A questionnaire survey on the ethics education in medical representatives’ continuing education in Japan / 医薬品情報学

<b>Objective: </b>The aim of this study was to identify the content and methods of ethics education for medical representatives as part of the continuing education program and to suggest a preferable supportive method of ethics education accordingly.<br><b>Method: </b>A questionnaire was mailed to the medical representative education managers of all 214 companies, all members of the MR Education & Accreditation Center, Japan.  The questionnaire was carried out from 31st July 2009 to 25th August 2009, and data from this questionnaire survey was analyzed by simple and cross tables.<br><b>Results: </b>Out of the 182 (response rate: 85.0%) who responded, we analyzed the 173 institutions for analysis as they responded as having the continuing education program.  In terms of education, “the fair competition code” was the most widely educated (82.6%).  Although “the fair competition code” required most time, “the ethics as a medical representative” was considered as the most important.  The simple kappa coefficient between actual educating item and important item was 0.29.  Answers were affected by whether he/she had experience as a medical representative.  As the method of ethics education, “lecture” style was most common (87.4% of respondents), “group work discussion” was considered the most effective (70.6%) for training a medical representative to think and learn by himself/herself.  The respondents of 82.2% referred to the continuing educations’ guidelines made by MR Education & Accreditation Center, and 81.0% respondents felt “training materials for lectures and/or discussions” necessary in the future.<br><b>Conclusion: </b>The ethics education for medical representatives placed a disproportionate emphasis on the importance of “the fair competition code.” Dissociation was seen between the actual education and the education considered as important by the respondents.  Accordingly, there is a need for appropriate materials for training and for a more adequate curriculum, taking time and content of education into consideration, especially for contents which training ways aren’t built up.

Association between daily physical activity and neighborhood environments

<p><b>OBJECTIVE</b>Previous studies on the association between physical activity (PA) and neighborhood environments (NE) focused on either objectively measuring the NE or the residents' perception of NE. Here, we investigate which actual or perceived NE is associated with residents' PA in Japan.</p><p><b>METHODS</b>Two regions with an objectively assessed high and low residential density, land use mix-diversity, and street connectivity, respectively, were identified in one city. The subjects were selected using a stratified random sampling method by sex and age in each region. The NE of the subjects was objectively measured using the Geographic Information System (GIS), and the subjects' perception of the NE was assessed using a questionnaire. The daily total number of walking steps was measured with an accelerometer, and walking and cycling time were assessed by a questionnaire.</p><p><b>RESULTS</b>For the female subjects, the mean cycling time, subjectively assessed as a means of transport, was significantly longer in the group with a high GIS score for the number of land use types, while the score for total number of walking steps was significantly higher among those who were aware of places to walk to, and cycling time for transport was longer for those who perceived an accessibility to post offices, banks/credit unions, gymnasiums/fitness facilities, and amusement facilities in their neighborhood. For the male subjects, the score for walking time for leisure was longer for those who perceived aesthetics and an accessibility to parks, and the score for total walking steps was significantly higher for those who perceived an accessibility to bookstores or rental video stores in their neighborhood.</p><p><b>CONCLUSIONS</b>The results to this study demonstrate that daily PA was high among female subjects living in a NE with land use mix-diversity, and who had an awareness of places to walk to and the accessibility to facilities for daily necessities in their neighborhood. For male subjects, daily PA was high among those who perceived the aesthetics of and accessibility to facilities for pleasure in their neighborhood. Further research is needed to determine the association between PA and NE on the basis of sex differences.</p>

Current and Future Public Health Ethics Education in Japan / 医学教育

Emerging ethical issues have prompted Western countries to focus more attention on public health ethics in medical education. To assess the current and future states of public health ethics education in Japan, we analyzed the opinions of public health educators in Japanese medical institutions and explored potential topics for public health ethics curriculums. 1) We mailed self-administered questionnaires to 201 hygiene and public health departments to inquire about their current curriculums and the state of public health ethics education at their institutions. 2) Of the 101 responding institutions, 60.4% were spending 8% of teaching hours on lectures related to ethical issues in public health. 3) Most institutions agreed with a proposal to require the completion of a public health ethics course in medical education programs. 4) Among the major topics chosen to be included in the potential course were ethical issues surrounding public health policy and medical research.

