Increasing hepatitis virus screening uptake at worksites in Japan using nudge theory and full subsidies

BACKGROUND@#Despite the importance of hepatitis screening for decreasing liver cancer mortality, screening rates remain low in Japan. Previous studies show that full subsidies increase screening uptake, but full subsidies are costly and difficult to implement in low-resource settings. Alternatively, applying nudge theory to the message design could increase screening at lower costs. This study examined the effects of both methods in increasing hepatitis virus screening rates at worksites.@*METHODS@#1496 employees from a Japanese transportation company received client reminders for an optional hepatitis virus screening before their general health checkups. Groups A and B received a client reminder designed based on the principles of "Easy" and "Attractive," while the control group received a client reminder not developed using nudge theory. Additionally, hepatitis virus screening was offered to the control group and group A for a co-payment of JPY 612, but was fully subsidized for group B. The hepatitis virus screening rates among the groups were compared using a Chi-square test with Bonferroni correction, and the risk ratios of group A and group B to the control group were also calculated. To adjust for unobservable heterogeneity per cluster, the regression analysis was performed using generalized linear mixed models.@*RESULTS@#The screening rate was 21.2%, 37.1%, and 86.3% for the control group, group A, and group B, respectively. And the risk ratio for group A was 1.75 (95% confidence interval [CI] 1.45-2.12) and that of group B was 4.08 (95% CI 3.44-4.83). The parameters of group A and group B also were significant when estimated using generalized linear mixed models. However, the cost-effectiveness (incremental cost-effectiveness ratio (ICER)) of the nudge-based reminder with the full subsidies was lower than that of only the nudge-based reminder.@*CONCLUSIONS@#While fully subsidized screening led to the highest hepatitis screening rates, modifying client reminders using nudge theory significantly increased hepatitis screening uptake at lower costs per person.

Ginsenoside Rd improves behavioral impairment of rats with acute plateau status by modulating synaptic plasticity / 中草药·英文版

Objective: To investigate the protective effect of ginsenoside Rd on the improvement of the behavior and synaptic plasticity in rats with acute plateau status. Methods: A total of 60 Wistar rats were randomly divided into the control group, the model group, and the intervention group, with 20 rats in each group. The model was established in low-pressure oxygen chamber simulating the plateau, and the intervention group was administered with ginsenoside. Electron microscope was used to observe synaptic ultrastructure of hippocampal CA1 area, and analyze the structural parameters on the Gray I synaptic interface. Morris water maze and Y electric maze experiment were used for behavioral detection. Results: Compared with the control group, the number of electrical stimulation required for rat to avoid was increased in the model group, the latency in the Morris water maze was prolonged, the swimming distance was increased, and the frequency of crossing the platform was decreased. Under the electron microscope, the synaptic cleft was increased, the length of the synaptic active area was shorter, the postsynaptic density (PSD) was thinner, the flat synapse was increased, and the concave and perforated types were significantly reduced. Compared with the model group, the number of electrical stimulation required for rat to avoid was decreased in the intervention group, the latency in the Morris water maze was shortened, the swimming distance was decreased, and the frequency of crossing the platform was increased. Under the electron microscope, the synaptic cleft was decreased, PSD was thicker, the flat synapse was decreased, and the concave and perforated types were increased. Conclusion: Low pressure and low oxygen environment of plateau damages the plasticity changes of the synaptic structure and function. And to a certain extent, ginsenoside Rd reverses Gray I synaptic interface structure parameters, so as to improve the behavior performance of model rats at high altitude condition.

Social validity of a contextual behavioral science-based intervention for retirement education

Abstract The literature shows that retirement can bring both positive and negative effects. However, there are few tested interventions for preparing workers for this transition and avoiding or minimizing its negative impacts. This paper presents a study with multiple groups that examined the social validity of an intervention for retirement education grounded in contextual behavioral science and acceptance and commitment therapy. Twenty-seven workers aged 29 to 65 divided into three intervention groups participated (group 1, N = 15; group 2, N = 9; group 3, N = 3). According to the participants' evaluations, the intervention provided socially valid goals, socially acceptable procedures, and socially important effects. However, some improvements are still needed, such as the use of more dynamic methods, better formatted printed material, and increased fidelity between the content's implementation and the prescribed activities. The positive results indicate that contextual behavioral science may bolster the development of interventions whose components possess evidence for their social validity. The further evaluation of the intervention via a clinical trial study will offer more robust evidence for its effectiveness. It is hoped that by increasing the availability of theory-based interventions in this area, the present study will promote valid strategies to facilitate better adjustment to retirement.

