ABSTRACT
Background/Aims@#Although risk factors of reflux esophagitis (RE) have been investigated in numerous cross-sectional studies, little is known about predictive factors associated with future onset of RE. We investigated time courses of clinical parameters before RE onset by a longitudinal case-control study using health checkup records. @*Methods@#We used health checkup records between April 2004 and March 2014 at 9 institutions in Japan. A multivariate logistic regression analysis was performed to evaluate associations of baseline clinical parameters with RE. The time courses of the clinical parameters of RE subjects were compared with those of non-RE subjects by the mixed-effects models for repeated measures analysis or longitudinal multivariate logistic analysis. @*Results@#Initial data were obtained from 230 056 individuals, and 2066 RE subjects and 4132 non-RE subjects were finally included in the analysis. Body mass index, alanine aminotransferase, smoking, acid reflux symptoms, hiatal hernia, and absence of atrophic gastritis at baseline were independently associated with RE. The time courses of body mass index, fasting blood sugar, triglyceride, aspartate aminotransferase, alanine aminotransferase, γ-glutamyl transpeptidase, percentages of acid reflux symptoms, feeling of fullness, and hiatal hernia in the RE group were significantly worse than in the non-RE group. @*Conclusions@#The RE group displayed a greater worsening of the clinical parameters associated with lifestyle diseases, including obesity, diabetes, hyperlipidemia, and fatty liver for 5 years before RE onset compared with the non-RE group. These results suggest that RE is a lifestyle disease and thus lifestyle guidance to at-risk person may help to prevent RE onset.
ABSTRACT
More than 2 years have passed since the new postgraduate clinical training program was instituted in 2004 to improve the clinical ability of Japanese physicians. However, there have already been discussions about whether the undergraduate curriculum and the postgraduate program should be improved.<BR>After the first physicians finished their training under the new program in the spring of 2006, questions were raised about whether the identical final goals of training could be achieved by transferring some items of postgraduate clinical training to the undergraduate period. Such a change might invigorate the undergraduate curriculum and enhance the effectiveness of the postgraduate program.<BR>1) Are-evaluation of the final goals of postgraduate clinical training might allow some items to be taught during the undergraduate period.<BR>2) Several questionnaires were sent to 211 supervising physicians and 184 first-year residents who had just completed the new internship program at 25 teaching hospitals (university hospitals and postgraduate training hospitals).<BR>3) Both trainees and supervising physicians reacted positively about and expressed a willingness to participate in training items, including noninvasive diagnostic procedures and laboratory studies not harmful to patients, during advanced courses in the undergraduate period.<BR>4) Both trainees and supervising physicians reacted negatively to participating in any invasive procedures that might affect a patient's welfare or sense of shame during the undergraduate period.<BR>5) In the future, training with simulated procedures before actual patients are encountered and enlisting enough supervising physicians are essential for unifying the undergraduate medical school curriculum and postgraduate clinical training programs.
ABSTRACT
1) PBM approach is imperative for health care reform and contributes to improvement of patients' confidence in medical care service, strengthening of health promotion and cost-efficient medical care service.<BR>2) Standardization of health information and promotion of IT in the field of health such as electronic patients record system can provide favorable environments for promotion of PBM.