An Observational Study of Google Reviews and Ratings of Medical Institutions / 日本プライマリ・ケア連合学会誌

Introduction: Patients often refer to information on the Internet when selecting a medical institution, and some patients provide feedback on their experiences. In this study, we analyzed the content of patients' evaluations of medical institutions on Google.Methods: This study evaluated Google reviews and ratings of medical institutions in Shizuoka Prefecture. We coded the reviews with 12 items according to their content, and further categorized them into "positive," "negative," "unclassifiable," and "no description." We used modified Poisson regression analysis to investigate the relationship between ratings and assessment items.Results: Our sample consisted of 2,044 medical institutions. The number of reviews included in the analysis was 13,769. Reviews frequently commented on "doctor's behaviors," and positive comments about doctor's behaviors were significantly associated with high ratings (B: 0.76, 95%CI: 0.70 to 0.82), whereas negative comments were associated with low ratings (−4.65, −5.24 to −4.06).Conclusion: Within the reviews on Google, doctors' behavior had an impact on the ratings of medical institutions.

Kinematic analysis and self-perceived exertion during the walking gait with a backpack in Brazilian scholars

Abstract Aim: The present study aimed to investigate the effects of different backpack loads on the walking gait kinematics and ratings of perceived exertion (RPE) in Brazilian scholars. Methods: The sample was composed of 25 male children and adolescents, from 10 to 14 years. The mean body mass and height were 45.3 kg ± 10.6 kg and 1.51 m ± 0.08 m, respectively. For the walking gait assessment, a tridimensional analysis system was used. In the backpack conditions, loads of 5%, 10%, 15%, and 20% were applied according to the body weight of everyone. Kinematic variables and angular amplitudes of head, shoulders, thorax, pelvis, and knees in the sagittal plane were collected. The OMNI scale was used to assess the RPE. Results: The loads of 5%, 10%, 15%, and 20% promoted postural adjustments and alterations in the walking gait, in which the RPE presented a correlation with those alterations. The step in the left cycle altered from the baseline in the 5% (p = 0.006). The stride length altered from baseline in the 5% (p = 0.030) and 10% (p < 0.001) load conditions. The single support time was different from baseline in all conditions (p = 0.003; p = 0.012; p = 0.005; p = 0.006). The walking gait cadence was different in the comparison between baseline in the 5% (p = 0.003). Thorax amplitude altered in the 10% (p = 0.023), 15% (p = 0.033) and 20% (p = 0.005) load conditions in the left cycle. Conclusion: We concluded that the posture, RPE, and the gait kinematic altered according to the increase in the backpack load.

The C.O.P.E. typology of coping with stressors at sea among Filipino merchant marine ratings: A Q methodology study

@#<p style="text-align: justify;"><strong>Background:</strong> The seafarers' poor mental health has been associated with significant morbidity, inefficiency, and accidents on board. Mental and physical health is largely dependent on the way seafarers handle stressors.<br />Anchored on the Transactional Model of Stress and Coping, this study aimed to identify the typology of Filipino merchant marine ratings according to their coping strategies to stressors on board vessels.</p><p style="text-align: justify;"><strong>Methods:</strong> Thirty-seven (37) Filipino merchant marine ratings participated in this study. They were chosen by purposive sampling. They rank-ordered 25 opinion statements on various stressors and coping mechanisms. The rank-ordered sorts were subjected to by-person factor analysis with Varimax rotation using the PQ Method version 2.32. The resulting factors were interpreted using the inductive approach, aided by the interview done after Q sorting.</p><p style="text-align: justify;"><strong>Results:</strong> Four factors were generated: solution-focused seafarers, stressor-focused seafarers, self-management- focused seafarers, and the social milieu-focused seafarers. There is a consensus on the supplication-focused seafarers who ask for God's help in times of stress.</p><p style="text-align: justify;"><strong>Conclusion:</strong> The generated typology provides a better understanding of seafarers' outlook on stress and coping and may help the stakeholders craft individualized strategies to help improve their coping mechanisms and overall mental health. Occupational health research must continue to focus on understanding the role of culture and adaptation on stress and coping behaviors to retain quality seafarers and promote a healthier workplace.</p>

Ratings of perceived exertion at anaerobic threshold in patients with coronary artery disease / Percepción subjetiva del esfuerzo en el liminar anaeróbico en pacientes con enfermedad arterial coronaria / Percepção subjetiva do esforço no limiar anaeróbio em pacientes com doença arterial coronariana

