67.9%).The results showed that no school had formally established a maternity leave policy for students.<BR>2) We found that medical educators had reorganized clinical clerkship programs to accommodate the pregnancies of students but expressed confusion about how to manage such situations.<BR>3) We also found that many female postgraduate students drop out because of pregnancy or child-care responsibilities. Medical schools and postgraduate schools should recognize the importance of maternity leave and should not close their doors to pregnant students who are contending with both motherhood and academic achievement.

Sociodemographic Characteristics for Use of Complementary and Alternative Medicine in Japan / General Medicine

BACKGROUND: Use of complementary and alternative medicine (CAM) has become popular in Japan.<BR>OBJECTIVE: To investigate associations of symptom-related CAM use with sociodemographic factors in Japan.<BR>DESIGN AND SETTING: A prospective cohort study of a nationally representative sample of households in Japan.<BR>PARTICIPANTS: Community-dwelling adults who developed at least one symptom during a 31-day period.<BR>MAIN OUTCOME MEASURES: Self-reported, symptom-related use of CAM, either physical CAM or oral CAM.<BR>RESULTS: Of 2, 453 adults, 2, 103 participants (86%) developed at least one symptom. Of these symptomatic adults, 156 (7.4% ; 95% CI: 6.3-8.5%) used physical CAM therapy. The likelihood of using physical CAM was not significantly influenced by annual household income, employment, or education. Participants living in large cities had an increased likelihood of using physical CAM with an odds ratio (OR) of 2.6 (95% CI: 1.2-5.8), compared to those living in rural areas. Oral CAM therapy was used by 480 participants (22.8%; 95% CI: 21.0-24.6%) among the symptomatic adults. An age of 60 years old and older (OR 2.0; 95% CI: 1.2-3.3) and female gender (OR 1.8; 95% CI: 1.3-2.6) were significantly associated with an increased use of oral CAM. The unemployed participants had a lower likelihood of using oral CAM, with an OR of 0.6 (95% CI: 0.4-0.9), compared to the employed.<BR>CONCLUSIONS: Oral CAM use is common among Japanese patients and is associated with older age, female gender, and employed status, while physical CAM use is less common and is associated with living in a large city.

Current Situation of Medical Student Abuse / 医学教育

1) To our knowledge, medical student abuse has not previously been studied in Japan.<BR>2) In our survey, 68.5% of respondents experienced medical student abuse.<BR>3) Several students reported that they had been frequently neglected or ignored by teaching physicians during clinical clerkships and that such attitudes discouraged them and decreased their motivation.<BR>4) To improve the learning environment, medical educators must take action to resolve this serious issue.

The Number of Lives Saved and Quality-adjusted Life Years Prolonged by Ticlopidine Hydrochloride over the Past 20 years in Japan / General Medicine

PURPOSE: Ticlopidine hydrochloride, an antiplatelet agent, is believed to have saved life years in many patients with ischemic cerebral vascular diseases in Japan. But severe adverse events have also been reported. The current investigation aimed to compare two hypothetical cohorts treated with and without ticlopidine in terms of risks and benefits of ticlopidine treatment using Markov model.<BR>METHODS: We conducted Markov decision analysis to estimate the number of lives saved and the increase in quality-adjusted life years (QALYs) over the past 20 years by ticlopidine in Japan. Two cohorts of 60-year-old male patients with previous histories of cerebral infarction, one of which treated with ticlopidine and the other not treated with ticlopidine, were compared with respect to the number of deaths and quality of life (QOL) . Data incorporated were the probabilities of the recurrence of cerebral infarction and the associated mortality, adverse events of the drug, and the utility of health status treated with ticlopidine.<BR>RESULTS: Approximately 1, 630, 000 patients were estimated to be on ticlopidine for variable periods of time during the past 20 years in Japan. With treatment, 17, 130 lives were saved, while 1, 338 patients died because of cerebral bleeding, agranulocytosis, severe hepatic dysfunction, or thrombotic thrombocytic purpura, resulting in a net benefit of 15, 792 lives saved by ticlopidine over the past 20 years. In terms of QOL, there was a total increase of 382, 191 QALYs. Sensitivity analyses showed that the older the patients when ticlopidine therapy was started, the smaller the benefits that were gained by treatment.<BR>CONCLUSIONS: Ticlopidine is considered to have made a great contribution in savingmany lives and improving QALYs in the past 20 years in Japan. This kind of analysis based on Markov model can be employed to demonstrate effectiveness of drugs and medical technologies in terms of population health outcomes.