Study on the Effects and Mechanism of Total Flavonoids from Armeniaca mume on Depression in Chronic Stress Depression Model Rats / 中国药房

OBJECTIVE:To investigate the effects and mechanism of total flavonoids from Armeniaca mume on depression in chronic stress depression model rats. METHODS:60 rats were randomly divided into normal saline group,model group,fluox-etine group(positive control,20 mg/kg)and total flavonoids from A. mume low-dose,medium-dose,high-dose groups(80,160, 240 mg/kg), 10 in each group. Except for normal saline group, the other groups adopted chronic unpredictable mild stress (CUMS)+solitary feeding condition to induce depression model. These groups were intragastrically administered,once a day,for 28 d. Changes of body mass and food intake,degree of preference for sugar were observed;forced swimming test and tail suspen-sion test were used to determine the time that rats did not move;open field test was used to determine the changes of residence time in central square,horizontal crossing lattice,standing times,modification times;tumor necrosis factor α(TNF-α),cortisol, interleukin 6 (IL-6),serotonin (5-HT) levels in serum after 24 h of last administration were determined. RESULTS:Compared with normal saline group,growth of body mass,food intake and sugar preference percentage in model group were decreased;the time that rats did not move was prolonged in forced swimming test and tail suspension test;residence time in central square was prolonged,while horizontal crossing lattice,standing times and modification times were decreased in open field test;serum levels of TNF-α,cortisol were increased,while IL-6,5-HT were decreased,with statistical significances (P<0.05 or P<0.01). Com-pared with model group,except that there were no obvious improvement in sugar preference percentage,the time that rats did not move in forced swimming test,modification times in open field test in total flavonoids from A. mume low-dose group and IL-6, 5-HT levels in serum in total flavonoids from A. mume low-dose,medium-dose groups,the above-mentioned indexes were obvious-ly improved in other groups (P<0.05 or P<0.01). CONCLUSIONS:Total flavonoids from A. mume can obviously improve the CUMS-induced depression in rats,and the mechanism may be related to inhibiting inflammation response,adjusting the hypothala-mus-pituitary-adrenal axis functions.

Consensus Statement; Behavioral and Social Sciences in Medical Education / 医学教育

<p>The Consensus of this Committee is:</p><p>1) To change the name of the present committee from "Premedical Education Committee" to "Committee on Behavioral and Social Science" ; accordingly to discuss theoretical foundations, clinical application, learning objectives and outcomes of behavioral and social science in Japanese medical schools.</p><p>2) To collect actual case studies of teaching behavioral and social sciences in Japanese medical schools and create a database for such practices.</p><p>3) To develop behavioral and social science curriculum content in Japanese medical schools.</p><p>4) To organize training courses for teaching methods for behavioral and social science curricula and develop standardized teaching methods and materials.</p>

7. Encouragement of medical behavioral science / 医学教育

<p>　Since the statement made by the ECMFG, WFME Global Standards have been focused on by medical departments, and pre-graduate behavioral science education which is one of the requirements included in these standards has gained prominent attention in Japan. In Japan's society, where the birthrate is decreasing and the population is growing older, physicians are required to have a patient-centered viewpoint instead of focusing on specialized treatment and hospital-oriented medical care. It has been 10 years since early clinical training became mandatory, and there is a need to develop medical education that allows physicians to nurture their professionalism and clarify their types of competence. In addition, using materials and strategies necessary for medical practice, medical departments need to provide education in practical medical behavioral science that facilitates the comprehensive learning of professionalism, medical ethics, NBE, and medical safety.</p>

1. Behavioral science in medical education / 医学教育

<p>　The roles of behavioral science in current medical education are examined in terms of its origin and the deregulation of the university establishment standards. Based on modern disease structures, the basic elements of behavioral science education are summarized from the viewpoint of human relationships that support holistic medicine. Specific examples of learning attitudes using laboratory training are also examined.</p>

A Proposal on the Curriculum of Behavioral Science / 医学教育

<p>Introduction: No formal curriculum has been formulated for teaching behavioral science to undergraduate medical students in Japan.<br>Method: We conducted a survey using the Delphi method to investigate the required competency in behavioral science for graduates in medicine. Then, we developed an outcome-oriented curriculum for teaching behavioral science.<br>Results: We propose an educational module of behavioral science consisting of 15 sessions of 90-minute lectures, small group discussions, and practice.<br>Discussion: We recommend including not only lectures but also practices according to problem-based learning as well as team-based learning in the curriculum to achieve the target outcome.</p>