Association between residents' perception of the neighborhood's environments and walking time in objectively different regions

<p><b>OBJECTIVE</b>The purpose of this study is to delineate the association between residents' perception of the neighborhood's environments and walking time in objectively different regions in Japan.</p><p><b>METHODS</b>Two regions were selected as high and low walkable regions on the basis of differences in their residential density, mixed land use and street connectivity. The subjects in this study were participants in a health promotion program focused on walking sponsored by local governments. A questionnaire was sent to the participants asking about how their perception of the neighborhood's environment related to walking, and the time spent walking per week. There were 237 residents from the high walkable region and 195 from the low walkable region who completed the study survey.</p><p><b>RESULTS</b>The high walkable region had a larger residential density, a high mixed land use and a higher street connectivity than the low walkable region. Walking time, and the scores of the perception of the neighborhood's environment for the high walkable region residents were significantly higher than those for the low walkable region residents. Thus, residents' perception of the neighborhood's environment generally reflected the actual physical environmental characteristics. Residents in the high walkable region whose scores for accessibility and aesthetics were high, spent significantly more walking time. Residents in the low walkable region whose scores for accessibility, safety, convenience and aesthetics were high, spent significantly more walking time.</p><p><b>CONCLUSION</b>The study results suggested that the neighborhood's environment may influence daily walking time. The perceptions of the neighborhood's environmental factors that correlate with walking times differ between the different regional physical environments. Therefore, to promote physical activity, the consideration of environmental factors unique to residents' neighborhood's environments is needed.</p>

Association between Residents\rq Perception of the Neighborhood\rqs Environments and Walking Time in Objectively Different Regions

Objective: The purpose of this study is to delineate the association between residents’ perception of the neighborhood’s environments and walking time in objectively different regions in Japan. Methods: Two regions were selected as high and low walkable regions on the basis of differences in their residential density, mixed land use and street connectivity. The subjects in this study were participants in a health promotion program focused on walking sponsored by local governments. A questionnaire was sent to the participants asking about how their perception of the neighborhood’s environment related to walking, and the time spent walking per week. There were 237 residents from the high walkable region and 195 from the low walkable region who completed the study survey. Results: The high walkable region had a larger residential density, a high mixed land use and a higher street connectivity than the low walkable region. Walking time, and the scores of the perception of the neighborhood’s environment for the high walkable region residents were significantly higher than those for the low walkable region residents. Thus, residents’ perception of the neighborhood’s environment generally reflected the actual physical environmental characteristics. Residents in the high walkable region whose scores for accessibility and aesthetics were high, spent significantly more walking time. Residents in the low walkable region whose scores for accessibility, safety, convenience and aesthetics were high, spent significantly more walking time. Conclusion: The study results suggested that the neighborhood’s environment may influence daily walking time. The perceptions of the neighborhood’s environmental factors that correlate with walking times differ between the different regional physical environments. Therefore, to promote physical activity, the consideration of environmental factors unique to residents’ neighborhood’s environments is needed.

Effect of β(3)-adrenergic receptor gene polymorphism on body weight change in middle-aged, overweight women

<p><b>OBJECTIVES</b>To examine the effects of β(3)-adrenergic receptor gene polymorphism on body weight change during a weight reduction program for middle-aged, overweight women with careful consideration of their energy intake and expenditure.</p><p><b></b>METHODS</p><p><b>DESIGN</b>Intervention study of weight reduction for 12 weeks in a community setting.</p><p><b>SUBJECTS</b>Eighty overweight middle-aged women who completed the individualized lifestyle modification program.</p><p><b>MEASUREMENTS</b>β(3)-adrenergic receptor gene polymorphism was identified by polymerase chain reaction and consecutive restriction fragment-length polymorphism analysis. Anthropometrical parameters, lifestyle factors, blood lipid and glucose levels, physical activity level and energy intake were measured before and at the end of the program.</p><p><b>RESULTS</b>The numbers of subjects with the Trp64Trp, Trp64Arg, and Arg64Arg genotypes were 45, 30 and 5, respectively. Baseline characteristics among subjects with the 64Arg allele had significantly smaller decrease in body weight and energy intake than those without the 64Arg allele. The change of other clinical characteristics did not differ between the two groups. After adjusting for the %change of energy intake, the %change of body weight did not differ between the two groups.</p><p><b>CONCLUSION</b>The 64Arg allele of the β(3)-AR gene is not likely to be the factor determining the difficulty in losing body weight in Japanese middle-aged, overweight women. Lifestyle factors, such as the decrease in energy intake, might mask the effect of the 64Arg allele on body weight loss. Specific considerations for the management of energy intake would be needed to promote body weight loss for those with the 64Arg allele.</p>

A Survey on the Current State of Postgraduate Medical Ethics Education in Japan / 医学教育

To examine the present state of postgraduate ethics education for residents in Japan, we sent an anonymous self-administered questionnaire to the directors of all 640 hospitals in Japan with a registered postgraduate clinical residency program. A total of 258 hospitals returned the questionnaire (response rate: 40.3%). Of these hospitals, 69 (26.7%) had a program for ethics education and 189 (73.3%) did not. The presence of a program was strongly correlated with the number of hospital beds and a history of problems with ethics education. Respondents showed a high degree of awareness about such significant topics in ethics education as “informed consent, ” “patient privacy, ” “patient rights, ” and “physician duties.”

