Factors Associated with Knowledge of the Common Cold and Desire for Medical Treatment: A Cross-sectional Study of Citizens Undergoing Health Checkups / 日本プライマリ・ケア連合学会誌

Introduction: We investigated the relationship between knowledge of the common cold and desire for medical treatment.Methods: We administered an anonymous self-questionnaire about the common cold to citizens receiving health checkups in City X, Ibaraki Prefecture, between August and September 2012. We assessed citizens' knowledge about the common cold and whether they sought medical treatment for it, in addition to their demographic attributes.Results: We included 1079 citizens (response rate, 74.5%) in the analysis. The majority of participants believed that receiving intravenous (IV) infusions or injections for the common cold led to faster recovery times (75.9%). Roughly half of the participants (42.0%) did not believe that antibiotics are not effective against virus-based colds, while 28.6% were unsure. Finally, endorsement of the questionnaire items "taking cold medications early leads to faster recovery" (OR: 1.61) and "IV infusions or injections lead to faster recovery times" (OR: 1.86) were associated with a desire for medical treatment.Conclusion: Our results indicate that patients' knowledge about the common cold and their understanding of treatment options available at medical institutions were inadequate. Furthermore, we found that an awareness of how cold medicines, IV infusions, or injections may shorten treatment duration was associated with a desire for treatment.

How do Health Care Professionals Change the Recognition of Relationships and Problems Among Them Through Dialogue? Qualitative Descriptive Research Exploring the Process of Home Health Care Promotion in Areas Where Medical Resources are Insufficient Using the Theoretical Framework of Complexity / 日本プライマリ・ケア連合学会誌

Introduction: The Japanese government implemented a community-based integrated care system that provides community healthcare resources for elderly people focusing on home health care in particular. To achieve this, interprofessional teams in the community need to function seamlessly. Thus, we explored the process by which healthcare professionals change their recognition of the relationships and problems among them through the dialogue of home health care promotion.Methods: We held the World Cafe to discuss with healthcare professionals about home health care in a city in Ibaraki Prefecture. All dialogues were audio-recorded, transcribed verbatim, and analyzed using thematic analysis.Results: Although healthcare professionals had strongly recognized the hierarchical relationship, they deepened their mutual understanding by sharing their background and values. While sharing the hope to make equitable relationships, they changed their recognition as follows: home health care was not "someone else's problem" but "their own problem" and "their own community's problem".Conclusion: It is necessary for healthcare professionals to share issues and explore methods to solve them in the community, and to change the relationships among stakeholders because problems related to home health care promotion are complex. This study clarified that healthcare professionals are motivated to seek solutions to problems proactively via their relationships in interprofessional teams in the community.

Survey of Formal Undergraduate Medical Curricula in Japan for Education on Drug Promotion / 医学教育

Introduction: Attention to undergraduate medical education on the relationship between physicians and the pharmaceutical industry has been increasing in North America and Europe. There are no reports, however, regarding this relationship in Japanese medical education.Methods: We conducted a cross-sectional survey using a self-administered questionnaire to investigate formal undergraduate curricula on the relationship between physicians and the pharmaceutical industry.Results: Forty-four of 80 medical schools approved participation in the study, with 16 (36.0%) reporting having a formal curriculum on drug promotion. Many of the themes included in the programs were related to research ethics or conflict of interest in research, with drug promotion covered in only a few programs.Discussion: More discussion and investigation into undergraduate education on the relationship between physicians and the pharmaceutical industry, especially on drug promotion, is warranted.

Likelihood of Chiikiwaku Medical Student Loan Repayment and Its Associated Factors / 医学教育

This study used a self-administered questionnaire to assess the likelihood of chiikiwaku medical student loan repayment and its associated factors. If chiikiwaku repayment is high, then it can have a negative effect on the chiikiwaku program, which was established to distribute doctors to outlying areas. A total of 112 students (37.8%) reported that the likelihood of repayment was "high" or "somewhat high." The factors statistically associated with repayment likelihood were female gender (odds ratio (OR) 3.2, 95% confidence interval (CI) 1.5-6.8), applying forchiikiwaku mainly due to the higher medical school acceptance rate (OR 2.9, 95%CI 1.2-6.8), private medical school (OR 10.3, 95%CI 2.6-40.3), and stress related to obligation or repayment (OR 2.4, 95%CI 1.3-4.3). The results suggest that to decrease the rate of loan repayment it is important to improve the process of selecting chiikiwaku students and to modify the chiikiwaku system to support students experiencing stress.