The study aimed to identify and compare the ratings of perceived exertion (RPE) at the ventilatory anaerobic threshold (VAT) in healthy subjects and patients with coronary artery disease (CAD). A total of 30 male subjects took part in the study and were divided into three groups: a control group (CG) composed of 10 healthy participants; a group composed of 10 participants diagnosed with CAD beta-blocker user (G-DACb); and a group composed of 10 participants with CAD non-beta-blocker user (G-DAC). The participants performed a cardiopulmonary exercise test (CPET) with continuous type ramp protocol to determine the VAT, through the visual graphical analysis (loss of parallelism between the oxygen uptake and the carbon dioxide output). During CPET, before the end of each one-minute period, the subjects were asked to rate dyspnea (RPE-D) and leg fatigue (RPE-L) on the Borg CR-10 scale. After the VAT was determined, the score that the participants gave on the Borg CR10 scale was verified. CG participants showed higher workload, oxygen uptake, carbon dioxide output, ventilation and heart rate at the VAT compared to the G-DAC and G-DACb (p<0.05). However, regarding the RPE-L and the RPE-D, no significant difference between the groups were observed (p<0.05). Values between five and six on Borg CR-10 scale matched the VAT in the subjects studied. However, other parameters must be concomitantly used for prescribing exercise intensity in physical training protocols, at levels close to the VAT for patients with CAD.

El objetivo del estudio fue identificar y comparar la percepción subjetiva del esfuerzo (PSE) en el liminar anaeróbico ventilatorio (LAV) en sujetos sanos y con enfermedad arterial coronaria (EAC). Fueron estudiados 30 hombres siendo10 sanos que constituyeron el grupo control (GC) y 20 diagnosticados con EAC, de los cuales 10 utilizaban medicamento betabloqueante (G-DACb) y 10 no utilizaban (G-DAC). Los voluntarios fueron sometidos a una prueba de ejercicio cardiopulmonar (TECP) con protocolo continuo tipo rampa para la determinación del LAV, a través del análisis gráfico visual (pérdida del paralelismo entre el consumo de oxígeno y producción de dióxido de carbono). Durante la realización del TECP, se pidió a los voluntarios que informaran al final de cada minuto la percepción subjetiva del esfuerzo de los miembros inferiores (PSE-M) y la percepción subjetiva del esfuerzo respiratorio (PSE-R) a través de la escala de Borg CR-10. El GC presentó mayores valores de potencia, consumo de oxígeno, producción de dióxido de carbono, ventilación y frecuencia cardiaca en el LAV comparado con los grupos G-DAC y G-DACb (p<0,05). La PSE-M fue menor en el G-DACb comparado con el GC (p<0,05). Después del ajuste por la covariable potencia, no hubo diferencia significativa entre los grupos para PSE-M y PSE-R (p>0,05). Los valores entre cinco y seis en la escala CR-10 de Borg correspondieron al LAV en la muestra estudiada. Sin embargo, otros parámetros deben ser utilizados simultáneamente para la prescripción de la intensidad del ejercicio en los protocolos de entrenamiento físico, en niveles cercanos al LAV para pacientes con EAC.

O objetivo do estudo foi identificar e comparar a percepção subjetiva do esforço (PSE) no limiar anaeróbio ventilatório (LAV) em indivíduos saudáveis e com doença arterial coronariana (DAC). Foram estudados 30 homens, sendo 10 saudáveis que constituíram o grupo controle (GC) e 20 diagnosticados com DAC, dos quais 10 faziam uso de medicamento betabloqueador (G-DACb) e 10 não faziam uso (G-DAC). Os voluntários foram submetidos a um teste de exercício cardiopulmonar (TECP) com protocolo contínuo tipo rampa para determinação do LAV, através da análise visual gráfica (perda do paralelismo entre o consumo de oxigênio e a produção de dióxido de carbono). Durante a realização do TECP, foi solicitado aos voluntários que relatassem ao final de cada minuto a percepção subjetiva do esforço de membros inferiores (PSE-M) e a percepção subjetiva do esforço respiratório (PSE-R), através da escala CR-10 de Borg. O GC apresentou maiores valores de potência, consumo de oxigênio, produção de dióxido de carbono, ventilação e frequência cardíaca no LAV comparado aos grupos G-DAC e G-DACb (p<0,05). A PSE-M foi menor no G-DACb comparado ao GC (p<0,05). Após ajuste pela covariável potência, não houve diferença significativa entre os grupos para PSE-M e PSE-R (p>0,05). Valores entre cinco e seis na escala CR-10 de Borg correspondeu ao LAV na amostra estudada. Entretanto, outros parâmetros devem ser utilizados concomitantemente para a prescrição da intensidade de exercício nos protocolos de treinamento físico, em níveis próximos ao LAV para pacientes com DAC.