Study on comparison of physical activity and behavior characteristics between male and female college students / 中华行为医学与脑科学杂志

Objective To compare the differences in physical activity (PA), self-efficacy, stages of change and physical exercise behaviour in college students. Methods International physical activivty questionnaire( IPAQ), scales of self-efficacy, questionnaire of stage of change in physical exercise behaviour, and scales of physical behaviour were used to make a study on college students from Zhejiang province. Results The rate of males (40.43%) was signficant higher than that of females (26.09%) MET in the high activity tertile. There was significantly more energy expenditure in males (( 3462.79 ± 976.31 ) MET) than in females (( 3118.63 ±944.29 ) MET) (P ＜ 0.05 ). The rate of males (44.68 % ) was more than females (25.00%) in maintainanee period and period of action. PA characteristics were shown significant defferences in different stages (F= 31. 380, F=6.012, P ＜ 0.01 ). Characteristics in stages of change were shown high in behaviour score (F= 13.071, F= 7. 461,P ＜0. 01 ). Four factors as attitude,cognitive controls, behavior disposition and self-efficacy in males were entered into regression model of MET( t = 2.138 ～ 3. 789, P ＜ 0.05 ), while in females only the factor of behaviour attitude was entered. Conclusion There is significant difference in PA, stages of change, behaviour characteristics, and self-efficacy between male and female college students.

Níveis de alfa-amilase, cortisol salivar e avaliação comportamental de crianças com retardo do desenvolvimento neuropsicomotor na situação odontológica, participantes da dinâmica de arte: análise comparativa / Levels of alpha-amylase, salivary cortisol and behavioral evaluation of children with neuro-psychomotor development retardation in the odontological situation, receiving art´s dynamics: comparative analysis

O objetivo desta pesquisa foi analisar os níveis de atividade da alfa-amilase, de cortisol salivar e avaliar o comportamento durante o tratamento odontológico, de pacientes portadores de retardo do desenvolvimento neuropsicomotor (rdnpm), participantes da dinâmica de arte, comparando seus valores segundo os procedimentos odontológicos realizados (cirurgia, dentística e prevenção), o gênero, a idade, estímulo artístico, odontopediatria e comportamento. Participaram 71 crianças, sendo 52 portadoras de rdnpm assistidos no Centro de Assistência Odontológica a Portadores de Necessidades Especiais (CAOE), e 19 crianças neurologicamente saudáveis, assistidas na clínica de Odontopediatria, da Faculdade de Odontologia de Araçatuba-FOA-UNESP; todos na faixa etária de 6 a 12 anos e de ambos os sexos. Os pacientes selecionados foram divididos em grupos, de acordo com a necessidade de tratamento odontológico (cirurgia, dentística, e prevenção). Esses mesmos pacientes foram analisados segundo o gênero (masculino e feminino) e a idade, agrupados em dois blocos, um de 6 a 9 anos e outro de 10 a 12 anos. Os níveis de alfa-amilase e cortisol salivar foram avaliados em 3 situações: inicialmente os pacientes foram calibrados por meio de análise de seus níveis habituais de cortisol e alfa amilase, através da coleta de saliva, no período da manhã, na situação SEST (sem estímulos odontológicos ou artísticos). Os mesmos pacientes foram atendidos nos consultórios, na situação TO, onde receberam tratamentos odontológicos e as coletas de saliva foram realizadas após as assistências, para se analisar os níveis de cortisol e alfa-amilase, sem a participação deles nas atividades do projeto da arte. Na situação EATO, os pacientes participaram das atividades da dinâmica da arte, previamente às assistências odontológicas e a coleta de saliva foi realizada após as atividades artísticas e a sessão odontológica. A avaliação do comportamento dos pacientes, foi verificada durante o tratamento...