Survey of Formal Undergraduate Medical Curricula in Japan for Education on Drug Promotion / 医学教育

Introduction: Attention to undergraduate medical education on the relationship between physicians and the pharmaceutical industry has been increasing in North America and Europe. There are no reports, however, regarding this relationship in Japanese medical education.Methods: We conducted a cross-sectional survey using a self-administered questionnaire to investigate formal undergraduate curricula on the relationship between physicians and the pharmaceutical industry.Results: Forty-four of 80 medical schools approved participation in the study, with 16 (36.0%) reporting having a formal curriculum on drug promotion. Many of the themes included in the programs were related to research ethics or conflict of interest in research, with drug promotion covered in only a few programs.Discussion: More discussion and investigation into undergraduate education on the relationship between physicians and the pharmaceutical industry, especially on drug promotion, is warranted.

Likelihood of Chiikiwaku Medical Student Loan Repayment and Its Associated Factors / 医学教育

This study used a self-administered questionnaire to assess the likelihood of chiikiwaku medical student loan repayment and its associated factors. If chiikiwaku repayment is high, then it can have a negative effect on the chiikiwaku program, which was established to distribute doctors to outlying areas. A total of 112 students (37.8%) reported that the likelihood of repayment was "high" or "somewhat high." The factors statistically associated with repayment likelihood were female gender (odds ratio (OR) 3.2, 95% confidence interval (CI) 1.5-6.8), applying forchiikiwaku mainly due to the higher medical school acceptance rate (OR 2.9, 95%CI 1.2-6.8), private medical school (OR 10.3, 95%CI 2.6-40.3), and stress related to obligation or repayment (OR 2.4, 95%CI 1.3-4.3). The results suggest that to decrease the rate of loan repayment it is important to improve the process of selecting chiikiwaku students and to modify the chiikiwaku system to support students experiencing stress.

University of Tsukuba's Short-Stay, Regional Health Care, Clinical Clerkship Program in Medically Underserved Areas / 医学教育

Since 2009, a five-day, regional health care, clinical clerkship in medically underserved areas has been available to all fifth-year medical students at the University of Tsukuba. In the program, students listen to and observe health problems in non-clinical settings, wherever these problems actually exist. Students can experience health care lectures and health examinations. They can also experience a clinical work environment. The short stay helps students to understand the living environment of the area they observe. It is also effective for students to consider health problems from the perspective of the local inhabitants. This program aims to directly convey the interest and importance of community medicine, and to contribute to the supply of physicians in these areas. A longitudinal study is needed to evaluate the effect of the program.

A National Survey of Community-Based Medical Education in Japanese Medical Schools (second report) / 医学教育

Introduction: Recently, community-based medical education has become widespread in Japanese medical schools, but the current status is not clear on a national level. A second survey of community-based medical education at all Japanese medical schools was conducted. The first survey was done in 2011. Methods: Members of the Council made and distributed a questionnaire to medical schools in order to assess the situation of community-based medical education as of April 2014. Results: A total of eighty schools responded. The number of schools which had community medicine programs was seventy-eight. In the first survey, the number was seventy-three. Seventy-seven schools gave community-based clinical clerkships. Discussion: The number of medical schools that had curriculum about community medicine was more than indicated in the first survey. Further research about the contents or implementation system of community-based clerkships is needed.

Comparative analysis of the depressive state, stressor, and stress-relieving factors of novice first year residents and established residents in Japan / 医学教育

Aim: We sought to compare the depression state of first-year residents, who were new to the system of clinical resident training, with those who had become completely familiar with the system.Method: A questionnaire-based survey on stress reaction was distributed to 250 resident training hospitals in Japan. The survey was taken by 1,753 first year residents who started postgraduate clinical training in 2011. The survey was given to the students once before the training and-again months after the training had started. The results were compared with those from a similar survey in 2004.Result: 3 months after the training had started, 30.5% of residents suffered from a depressive state. At that time, the prevalence of residents with newly developed symptoms of depression, who had no depressive state before the training, significantly decreased compared to those in 2004 (19.6 vs. 25.2%, p<0.001). The decrease of depressive state in 2011 may be due to the decrease of working hours, the improvement of stressor and stress-relieving factors.Discussion: Many residents still experienced a stress reaction. Further improvement of the training environment should be considered.

