Scale development and validation of perimenopausal women disability index in the workplace

BACKGROUND@#Menopausal disorders include obscure symptomatology that greatly reduce work productivity among female workers. Quantifying the impact of menopause-related symptoms on work productivity is very difficult because no such guidelines exist to date. We aimed to develop a scale of overall health status for working women in the perimenopausal period.@*METHODS@#In September, 2021, we conducted an Internet web survey which included 3,645 female workers aged 45-56 years in perimenopausal period. We asked the participants to answer 76 items relevant to menopausal symptomatology, that were created for this study and performed exploratory and confirmatory factor analyses for the scale development. Cronbach's alpha, receiver operating characteristic analysis, and logistic regression analysis were used to verify the developed scale.@*RESULTS@#Approximately 85% participants did not have menstruation or disrupted cycles. Explanatory factor analysis using the maximum likelihood method and Promax rotation identified 21 items with a four-factor structure: psychological symptoms (8 items, α = 0.96); physiological symptoms (6 items, alpha = 0.87); sleep difficulty (4 items, alpha = 0.92); human relationship (3 items, alpha = 0.92). Confirmatory factor analyses found excellent model fit for the four-factor model (RMSR = 0.079; TLI = 0.929; CFI = 0.938). Criterion and concurrent validity were confirmed with high correlation coefficients between each of the four factors, previously validated menopausal symptom questionnaire, and Copenhagen Burnout Inventory scales, respectively (all ps < 0.0001). The developed scale was able to predict absenteeism with 78% sensitivity, 58% specificity, and an AUC of 0.727 (95%CI: 0.696-0.757). Higher scores of each factor as well as total score of the scale were more likely to be associated with work absence experience due to menopause-related symptoms even after adjusting for Copenhagen Burnout Inventory subscales (all ps < 0.0001).@*CONCLUSION@#We found that the developed scale has high validity and reliability and could be a significant indicator of absenteeism for working women in perimenopausal period.

Cross-sectional survey of depressive symptoms and suicide-related ideation at a Japanese national university during the COVID-19 stay-home order

BACKGROUND@#We aimed to estimate the prevalence of depressive symptoms as well as suicide-related ideation among Japanese university students during the stay-home order necessitated by the coronavirus disease 2019 pandemic in Japan, and offer evidence in support of future intervention to depression and suicide prevention strategies among college and university students.@*METHODS@#The data for this cross-sectional study were derived from the Student Mental Health Survey conducted from May 20 to June 16, 2020 at a national university in Akita prefecture. Among the 5111 students recruited, 2712 participated in this study (response rate, 53%; mean age ± standard deviation, 20.5 ±3.5 years; men, 53.8%). Depressive symptoms were identified by using the Patient Health Questionnaire-9 (PHQ-9).@*RESULTS@#The prevalence of moderate depressive symptoms based on a PHQ-9 score ≥10 and suicide-related ideation based on question 9 of PHQ-9 ≥1, which encompasses thoughts of both suicide and self-harm, was 11.7% and 6.7%, respectively. Multivariable logistic regression analyses showed that risk factors for depression included being a woman, smoking, alcohol consumption, and social network communication using either video or voice. For suicide-related ideation, alcohol consumption was the only risk factor. Exercise and having someone to consult about worries were associated with decreased risk of both depressive symptoms and suicide-related ideation.@*CONCLUSIONS@#Negative lifestyles of smoking and drinking, and being a woman, may be important risk factors for depressive symptoms, whereas exercise and having someone to consult about worries may be protective factors.

Domestic work stress and self-rated psychological health among women: a cross-sectional study in Japan

BACKGROUND@#Despite the huge burden of domestic work on women in Japan, its effects on their health have been poorly investigated. We aimed to assess the association between domestic work stress and self-rated psychological health among women.@*METHODS@#We conducted a cross-sectional survey using an online social research panel in February 2018. Participants were 2,000 women with paid work (the "workers" group) and 1,000 women without paid work (the "homemakers" group), aged between 25 and 59 years old and living with a partner. Self-rated psychological health (Mental Health and Vitality scales of the Japanese SF-36), occupational and domestic work stress (the Brief Job Stress Questionnaire), the 10-item Work-Family Conflict Scale, and sociodemographic factors were assessed.@*RESULTS@#The workers had lower domestic job control and higher support from a partner and their parents than the homemakers (p < 0.001), whereas domestic job demand and psychological health were similar between the groups. After adjustment for the covariates using multiple linear regression models, better psychological health was significantly associated with lower domestic job demand, higher domestic job control, and having a young child in both groups. In addition, work-family conflicts and occupational job stress among the workers and caregiving among the homemakers showed negative associations with psychological health.@*CONCLUSION@#Self-rated psychological health in women was associated with domestic work stress regardless of employment status. To promote women's health, we need to take into account the effects of domestic work, work-family conflicts, and social support from families, as well as occupational factors.