Change in heart rate at double product break point and validity of utilizing age-predicted heart rate at 50%VO₂max due to improvement of cardiovascular fitness / 体力科学

Previously, we have reported that age-predicted heart rate at 50%VO₂max (HR@50%VO₂max) is an effective index of adjusting appropriate exercise intensity for health promotion exercise. Thus, the aim of this study is to elucidate the change in HR at double product break point (HR@DPBP) and the validity of HR@50%VO₂max due to improvement of cardiovascular fitness. Ninety two healthy adults (57 +/- 9 years old), who participated in the health exercise training course, were studied. Participants were instructed how to control the intensity of physical activity for DPBP during their daily life. DPBP was determined with the use of incremental exercise test, and METs at DPBP (METs@DPBP), HR@DPBP, ratings of perceived exertion at DPBP (RPE@DPBP) were measured before and after the course. HR@50%VO₂max was calculated with the following formula; 138 - age/2 (bpm). METs@DPBP significantly increased (p<0.001) after 10 weeks of the course, whereas HR@DPBP did not change. Interestingly, however, there was a significantly positive correlation (p<0.001) between amount of change in METs@DPBP and that in HR@DPBP (ΔHR@DPBP). Multiple linear regression analysis indicated this correlation was independent from sex, age and amount of change in HR at rest (p<0.001). Before and after the course, proportion of study subjects’ %ΔHRs ((HR@50%VO₂max - HR@DPBP) / HR@DPBP x 100) within -10% ~ +10% were both 48.9%, and proportion of study subjects’ RPEs@DPBP within 11~13 were 92% and 85%, respectively. In this study, it was identified that significantly positive relation between amount of change in cardiovascular fitness and that of ΔHR@DPBP. This finding was independent from potentially affecting factors. In conclusion, this longitudinal study could suggest that HR@50%VO₂max and RPE were valuable indexes of determining exercise intensity for health promotion exercise.

Monitoramento do treinamento no judô: comparação entre a intensidade da carga planejada pelo técnico e a intensidade percebida pelo atleta / Training load monitoring in judo: comparison between the training load intensity planned by the coach and the intensity experienced by the athlete

O objetivo do presente estudo foi comparar a percepção referente à intensidade da carga de treinamento planejada pelos técnicos com a percepção de intensidade reportada pelos atletas de Judô. A amostra foi composta por quatro técnicos e 40 atletas da Seleção Brasileira de Judô. A comparação entre a intensidade planejada e a intensidade experienciada foi realizada através da aplicação do método da percepção subjetiva do esforço (PSE) da sessão durante um training camp. Também foram realizadas coletas de sangue para determinação da concentração de lactato sanguíneo. A intensidade da carga de treinamento reportada pelos atletas superou a intensidade planejada pelos técnicos em todas sessões de treinamento. Com relação à concentração de lactato, houve aumento no período pós-treino em todas as sessões do training camp, não havendo diferença entre as sessões. Os resultados do presente estudo demonstram que, embora o programa de treinamento tenha sido elaborado por técnicos experientes, foi detectada diferença entre a intensidade da carga externa planejada pelo técnico e a intensidade da carga interna percebida pelos atletas. Estes dados reforçam a importância do constante monitoramento do treinamento, a fim de maximizar o desempenho de atletas de elite.

The aim of this study was to compare the perception concerning of the training load intensity of Judo coaches and athletes. The sample consisted of 4 coaches and 40 athletes of the Brazilian National Judo Team. The comparison between the intensity planned by the coach and the intensity experienced by the athletes was determined by the Session RPE method during a "Training camp". In order to assess lactate responses to training, blood samples were collected pre- and post training session. The intensity experienced by athletes was higher than the intensity planned by coaches in all training sessions. Regarding lactate concentration, it was observed an increase at post-training as compared to pre-training in all sessions, with no differences between sessions. The results of this study demonstrate that although the training session has been developed by experienced coaches, significant differences were detected between the intensity of external training load planned by the coach and the intensity of the internal training load experienced by the athletes. These data reinforce the relevance of training monitoring in order to maximize performance of elite athletes.

