Investigating the perceptions of career development as the Japanese regional quota medical students and graduates in A prefecture.

Background: There are few reports about the perceptions of the regional quota called Chiikiwaku medical students and graduates. Method: Eighty-four medical students and 41 graduates were enrolled in A prefecture. The questionnaire comprised 22 items scored on a 7-point Likert scale, focusing on perceptions of merit and demerit of Chiikiwaku. The data were collected online. Results: Chiikiwaku students scored higher on an item such as 'regional quotas are a solution to the doctor shortage'. Chiikiwaku graduates felt more burdened than Chiikiwaku students. Conclusion: Our results suggested that the perception of Chiikiwaku was different between Chiikiwaku students and graduates.

The present circumstances of pediatric practice by family physicians in Japan: Cross sectional research.

Background: In Japan, pediatric primary care has often been provided not by general practitioners, but by specialists. Although official pediatric training of general practitioners started in Japan in 2018 no studies to date show the extent to which Japanese general practitioners are committed to pediatric care. Methods: We conducted a questionnaire survey on pediatric training and current pediatric practice for family physicians certified by the Japan Primary Care Association. Results: Of 1067 Japan Primary Care Association certified family physicians, 288 (27%) responded to the survey. More than 90% had received at least 3 months of pediatric training. Family physicians who completed 6 or more months of pediatric training provided significantly more pediatric care (p = 0.005). However, nearly 40% were currently not involved in pediatric care. Japan Primary Care Association certified family physicians are treating acute and chronic common diseases as well as diseases that may intersect with other departments. However, most respondents indicated there are not many opportunities to learn systematically about the care of these diseases. Conclusions: In Japan, general practitioners are still not actively involved in pediatric care, but they treat patients with diseases that make it difficult to determine the most appropriate department to see and a wide range of age groups. It will become increasingly important to provide learning opportunities and better training environments in these areas with related organizations.

Impact of a national screening programme on obesity and cardiovascular risk factors.

AIMS: The benefits of nationwide screening and tailored health guidance on improving obesity and cardiovascular risk factors is uncertain. The aim of the present study was to investigate the association of the national health screening and tailored health guidance with population health outcomes. METHODS AND RESULTS: A fuzzy regression discontinuity design analysed data of men and women aged 40-74 years who participated in a nationwide health screening programme in Japan from 1 April 2008 to 31 March 2019 and were recorded in the Japanese National Database. Exposure was assignment to the national health guidance of counselling on healthy lifestyle and clinical follow-up for individuals found to have waist circumference ≥85 cm for men ≥90 cm for women with one or more cardiovascular risk factors during annual national health screening. The primary outcomes were changes in obesity status and cardiovascular risk factors 1 year after screening. Of 3 490 112 men and 2 328 929 women, the assignment to the health guidance resulted in small reductions in obesity parameters: waist circumference; men, -0.27 cm [95% confidence interval (CI) -0.29 to -0.26]; women -0.34 (-0.41 to -0.27); body mass index, -0.07 kg/m2 (-0.075 to -0.066); -0.11 kg/m2 (-0.13 to -0.10); weight, -0.21 kg (-0.22 to -0.19); -0.28 kg (-0.32 to -0.24) that attenuated over time. Short-term improvements were also observed in blood pressure, haemoglobin A1c, fasting glucose and triglycerides across both sexes. CONCLUSION: A nationwide health screening programme was associated with only small, and transient improvements in obesity and cardiovascular risk factors.

In this national cohort of 5 819 041 men and women in Japan, we provide robust evidence that nationwide assignment to the health guidance resulted in only a small reduction in obesity parameters in men and women which was lost within only a few years. Exposure to the health guidance also failed to lead to long-term changes in cardiovascular risk factors and lifestyle behaviours. Japan is the only country with large populace across the globe that provides the annual prevention programme, and thus this study renders unique results of international importance.

Investigating women's health issues and help-seeking intentions in primary care in Japan: a cross-sectional study.