For making a declaration of countermeasures against the falling birth rate from the Japanese Society for Hygiene: summary of discussion in the working group on academic research strategy against an aging society with low birth rate

In 1952, the Japanese Society for Hygiene had once passed a resolution at its 22nd symposium on population control, recommending the suppression of population growth based on the idea of cultivating a healthier population in the area of eugenics. Over half a century has now passed since this recommendation; Japan is witnessing an aging of the population (it is estimated that over 65-year-olds made up 27.7% of the population in 2017) and a decline in the birth rate (total fertility rate 1.43 births per woman in 2017) at a rate that is unparalleled in the world; Japan is faced with a "super-aging" society with low birth rate. In 2017, the Society passed a resolution to encourage all scientists to engage in academic researches to address the issue of the declining birth rate that Japan is currently facing. In this commentary, the Society hereby declares that the entire text of the 1952 proposal is revoked and the ideas relating to eugenics is rejected. Since the Society has set up a working group on the issue in 2016, there have been three symposiums, and working group committee members began publishing a series of articles in the Society's Japanese language journal. This commentary primarily provides an overview of the findings from the published articles, which will form the scientific basis for the Society's declaration. The areas we covered here included the following: (1) improving the social and work environment to balance between the personal and professional life; (2) proactive education on reproductive health; (3) children's health begins with nutritional management in women of reproductive age; (4) workplace environment and occupational health; (5) workplace measures to counter the declining birth rate; (6) research into the effect of environmental chemicals on sexual maturity, reproductive function, and the children of next generation; and (7) comprehensive research into the relationship among contemporary society, parental stress, and healthy child-rearing. Based on the seven topics, we will set out a declaration to address Japan's aging society with low birth rate.

A Qualitative Study on Career Conversion to a "General Practitioner" in Hospital Internal-medicine Physicians Specialized for Organs/Region / 日本プライマリ・ケア連合学会誌

Background: Internal medicine physicians are able to convert to "general practitioners" in the future.Objective: To examine factors related with "career conversion to a general practitioner" conceived by hospital internal-medicine physicians specializing in organs/regions.Materials and Method: A semi-structured interview was conducted for 20 internal-medicine physicians with their consent from November 2014 to November 2015. The verbatim records were analyzed with the modified grounded theory approach.Results: The facilitating factors for career conversion consisted of "a career plan where characteristics of a general practitioner can be utilized", "high-quality training that combines practical conditions", and "diverse ways of working and a specialist-licentiate who has opportunities for learning".On the other hand, the suppressive factors consisted of "a lack of understanding of general practitioners", "difficulties associated with re-training", and "a feeling of resistance toward comprehensiveness of general practitioners".Conclusions: Career conversion to general practitioner by qualified internal-medicine physicians was suggested to be promoted by enhancing the meaningfulness of the general practitioner license, the training circumstances, and ensuring the professionalism and financial aspects of physician life.

Survey of female physicians about leaving a full-time joband returning to work / 医学教育

Introduction: In Japan, the number of female physicians is increasing rapidly. Therefore, surveying female physicians about their current working status, especially about their continuing to work, is important.<br>Methods: In September 2009, we sent a questionnaire regarding working status to 1403 female physicians who had graduated from Okayama University Medical School or who were working at university-affiliated hospitals or facilities at the time of investigation.<br>Results: Of the 420 female physicians who responded （response rate, 29.9％）, 46.6％ （n＝191） had left their jobs at some time, and 92.4％ （n＝171） of them had done so within 10 years after medical school graduation. The most common reason for leaving their jobs was childbirth／childcare, and the second most common was their husband’s job transfer. Of those who had ever left their job, 82％ （n＝151） wished to return to work at the time of their leaving. Only 27.2％ （n＝74） took childcare leave.<br>Discussion: Female physicians have trouble continuing their clinical work and developing their careers while caring for children. A system should be developed to support physicians who wish to continue their clinical work during life events, such as childcare. In particular, career support during the first 10 years after graduation from medical school is extremely important.