The purpose of this study was to analyze the levels of alpha-amylase and salivary cortisol and to assess the behavior during dental treatment of patients with neuro-psychomotor development retardation (NPDR), who received art´s dynamics, comparing their values according to the accomplished dental procedures (surgery, dentistry and prevention), gender, age, artistic stimulus, pediatric dentistry and behavior. The study included 71 children aging from six to twelve years old, from both genders: 52 with NPDR assisted at the Dental Care Center for Patients with Special Needs (CAOE - Centro de Assistência Odontológica ao Excepcional, Araçatuba, São Paulo, Brazil), and 19 neurologically healthy children, assisted at the Pediatric Dentistry Clinic, both from Araçatuba School of Dentistry, UNESP. These patients were divided into groups, according to the dental treatment necessity (surgery group, dentistry group and preventive group), and analyzed according to gender (male or female) and age (grouped into two sub-groups: from 6 to 9 years old and from 10 to 12 years old). Alpha-amylase and salivary cortisol levels were evaluated in three situations. Initially, the patients were calibrated through the normal cortisol and alpha-amylase levels, in the morning, in the situation called WDAS (without dental treatment and without artistic stimulus). The same patients were attended at the Clinics, in the situation called DT (dental treatment), where they received dental treatments and, following, saliva collection, in order to analyze the levels of cortisol and alpha-amylase, without receiving activities from the arts project. In the situation called DTAS (with dental treatment and artistic stimulus), previously to the dental treatments, patients took part in art’s dynamics activities, and saliva collection was accomplished after the dental treatments. The behavioral evaluation was accomplished during the dental treatment and reported after the two situations: DT and DTAS…

Níveis de alfa-amilase, cortisol salivar e avaliação comportamental de crianças com retardo do desenvolvimento neuropsicomotor na situação odontológica, participantes da dinâmica de arte: análise comparativa / Levels of alpha-amylase, salivary cortisol and behavioral evaluation of children with neuro-psychomotor development retardation in the odontological situation, receiving art´s dynamics: comparative analysis

O objetivo desta pesquisa foi analisar os níveis de atividade da alfa-amilase, de cortisol salivar e avaliar o comportamento durante o tratamento odontológico, de pacientes portadores de retardo do desenvolvimento neuropsicomotor (rdnpm), participantes da dinâmica de arte, comparando seus valores segundo os procedimentos odontológicos realizados (cirurgia, dentística e prevenção), o gênero, a idade, estímulo artístico, odontopediatria e comportamento. Participaram 71 crianças, sendo 52 portadoras de rdnpm assistidos no Centro de Assistência Odontológica a Portadores de Necessidades Especiais (CAOE), e 19 crianças neurologicamente saudáveis, assistidas na clínica de Odontopediatria, da Faculdade de Odontologia de Araçatuba-FOA-UNESP; todos na faixa etária de 6 a 12 anos e de ambos os sexos. Os pacientes selecionados foram divididos em grupos, de acordo com a necessidade de tratamento odontológico (cirurgia, dentística, e prevenção). Esses mesmos pacientes foram analisados segundo o gênero (masculino e feminino) e a idade, agrupados em dois blocos, um de 6 a 9 anos e outro de 10 a 12 anos. Os níveis de alfa-amilase e cortisol salivar foram avaliados em 3 situações: inicialmente os pacientes foram calibrados por meio de análise de seus níveis habituais de cortisol e alfa amilase, através da coleta de saliva, no período da manhã, na situação SEST (sem estímulos odontológicos ou artísticos). Os mesmos pacientes foram atendidos nos consultórios, na situação TO, onde receberam tratamentos odontológicos e as coletas de saliva foram realizadas após as assistências, para se analisar os níveis de cortisol e alfa-amilase, sem a participação deles nas atividades do projeto da arte. Na situação EATO, os pacientes participaram das atividades da dinâmica da arte, previamente às assistências odontológicas e a coleta de saliva foi realizada após as atividades artísticas e a sessão odontológica. A avaliação do comportamento dos pacientes, foi verificada durante o tratamento...

The purpose of this study was to analyze the levels of alpha-amylase and salivary cortisol and to assess the behavior during dental treatment of patients with neuro-psychomotor development retardation (NPDR), who received art´s dynamics, comparing their values according to the accomplished dental procedures (surgery, dentistry and prevention), gender, age, artistic stimulus, pediatric dentistry and behavior. The study included 71 children aging from six to twelve years old, from both genders: 52 with NPDR assisted at the Dental Care Center for Patients with Special Needs (CAOE - Centro de Assistência Odontológica ao Excepcional, Araçatuba, São Paulo, Brazil), and 19 neurologically healthy children, assisted at the Pediatric Dentistry Clinic, both from Araçatuba School of Dentistry, UNESP. These patients were divided into groups, according to the dental treatment necessity (surgery group, dentistry group and preventive group), and analyzed according to gender (male or female) and age (grouped into two sub-groups: from 6 to 9 years old and from 10 to 12 years old). Alpha-amylase and salivary cortisol levels were evaluated in three situations. Initially, the patients were calibrated through the normal cortisol and alpha-amylase levels, in the morning, in the situation called WDAS (without dental treatment and without artistic stimulus). The same patients were attended at the Clinics, in the situation called DT (dental treatment), where they received dental treatments and, following, saliva collection, in order to analyze the levels of cortisol and alpha-amylase, without receiving activities from the arts project. In the situation called DTAS (with dental treatment and artistic stimulus), previously to the dental treatments, patients took part in art’s dynamics activities, and saliva collection was accomplished after the dental treatments. The behavioral evaluation was accomplished during the dental treatment and reported after the two situations: DT and DTAS…