A percepção de esforço no treinamento de força / Perceived exertion in strength training

A percepção de esforço (PE) é definida por Robertson e Noble(1) como sendo a intensidade subjetiva de esforço, tensão, desconforto e/ou fadiga que são experimentados durante os exercícios físicos aeróbicos e de força. Sua aplicabilidade é bastante grande, tendo como ponto principal a mensuração do esforço físico. Um mesmo padrão neurofisiológico, através da integração dos comandos feedforward-feedback poderia explicar a PE(2). Diferentes escalas (RPE, CR10, VAS, Omni) foram elaboradas e têm sido aplicadas em estudos que investigaram diferentes exercícios e populações, apresentando fortes correlações com importantes variáveis fisiológicas. Inúmeros estudos têm sido desenvolvidos, principalmente na última década, buscando verificar o comportamento da PE em relação às diferentes variáveis do treinamento de força (TF). Em relação à variável carga, maiores cargas produzem maiores PE, mesmo quando volumes ou o número de repetições diferenciados é utilizado, apresentando altas e significativas correlações entre a PE e diferentes cargas. Esforços máximos (repetições máximas) causam uma similar PE, independente do número de repetições. Ainda, quanto maior a carga utilizada, menor a variabilidade das respostas da PE entre os sujeitos. A PE aumenta conforme o crescimento do número de repetições realizadas na série, para uma mesma carga, parecendo não existir diferenças na PE entre homens e mulheres. Outras variáveis do TF ainda merecem ser investigadas, não sendo possível apresentar dados conclusivos sobre o comportamento da PE quando estas variáveis são avaliadas. Contudo, os estudos apresentados até então têm indicado que as contrações excêntricas e maiores velocidades de execução indicam uma menor PE, enquanto que a ordem, a quantidade e o tipo de exercícios indicam ter pouca ou nenhuma influência. Quanto ao nível de treinamento dos sujeitos, mais estudos são necessários, sendo contraditórios os dados apresentados até então pela literatura. Possivelmente, a grande di...

Perceived exertion (PE) is defined by Robertson and Noble(1) as the subjective intensity of effort, strain, discomfort and/or fatigue experienced during both aerobic and resistance exercise. Its application is fairly wide and has as main focus the measurement of physical exertion. The same neuro-physiological pattern, through the integration of feedforward-feedback commands could explain PE(2). Different scales (RPE, CR10, VAS, OMNI) were developed and have been applied in studies that investigated different exercises and populations, showing high correlations with important physiological variables. Several studies have been developed, especially in the last decade, in order to verify the PE behavior concerning different variables of the strength training (ST). Regarding the load variable, the results showed that higher loads produce greater PE, even when different volumes or number of repetitions are used, with high and significant correlations between PE and different loads. Maximum efforts (repetition maximum) cause a similar PE, regardless of the number of repetitions. Moreover, the higher the load used, the lower the responses variability of the PE among subjects. PE increases according to the number of repetitions performed in the sets for the same load, with no differences in PE being shown between men and women. Further ST variables must be investigated and it is not possible to provide conclusive data on the PE performance when these variables are evaluated. However, the studies presented until the present moment, have indicated that eccentric contractions and higher performance speeds indicate lower PE, while order, amount and type of exercises show little or no influence. Further studies should be conducted about the trainability status of the subjects, and contradictory data were found so far by the literature. Possibly, the major difficulty of these studies is not the PE application per se, but the isolation of each ST variable. As long as protoc...

Analysis of Rating Appropriateness and Patient Outcomes in Cataract Surgery

PURPOSE: Using the RAND/UCLA methodology to create the appropriateness criteria, we assessed that the appropriate ratings in cataract surgery can be a better prognosis of outcomes in postoperative 12 months than uncertain or inappropriate ratings. In addition, we indentified the degree of the appropriate rating surgery associated with the outcome changes in postoperative 12 months. MATERIALS AND METHODS: The patients in this study were followed up prospectively in preoperative and postoperative 12 months periods. The 20 ophthalmologists in 14 hospitals were asked to refer about 20 patients who were scheduled to undergo cataract surgery from March and June of 1997. A multiple regression analysis was used to identify the degree of the appropriate surgery associated with the changes of outcomes. The outcomes were designed as the clinical and functional outcomes (visual acuity, visual function, satisfaction with vision, and satisfaction with overall care). RESULTS: The outcome changes of vision acuity (p < 0.001), vision function-14 (p < 0.001), and symptom score (p < 0.006) were significantly different between four appropriateness ratings (crucial, appropriate, uncertain, and inappropriate). There was a trend that the appropriate rating surgeries were related to the successful change of the vision function (2.29, p = 0.015) and satisfaction with vision (3.84, p = 0.014) in 12 month postoperative period. CONCLUSION: The crucial or appropriate rating surgeries may indicate better outcomes than uncertain or inappropriate rating surgeries do. The appropriate rating surgeries were more closely related to functional outcome vision function, VF-14 and subjective outcome (satisfaction with vision) in postoperative 12 months than inappropriate rating surgeries.