Gender equality in Japanese medicine / 医学教育

　Although the problem of improving the retention rate of female physicians in Japan has been vigorously discussed, a more comprehensive discussion on gender equality has been lacking. This paper provides an overview of gender inequality in Japanese medicine and discusses measures to promote gender equality. The main causes of gender inequality include gender stereotype, bias, discrimination, women’s double burden of paid and domestic work, and a working system of long and irregular hours based on the gender division of labor. Measures to promote gender equality are necessary to create a working environment that does not disadvantage female physicians.

Characteristics of second-year residents intending to become a primary care physicians / 日本プライマリ・ケア連合学会誌

<b>Purpose</b> : To examine the characteristics of second-year residents intending to become primary care physicians.<br><b>Methods</b> : Using a self-administered questionnaire, we surveyed 7344 second-year residents in March, 2006. Of the 4167 responders (response rate 56.7%), the 3838 who answered that they intended to make a career choice of being clinical practitioners were taken as subjects for analysis. The odds ratios (OR) for the intention of being a primary care physician was calculated, together with the 95% confidence interval (95% CI), using logistic regression models (primary care physicians intended=1 vs. specialist intended=0) <br><b>Results</b> : In total, 56% of the residents affirmed an interest in becoming primary care physicians. Multiple stepwise logistic models showed that residents intending to become primary care physicians planned to open their own clinics in the future (OR 1.44, 95% CI : 1.20-1.73), did not wish to obtain doctor of medical science (DMSc) degrees (OR 1.29, 95% CI : 1.07-1.55), and were more likely to choose internal medicine (OR 1.44, 95% CI : 1.07-1.94).<br><b>Conclusion</b> : This study demonstrated that second-year residents who aimed to be primary care physicians were associated with more interest in opening private clinics for their future practice, preferably in the field of internal medicine, and with less interest in earning DMSc degrees.

The division of labor by sex among Japanese physicians / 医学教育

1）To evaluate the division of labor by sex among Japanese physicians, we used anonymous, voluntary questionnaires to survey the alumni of a private medical school about the time spent weekly on clinical activities and unpaid domestic work.<br>2）Although the median time spent per week on clinical activities was less for women physicians （40 hours） than for men （50 hours）, the time spent on unpaid domestic work was significantly more for women （30 hours） than for men （3 hours）.<br>3）When the time spent on both clinical activities and domestic activities was totaled, women physicians worked more hours per week than did men physicians.<br>4）Our study showed a division of labor by sex among Japanese physicians.

The effects of marriage and child–bearing on career satisfaction among female physicians / 医学教育

The number of female physicians is increasing. In Japan, marriage and child–bearing have been considered barriers preventing female physicians from working continuously. This study investigated the effects of marriage and child–bearing on career satisfaction among female physicians.<br>1)We surveyed the alumni of two private medical schools (University A: n=646; University B: n=316). The response rate was 38% for University A and 71% for University B.<br>2)When the subjects were asked if they were satisfied that they had chosen a career as a physician, 85%(n=400) answered that they were satisfied.<br>3)In total, 348 female physicians (74%) were married, and of them, 280 (80%) had experienced childbirth, and 259 (77%) were married to physicians.<br>4)Factors that significantly and positively affected career satisfaction were marriage for all female physicians and child–bearing for married female physicians.<br>5)The results of this study suggest that marriage and child–bearing, rather than being obstacles to career development, have positive effects on the career satisfaction of female physicians.

Training in End-of-life Care as an Elective Program for Medical Students / 医学教育

Bioethics and palliative care have rarely been taught systematically in Japanese medical schools, and methods for teaching them have not been established. This report is based on a program to teach end-of-life care as part of public health education for fifth-year students at Teikyo University School of Medicine. Medical students participated in an elective program for nursing students in end-of-life care, visited terminally ill patients, and made care plans. Through this experience, students came to understand the purpose of terminal care and became aware of the importance of mental support to patients and teamwork with co-medical staff. Having the opportunity to contemplate human death before starting clinical practice helps students acquire behaviors appropriate for physicians.

Our Visit to Sweden / 医学教育

We spent 18 days in Stockholm studying welfare facilities for the aged, a subject in which we have a strong interest. It was a short visit but turned out to be an extremely informative and wonderful experience thanks to Prof. Bredberg, Dr. Linde, and many other people who took care of us in Stockholm. We found Sweden to be a country which is organized in such a way that everybody can enjoy life. Next time it will be your turn ! I You should have the opportunity to share our experiences in Sweden.