What Aspects of Patient Affect Medical Students? A Qualitative Analysis of the Experiences of Medical Students at General Medical Ward and Clinic / 医学教育

<B>Objective:</B> To identify the usefulness of critical-incident reports for reflective learning and for classifying the types of experiences that medical students regarded most memorable during clinical clerkship at general medical ward and clinic.<BR><B>Design:</B> Descriptive qualitative study using the critical-incident technique.<BR><B>Setting:</B> General medical ward and clinic of a university hospital.<BR><B>Participants:</B> Fifth-year medical students that took part in the clinical care of patients during the clerkship from October 1, 1996 to September 31, 1997.<BR><B>Measurements and Main Results:</B> Ninety-five reports were collected over one year and subjected to the analysis. Reports were classified for seven major themes, with a mean of 1.85 themes per narrative. As for the distribution of themes, 68 reports (72%) dealt with biomedical topics, 45 (47%) with communication with patients and families, 26 (27%) with personal feelings, 19 (20%) with the physician's role, 11 (12%) with ethics, 7 (7%) with psychosocial subjects, and 1 (1%) with recognition of alternative medicine. Reports from men and women contained a similar mean number (men 1.82; women 2.09) and distribution of themes.<BR><B>Conclusions:</B> Medical students have divergent meaningful experiences on non-biomedical themes as well as biomedical issues during their general medicine rotation.

Combining Data from Subjects' Histories for the Prediction of Imminent Atrial Fibrillation is Useful for the Elderly Male Population / General Medicine

OBJECTIVE: (1) To estimate the prevalence of atrial fibrillation (Af) in the general population of Saitama Prefecture, (2) to identify useful information obtained from subjects' history and laboratory findings for predicting imminent occurrence of Af.<BR>DESIGN: Cross sectional study and retrospective cohort study.<BR>SETTING: Annual health examination of the general population.<BR>PARTICIPANTS: Subjects were 5, 375 men and 8, 419 women with a mean age±standard deviation of 47.2±9.6 and an age range of 18 to 88 years old.<BR>MEASUREMENTS AND MAIN RESULTS: Among the 13, 794 participants who underwent conventional 12-lead electrocardiography (ECG) every year from 1994 to 1997, the prevalence of Af was 0.3%. The cross sectional data showed significant differences between male subjects with and without Af regarding age (P<0.0001), current treatment for hypertension (P<0.0001), arrhythmia (P<0.0001), angina pectoris (P<0.05), history of myocardial infarction (P<0.05), perception of palpitation (P<0.0001), perception of irregular pulse (P<0.0001), shortness of breath (P<0.0001), diastolic blood pressure (P<0.05), total cholesterol (P<0.0001), and casual glucose level (P<0.05) . Significant differences were also found between female subjects with and without Af with respect to creatinine (P<0.0001), current treatment of arrhythmia (P<0.0001), perception of palpitation (P<0.0001), perception of irregular pulse (P<0.0001), and HbAlc level (P<0.05) .<BR>The retrospective cohort data identified 22 subjects who had persistent Af during the study period, and 20 (0.15%) who had newly developed Af during this period on the basis of consecutive ECG recordings of the 13, 772 participants in 1994-1996. Logistic regression analysis revealed that there were significant differences in perception of irregular pulse (P=0.0004), history of myocardial infarction (P=0.0134), fatigability (P=0.0243), aging (P=0.0039) and total cholesterol level (P=0.025) for men, and in history of arrhythmia (P=0.0007) for women between the group with and without Af.<BR>The likelihood ratios and the respective 95% confidence intervals (C.I.) for ECG findings to identify the subjects who would develop Af were as follows: ST depression, 14.6 (C.I., 5.1-42) ; ventricular arrhythmia, 14.9 (3.9-56) ; incomplete RBBB, 9.2 (2.4-34) ; supraventricular arrhythmia, 8.9 (1.3-61) ; second-degree atrioventricular block, 342 (32-3624) ; abnormal Q wave, 16.3 (2.4-112) ; left atrial enlargement, 52.7 (7.2-383) .<BR>CONCLUSIONS: Combining data from subjects' histories for the prediction of imminent Af among subjects in the general population is likely to be useful, especially for the elderly male population. Aging in men, in particular, is an important factor when combined with abnormal findings on conventional 12-lead ECG.