EFFECT OF INDIVIDUAL FEEDBACK INFORMATION IN A CORRESPONDECE COURSE TYPE WALKING PROGRAM BASED ON BEHAVIORAL SCIENCE / 体力科学

The purpose of this study was to investigate the effect of individual feedback intervention (IFB) or general video intervention (GV) on promoting daily physical activity. One hundred and thirty-six community-dwelling people volunteered as subjects and participated in the 2-month walking program provided as a correspondence course. The subjects were randomly allocated to one of four groups, which consisted of either IFB or GV. Each of the groups was based on behavioral science. The stage of change in exercise, self-efficacy for exercise and daily physical activity were measured before and after intervention 4 months later during the follow-up period. There were statistically significant effects of both ‘time’ (F=3.71, p=0.026) and ‘time’בIFB’ (F=3.76, p=0.025) in self-efficacy for exercise; while there was no significant effect of interaction between ‘time’בGV’. As for daily physical activity, there was no significant effect of the interaction both of ‘time’בIFB’ and ‘time’בGV’. These results suggest the IFB of promoting self-efficacy for exercise.

A Family Case Study of the Family Medicine Clerkship at the University of Michigan / 医学教育

In the United States, the Family Case Study is a tool used in family medicine to teach students about clinical problems and the effects of illness on the patient and the family. Because the Family Case Study is not well known in Japan, the purpose of this paper was to introduce the Family Case Study on the basis of our experiences and to describe its implementation in the Department of Family Medicine of the University of Michigan Medical School. Although the Family Case Study must be adapted for Japan, we urge its use as a practical means of learning about family medicine and the concept of the biopsychosocial approach through practical learning experiences.

Survey on Behavioral Science Education in Korean Medical Schools and Development of a Standard Syllabus / 한국의학교육

OBJECTIVES: To survey the behavioral science education in Korean medical schools and to develop a standard syllabus for behavioral science course. SUBJECTS: Professors who are in charge of behavioral science course in 32 medical schools in 1996. METHODS: To develop a standard syllabus of behavioral science course for medical school Delphi technique was used. A questionnaire was mailed to each professor who was in charge of the behavioral science course in 32 medical schools to ask about the course objectives and contents and educational method in January 1996 and 27 questionnaires were completed and returned. The course objectives and syllabi of 27 medical schools were listed and mailed to the same professors to check his/her opinion on the necessity of each item for the behavioral science course. Twenty-three questionnaires were returned and analyzed. The opinion of 23 respondents on each objective and syllabus were listed again and mailed back to the respondents and asked to check if he/she agree with the other respondents' opinion. Nineteen questionnaires were collected. From this results a standard syllabus was developed. RESULTS: We recommend that educational objectives of behavioral science course for medical students include understanding of human behavior in biologic, psychologic and sociocultural contexts, understanding of the relationship between body and mind (stress and diseases), acquiring techniques for establishing doctor-patient relationship, and acquiring knowledge and skill for holistic approach to patient care. Recommendable syllabi for behavioral science course are medicine and behavioral science (basic principles of human behavior), body and mind, growth and development, family and health, medical care and society and culture, illness behavior, physician's identity, doctor-patient relationship, communication (clinical interview), and psychologic aspects of human behavior. We recommend that the behavioral science course be offered in the first and second grades of medical students, be integrated into the medical curriculum to link better with clinical courses. Duration of course needs to be expanded from 25.2 hours on the average at present to at least 48 hours. To improve the effectiveness of behavioral science education, it is necessary to develop various teaching methods such as small group discussion, panel discussion, case study, role play and clinical practicum. It is recommended that behavioral science be taught by a team consisted of behavioral scientists and physicians with behavioral science background including psychiatrists instead of by psychiatrist alone.