Effect of $\beta$_{3}-Adrenergic Receptor Gene Polymorphism on Body Weight Change in Middle-Aged, Overweight Women

Objectives: To examine the effects of β3-adrenergic receptor gene polymorphism on body weight change during a weight reduction program for middle-aged, overweight women with careful consideration of their energy intake and expenditure. Methods: Design: Intervention study of weight reduction for 12 weeks in a community setting. Subjects: Eighty overweight middle-aged women who completed the individualized lifestyle modification program. Measurements: β3-adrenergic receptor gene polymorphism was identified by polymerase chain reaction and consecutive restriction fragment-length polymorphism analysis. Anthropometrical parameters, lifestyle factors, blood lipid and glucose levels, physical activity level and energy intake were measured before and at the end of the program. Results: The numbers of subjects with the Trp64Trp, Trp64Arg, and Arg64Arg genotypes were 45, 30 and 5, respectively. Baseline characteristics among subjects with the Trp64Trp, Trp64Arg and Arg64Arg alleles did not differ. After 12 weeks, the subjects with the 64Arg allele had significantly smaller decrease in body weight and energy intake than those without the 64Arg allele. The change of other clinical characteristics did not differ between the two groups. After adjusting for the %change of energy intake, the %change of body weight did not differ between the two groups. Conclusion: The 64Arg allele of the β3-AR gene is not likely to be the factor determining the difficulty in losing body weight in Japanese middle-aged, overweight women. Lifestyle factors, such as the decrease in energy intake, might mask the effect of the 64Arg allele on body weight loss. Specific considerations for the management of energy intake would be needed to promote body weight loss for those with the 64Arg allele.

Report of the First Workshop on Medical Ethics Education / 医学教育

The first workshop on medical ethics education was held for 28 members including mainly university tutors and hospital tutors in November 2002 at Gifu. Trail for training of several kinds of medical ethics education technique was evaluated to a certain extent. We submit report of the practice and participants' evaluation of the workshop.

The Medical Ethics Education Manual in the Undergraduate Medical Education / 医学教育

We proposed the curriculum plan of medical ethics in the medical school in our country. That was the curriculum throughout a few years and the participating education. Now we present the manual for one case of the each six strategies. When the teacher holds classes according to this manual or with some modifications, the medical students will probably participate the education with high motivation to learn.

The Medical Ethics Education Curriculum Propose in the Undergraduate Medical Education / 医学教育

There is no objection that the medical ethics enters basic matters of the undergraduate medical education. The curriculum plan of medical ethics in the medical school in our country is proposed. This curriculum aims at the participating education that the student personally chooses and discovers the result to be studied instead of the passive lecture like the boring preaching from the platform. This is the curriculum throughout a few years, because it is necessary to repeatedly study adjusting to the learning achievement.

Study of 5th-Year Medical Student Interest in Medical Ethics and Related Factors / 医学教育

To investigate medical student interest in medical ethics and associated factors, a self-administered questionnaire was distributed to 187 5th-year medical students who attended a 2-hour small-group class, “ Introduction to Biomedical Ethics, ” which is held as part of bedside teaching at the University of Tokyo. This study was performed from April 1995 through March 1998. All 187 questionnaires were returned. The degree of student interest in biomedical ethics was significantly associated with student perceptions of the importance of the medical ethics class relative to other classes and with the strength of the connection between medical ethics and 1) clinical practice, 2) law and the courts, e. g., malpractice suits, and 3) health policy. Students who perceived medical ethics as having greater importance or a stronger connection to these issues had more interest. Students were also asked what topics related to medical ethics they were interested in and what type of class was best. Finally, factors that should be taken into account when developing a medical ethics curriculum were discussed.

Survey of Medical Ethics Education in Japanese Medical Schools / 医学教育

To investigate the status of ethics education in Japanese medical schools, a self-administered questionnaire was sent to all 80 medical schools in 1995. Sixty-four (80.0%) medical schools responded, of which 60 answered they offer or will offer courses in which medical ethics topics are taught. Most classes are compulsory and are held before bedside teaching begins. Nineteen medical schools have separete medical ethics courses, and the others have medical humanities courses in which medical ethics are taught as part of the course. The respondents rated “the physician's duty, ” “informed consent, ” and “patients' rights” as the three most important topics that should be taught to medical students.