ABSTRACT
We conducted a questionnaire survey to examine the association between loneliness and health with consideration of lifestyle and social relationships in a mountainous rural area of Japan. We used the Japanese versions of the short-form University of California, Los Angeles Loneliness Scale (UCLA score: 3-9 points) and the 12-item World Health Organization Disability Assessment Schedule 2.0 (WHODAS score: 12-48 points). Among 108 respondents (47 men, 61 women), mean age was 74.1 years, 30 (28%) were obese, 40 (37%) had a smoking habit, and 38 (35.1%) had an alcohol habit. Negative social relationships were reported by5 (4.6%) respondents. Mean UCLA score was 4.08 ± 1.34 and mean WHODAS score was 7.68 ± 8.84. Respondents were classified into the loneliness group if the UCLA score was greater than 4 points (58/108, 53,7%) and into the healthy group if the WHODAS score was 7 points or less (66/108, 61.1%). In univariable analysis, lower health status was significantly associated with age > 75 years (odds ratio [OR] 0.29, 95% confidence interval [CI] 0.11-0.73, p = 0.003), female sex (OR 2.82, 95%CI 1.15-7.09, p = 0.01), living alone (OR 0.44, 95%CI 0.14-1.33, p = 0.01), divorce, separation, or bereavement (OR 0.24, 95%CI 0.09-0.60, p < 0.001), ≤ 9 years of education (OR 0.18, 95%CI 0.07-0.46, p < 0.001), unemployed/looking for work (OR 0.9, 95%CI 0.26-0.27, p < 0.001), no alcohol habit (OR 2.66, 95%CI 1.05-7.05, p = 0.02), and loneliness (OR 0.29, 95%CI 0.11-0.72, p = 0.003). On multivariable analysis, loneliness was identified as an independent risk factor for poorer health status (OR 0.11, 95%CI 0.02-0.43, p =0.002) after adjusting for the other significant items on univariable analysis.
ABSTRACT
Objective: Previous studies have investigated medical students’ interest in family medicine, as well as their intentions to work in rural areas after taking part in community-based clinical clerkships. Community-based clerkships are designed to teach medical students community healthcare and to increase the number of physicians working in rural communities following their graduation. However, few studies have examined which clerkship experiences, specifically, enhance medical students’ positive perceptions on community healthcare. This study aimed to examine the association between experiential learning in community-based clerkships and students’ positive perceptions on community healthcare.Patients and Methods: From 2015 to 2017, we conducted a questionnaire survey of 290 final year medical students, before and after completion of their community-based clerkships. The survey asked the students about their perceptions (categorized into “Worthwhile” and “Confident”) of community healthcare and experiential learning during their clerkships. We assessed 13 medical learning areas involving healthcare, medical care, welfare, and nursing care practice. Multivariable logistic regression was used to evaluate the factors associated with positive student perceptions.Results: Of the 290 students, 265 (91.3%) completed both the pre- and post-questionnaires. Of these, 124 (46.8%) were female, 67 (25.2%) were from small towns (of <100,000 people), and 87 (32.8%) selected clinical clerkships within depopulated areas. A total of 205 (73.3%) students reported positive perceptions on community healthcare. There was a significant association discovered between students’ positive perceptions on community-based healthcare and them taking part in experiential learning in mobile medical services (43 [16.2%] students experienced mobile medical services—adjusted odds ratio 6.65, 95%, confidence intervals 1.67–26.4, p = 0.007).Conclusion: Medical students’ positive perceptions on community healthcare were discovered to be associated with them taking part in experiential learning in mobile medical services during their community-based clerkships.