Medical Students Learning from a Problem Based Learning (PBL) Style In-home Care Course: A Qualitative Analysis of the Reports / 日本プライマリ・ケア連合学会誌

<p><b>Introduction: </b>The University of Tsukuba has a one-week in-home care course combining a problem-based learning style tutorial and lectures in the comprehensive community-based learning curriculum for 2^nd year students. This study aimed to investigate what medical students are learning concretely from this course.</p><p><b>Methods: </b>We performed a qualitative date analysis of the contents of all 111 student course reports written in the free description using a modified Steps Coding and Theorization method employing the framework of patient-centered clinical method (PCCM).</p><p><b>Results: </b>Medical students learned with keen interest based on their experiences and in the framework of PCCM such as 'Exploring health, disease and the illness experience', 'Understanding the whole person'. These processes led to the awareness of responsibility as a physician.</p><p><b>Conclusion: </b>The in-home care course in the classroom may provide medical students with an opportunity to become aware of their responsibility as a physician.</p>

Patients' impressions about physicians working short-term in community clinics : A qualitative analysis of individual patient interviews / 日本プライマリ・ケア連合学会誌

<b>Introduction</b> : To reveal patients' impressions of physicians working short-term in community clinics, and to explore methods for physicians to work short-term in community clinics.<br><b>Methods</b> : We conducted a qualitative analysis of recordings of individual interviews performed on patients in community clinics using a partially revised SCAT (Steps for Coding and Theorization) method.<br><b>Results</b> : Patients indicated that they felt reassured by the constant presence of a chief physician at community clinics. They expected care within the scope of primary care, but were not expecting every element within this scope to be met. Patients had the attitude of accepting the current situation and were selecting how to receive medical care from the available options based on their personal priorities.<br><b>Conclusion</b> : Physicians working short-term in community clinics were satisfying a portion of the patients' needs. Providing care within the scope of primary care and taking the initiative in getting to know patients are essential elements for physicians working short-term in community clinics.

How can Japanese University-based Primary Care Physicians Attend International Conferences? / General Medicine

<b>Background: </b>Activity in international conferences is essential for the academic progress of primary care in Japan. We aimed to clarify the obstacles Japanese university-based primary care physicians face in attending and presenting at international conferences.<br><b>Methods: </b>We conducted a questionnaire of 10 residents and 22 physicians in the Department of General Medicine and Primary Care at the University of Tsukuba.<br><b>Results: </b>The primary obstacle preventing conference attendance was English language skills. A secondary obstacle was insufficient time off work.<br><b>Conclusions: </b>Additional support in English language skills and time off work is necessary to promote attendance at international conferences.

Association between smoking prevention education for elementary and junior high school students and modification of their parents' smoking behavior<br>- Can children's talk change parents' behavior? / 日本プライマリ・ケア連合学会誌

Association between smoking prevention education for elementary and junior high school students and the modification of their parents' smoking behavior — Can child education change parental behavior?<br><b>Introduction</b> : This study aimed to investigate an association between a smoking prevention education program for elementary and junior high school students, and the subsequent behavior modifications of their parents.<br><b>Methods</b> : Preventative education programs for smoking were provided to four elementary and three junior high schools in Kamisu City, Ibaraki Prefecture, Japan. We encouraged participating students to discuss the knowledge derived from the education sessions with their families. One month after completing the program, questionnaires were distributed to the parents of the students to investigate whether they had modified their smoking behavior as a result of what they had learnt from their children.<br><b>Results</b> : Two questionnaires were distributed to each of 1109 families, and 1427 valid responses were received. Analysis showed that 794 parents had been informed about tobacco use from their children (55.6%) and 271 parents had modified their smoking behavior (19.0%) as a consequence. This included smoking cessation, decreasing tobacco consumption, and smoking avoidance in the presence of their children. Behavior modification was significantly correlated with the knowledge they had derived from their children based on the preventative smoking education program (odds ratio = 3.3 ; 95% CI : 2.4-4.6).<br><b>Conclusion</b> : Implementation of an education program for smoking prevention focused on elementary and junior high school students can lead to modification of smoking behavior in both students and their parents, respectively.