Appropriateness Ratings in Cataract Surgery

This study aimed to evaluate the appropriateness of cataract surgery and identify the characteristics of patients and surgeons, clinical and functional outcomes, and surgical methods associated with appropriate cataract surgery. For this purpose, Korean cases of cataract surgery were rated as either 'necessity', 'appropriate', 'uncertain' or 'inappropriate', based on RAND/UCLA Ratings. For this assessment, the cases of 222 patients who underwent cataract surgery, on either one or both eyes, were studied. The surgeries were performed by 20 ophthalmologists practicing at one of fourteen medical institutions (university hospitals and general hospitals). Patients were interviewed and clinical data collected. The Doctors were questioned with self-entered questionnaire forms. The medical records were also examined to gain an understanding of the surgical process. The ratings were as follows: 30.6% (68 patients) of surgeries belonged to the bracket "necessity", 46.4% (103 patients) to "appropriate", 15.3% (34 patients) to "uncertain" and 7.7% (17 patients) to "inappropriate". In this study, "necessity" and "appropriate" were defined as "appropriate" (77.0%, 171 patients), and "uncertain" and "inappropriate" as "inappropriate" (23.0%, 51 patients). The low preoperative Snellen visual acuity and visual function, advanced age and male patients were associated with appropriate surgery. It is concluded that appropriate surgery was related to the clinical and functional outcomes (visual acuity and visual function) and patient characteristics (age and male).

DEVELOPMENT OF PREDICTION EQUATIONS FOR CARDIORESPIRATORY FITNESS USING RATINGS OF PERCEIVED EXERTION IN JAPANESE MEN AND WOMEN / 体力科学

A study was conducted to develop prediction equations for cardiorespiratory fitness (maximal oxygen uptake : VO<SUB>2max</SUB> and oxygen uptake at anaerobic threshold : VO<SUB>2AT</SUB>) in Japanese adult men and women. Eighty-three healthy men and 86 healthy women, aged 20-64 years (41.1±13.5 and 41.5±13.5, respectively), were recruited as subjects. Mean (±SD) of VO<SUB>2max</SUB> and VO<SUB>2AT</SUB> measured during a cycling test were 37.2±6.4 and 20.5±4.7 ml/kg/min, respectively, in men and 32.7±7.3 and 17.8±4.1 ml/kg/min, respectively, in women. In this study 36 kinds of equations applicable to each sex were developed using all the subjects (n=169) . These equations consisted of independent variables such as work rate divided by body weight (W/Wt), age and body fat percentage (%Fat), which were signficantly correlated with measured VO<SUB>2max</SUB> and VO<SUB>2AT</SUB>. Multiple correlation coefficients (R) and standard errors of estimate (SEE) of the equations ranged from 0.641 to 0.830 (<I>P</I><0.05) and from 3.66 to 4.98 ml/kg/min, respectively, for VO<SUB>2max</SUB> and from 0.661 to 0.815 (<I>P</I><0.05) and from 2.77 to 3.20 ml/kg/min, respectively, for VO<SUB>2AT</SUB>. Reliability coefficients (r) between the first and second tests were 0.911 in men and 0.873 in women for VO<SUB>2max</SUB>, and 0.869 in men and 0.770 in women for VO<SUB>2AT</SUB>, all of which were statistically significant (<I>P</I><0.05) . It is concluded that the equations developed in the present study have the merits of simplicity, economy, accuracy and reliability. Furthermore, from the viewpoint of safety and convenience, the following prediction equations are recommended.<BR>(Male)<BR>VO<SUB>2max</SUB> (ml/kg/min) =6.57 W<SUB>RPE-legs 15</SUB>/Wt-0.19 Age-0.36%Fat+41.29<BR>(R=0.830, SEE=3.66 ml/kg/min)<BR>VO<SUB>2AT</SUB> (ml/kg/min) =7.35 W<SUB>RPE-legs 14</SUB>/Wt-0.06Age-0.23%Fat+15.62<BR>(R=0.815, SEE=2.77 ml/kg/min)<BR>(Female)<BR>VO<SUB>2max</SUB> (ml/kg/min) =7.30 W<SUB>RPE-legs 15</SUB>/Wt-0.12 Age-0.46%Fat+37.32<BR>(R=0.828, SEE =4.16 ml/kg/min)<BR>VO<SUB>2AT</SUB> (ml/kg/min) =5.03 W<SUB>RPE-legs 14</SUB>/Wt-0.01 Age-0.16%Fat+14.15<BR>(R=0.680, SEE=3.06 ml/kg/min)