Diagnostic Characteristics of Symptom Combinations over Time in Meningitis Patients / General Medicine

<b>Objective:</b> The aim of this study was to investigate diagnostic characteristics to distinguish bacterial meningitis (BM) from aseptic meningitis (AM) in meningitis patients. Indicators from the initial consultation were combined with a measure of time since the onset of fever.<br><b>Methods:</b> This was a retrospective chart review. We examined the sensitivity and specificity of the clinical information for BM. The diagnostic characteristics for BM were analyzed by considering the duration of fever for each patient at consultation, together with the presence or absence of changes in their mental status.The study examined 117 inpatients diagnosed with meningitis in their clinical record at the time of admission. The patients were admitted into two emergency hospitals in Japan between 2001 and 2011. Meningitis was defined as the presence of five or more cells per mm³ of CSF.<br><b>Results:</b> Twenty-five patients were diagnosed with BM and 92 patients with AM. There was no single clinical symptom that could distinguish BM from AM in patients suspected of meningitis. The sensitivity and specificity of the clinical information for fever duration and disturbance of consciousness at consultation were 95.0% and 40.3%, respectively, for BM patients with disturbance of consciousness or with duration of fever less than three days. Thus, the proportion of BM patients without disturbance of consciousness for three or more days after fever onset was only 5%.<br><b>Conclusions:</b> Patients without disturbance of consciousness for three or more days after fever onset are rarely suffering from BM.

Influence of parental smoking on junior high school students' perceptions of smoking / 日本プライマリ・ケア連合学会誌

<b>Introduction</b> : This study aimed to clarify any associations between familial smoking, especially parental smoking, and high school students' perceptions of smoking.<br><b>Methods</b> : Questionnaires on familial smoking and the Kano Test for Social Nicotine Dependence (KTSND) were distributed to junior high school students. The KTSND is a tool to evaluate positive perceptions of smoking. We analyzed the relationship between the total KTSND score and school grade, gender, familial smoking, paternal smoking, and maternal smoking.<br><b>Results</b> : We received 761 valid responses (valid response rate : 90.4%). Five hundred forty-three students had family members who smoked (71.4%), 394 had smoking fathers (51.8%), and 214, smoking mothers (28.1%). The total KTSND score correlated with familial smoking (10.55 vs 9.46, <italic>p</italic>=0.009) and maternal smoking (11.18 vs 9.87, <italic>p</italic>=0.002).<br><b>Conclusion</b> : Familial smoking, especially maternal smoking, correlated with positive perceptions of high school students towards smoking. Promoting smoking cessation in women with children may be effective in preventing tobacco use among children.

An Investigation of the Relationship between Senior Doctor's Support and Resident's Depressive State / General Medicine

<b>Background:</b> A depressive state for residents during residency training is a serious problem. Enhancement of senior doctor's support is considered to be one preventive measure, but it is uncertain whether onset of a new depressive state during training is related to senior doctors' support.<br><b>Methods:</b> A dual questionnaire survey was conducted in 2003 on 608 first-year residents at 40 teaching hospitals in Japan. Residents who had not been in a depressive state at the time of the first survey-using the Center for Epidemiologic Studies-Depression (CES-D) Scale, but were in a depressive state at the time of the second survey were defined as “residents in a new-onset depressive state.” The degree of senior doctors' support was assessed with Senior Doctor's Support Scale (SDSS), then adjusted OR and 95% CI of the residents in a new-onset depressive state were computed with a multivariate logistic regression model.<br><b>Results:</b> 82 residents (24.4%) were determined to be “residents in the new-onset depressive state.” The mean CES-D Score of Low SDSS Score Group (n=24), Middle SDSS Score Group (n=100), and High SDSS Score Group (n=152) were 20.0 (SD=9.9), 13.8 (SD=8.7), and 11.0 (SD=8.0), respectively (p<0.001). With logistic regression, residents who could fall into a depressive state during residency training were considered to be those who achieve middle SDSS Score (OR: 3.04, 95% CI: 1.45-4.80) and low SDSS score (OR: 17.89, 95% CI: 4.83-66.30).<br><b>Conclusion:</b> Because onset of residents' depressive state is related to senior doctors' support, we should enhance support during residency training.

Prevalence of Sleep Apnea Syndrome in Japanese Patients with Persistent Fatigue / General Medicine

<b>Background:</b> Sleep apnea syndrome (SAS) is a common medical condition with significant adverse effects; however, it remains undiagnosed in many individuals. This study was conducted to assess the prevalence of SAS in fatigued subjects and to elucidate the factors associated with SAS.<br><b>Methods:</b> From March 2008 to March 2011, a cross-sectional, observational study was conducted in patients with persistent (≥1 month) fatigue. Patients with known causes of persistent fatigue were excluded. Data on patient characteristics (e. g., blood pressure, neck circumference, etc.) and overnight pulse oximetry were collected. SAS was defined as a 3% oxygen desaturation index (ODI) of 15 or more.<br><b>Results:</b> Among 46 subjects, the prevalence of SAS was 6.5% (95% CI, 1.4-17.9%). SAS was significantly more prevalent in patients with high systolic blood pressure (≥140 mmHg) than in patients with normal systolic blood pressure (<140 mmHg) (33.3% vs. 2.8%, P=0.049). Even after adjustment for age and sex, high systolic blood pressure showed a statistically significant association with SAS.<br><b>Conclusions:</b> Promoting awareness about SAS could be necessary in patients with persistent fatigue, especially in patients with high systolic blood pressure.

The clinical experience of medical students compared with that of residents / 医学教育

1) We evaluated the clinical experiences of 102 medical students who completed clinical clerkships at the University of Tsukuba, by analyzing their self-assessments on the clinical evaluation form normally used for the postgraduate residency program. <br>2) The medical students participated in the management of a broad range of diseases. However, in most cases, their participation was only partial. <br>3) To improve the continuity between the undergraduate and postgraduate medical education systems, it is important to expand the amount of hands-on participation of medical students in medical practice.

The relationship between medical students' eagerness in clinical clerkships and their interest in medical departments / 医学教育

Medical students must have motivation to participate in medical care during clinical clerkships. How much interest students have in each department might be a factor in making them more active in clerkships. To make clerkships more effective, we performed a questionnaire survey to investigate the relationship between students' interest in each department and their eagerness in clinical clerkships and to investigate factors to increase their eagerness.<br>1) Questionnaires were distributed to 92 sixth-year medical students at the University of Tsukuba. The questionnaire consisted of 6-point Likert scales of 4 specific student attitudes in clerkships. We asked the same questions about clerkships at medical departments that each student found more or less interesting.<br>2) We asked the students to report anecdotes about when they were motivated to learn more in the clerkships. We grouped similar answers into categories.<br>3) The response rate was 94%. The students were more eager in departments they found more interesting than in departments they found less interesting.<br>4) Thirty-eight students reported a total of 56 anecdotes. Among the categories, questions or words of encouragement from patients were mentioned in 29 anecdotes, and devoted faculty members were mentioned in 9 anecdotes.<br>5) These results suggest that medical students' eagerness in clinical clerkships could be increased by deepening their interest in medical departments and by improving communication with patients and physicians.

A survey comparing the mental health of residents before and after compulsory postgraduate clinical training / 医学教育

The new postgraduate clinical training system that started in 2004 is expected to have positive effects on the health of residents and the quality of treatment they provide.We performed a survey to examine the effects of this training system on the mental health of residents.<BR>1) The subjects were first-year residents (458 in 2003 and 549 in 2004) who had started postgraduate clinical training at 38 hospitals in Japan.Self-administered questionnaires, which included items about working conditions and mental health, were mailed to each subject.<BR>2) The mean score on the 12-item version of the General Health Questionnaire was 4.8 both before and after the new training system was introduced.The mean Center for Epidemiologic Studies Depression Scale score was 15.3 before and 14.4 after the system's introduction.The results showed no significant difference in mental health of residents before and after the system was changed.<BR>3) The results suggest that the new training system has a positive effect on residents' mental health by increasing sleep time and decreasing occupational stress; however, the new system has also decreased job satisfaction and negatively affected their mental health.<BR>4) Job satisfaction may significantly affect the mental health of residents.