BACKGROUND: Many women face a variety of barriers to seeing obstetricians and gynecologists (OB/GYNs). Primary care physicians (PCPs) in Japan are not well equipped to address and adequately handle women's health issues. Hence, opportunities for women to consult PCPs about women's health issues are often limited during busy outpatient encounters. It is essential to explore PCP's roles in women's health care by examining women's health needs in a primary care setting. The aim of the study is to describe the prevalence and distribution of women's health issues and help-seeking intentions among women visiting a primary care clinic. METHODS: This was a cross-sectional study using a questionnaire. We included women aged 20-60 years who visited a primary care clinic for any reason. The questionnaire comprised a list of women's health issues, the General Help Seeking Questionnaire to assess help-seeking intentions, and participants' demographics including their reasons for visiting and regularity of OB/GYN visits. RESULTS: We distributed the questionnaire to 294 women and analyzed 260 valid responses. The average age of the respondents was 40.5 years old, and they had an average of 5.2 clinic visits a year. Approximately half of them (50.4%) visited for their own care. One hundred thirty-nine (53.9%) reported at least one women's health issue, and 73.9% of them had no regular visit to an OB/GYN. The major concerns of women's health issues included gynecological cancer screenings and menstrual problems. The distribution of help-seeking intentions for each source of care appeared to be classified into three patterns. One fifth of the women indicated high help-seeking intentions for PCPs, and a greater number of women expressed higher help-seeking intentions for PCPs when they did not regularly see an OB/GYN. CONCLUSIONS: A significant number of women who visited a primary care clinic had a specific concern about women's health issues, and a majority of them had not regularly visited their OB/GYN. PCPs may have an important role in providing an opportunity for women to discuss their concerns about women's health issues as part of comprehensive care during a daily clinical encounter.

Effect of Daily Multidisciplinary Team Reflection in Ambulatory Care: A Qualitative Analysis.

PURPOSE: Research suggests that daily previsit team huddling leads to improved teamwork, however there are no reports on the effect and mechanism of daily team reflection in primary care practice. To help healthcare professionals to integrate fragmented information and to enhance continuity, we previously developed and implemented a daily multidisciplinary team reflection (DMDTR) approach. The present study aimed to construct a conceptual diagram illustrating how participation in DMDTR influence medical care in an ambulatory clinic. PARTICIPANTS AND METHODS: In this qualitative study, we analyzed data from semi-structured interviews (n = 12) conducted with physicians, nurses, and medical assistants who regularly participated in DMDTR. Modified grounded theory approach (M-GTA) was adopted as the analysis method, and structure-construction qualitative research method (SCQRM) was used as a meta-theory to determine the number of cases correlatively with the research objectives. RESULTS: Our conceptual diagram demonstrated that, through DMDTR, team members shared fragmented information to gain a more holistic view of the patient and discuss diverse points of view, a process that resulted in real-time problem solving through collaboration. This team approach showed benefit to each discipline and improves the care attributes of contextuality, coordination, accessibility, accountability, continuity, and comprehensiveness of care. CONCLUSION: We generated a conceptual diagram showing that DMDTR embodies a team approach that leads to improved care attributes, which results in enhanced quality of primary care.

Overdiagnosis or not? 2017 ACC/AHA high blood pressure clinical practice guideline: Consequences of intellectual conflict of interest.

American Heart Association/the American College of Cardiology and nine other professional organizations have issued a new hypertension clinical practice guideline (CPG) on November 2017, which has lowered the hypertension threshold to 130/80 mmHg. American Academy of Family Medicine has decided to not endorse this new CPG for various reasons including flaws in CPG development process and a limited additional benefit for lower treatment targets. The major concern was intellectual conflict of interest (COI). Substantial weight was given to SPRINT trial, which provided the basis for the recommended change in blood pressure targets. It is a serious intellectual COI that the Chair of the SPRINT trial steering committee was commissioned as chair of the guideline panel. The new threshold would lead to 46 percent of the U.S. adult population being categorized as having hypertension, while using the previous threshold that figure would be 32 percent. Should we call this change as overdiagnosis?

Prenatal group visit program for a population with limited English proficiency.

INTRODUCTION: The declining number of family physicians providing pregnancy care is of concern because they are an important source of pregnancy care in underserved communities. Innovative approaches might reinforce family physician participation in pregnancy care for the underserved. Since group prenatal visits have been shown to improve patient education, support, and satisfaction, we implemented and evaluated a group prenatal visit program for Japanese women in Michigan, an underserved population because of their limited proficiency with English. METHODS: We conducted a convergent quantitative and qualitative mixed methods evaluation involving repeated survey administration (program evaluations, 4-item Patient Health Questionnaire, pregnancy distress questionnaire) to participants during 5 group visits and in-depth postpartum interviews in the University of Michigan Japanese Family Health Program setting. We conducted independent quantitative and qualitative analytics and then thematically integrated these data. RESULTS: Cultural adaptations to the Centering Pregnancy format involved changes in total visits, educational content, and participation format. Based on 5 groups attending 5 sessions each, 42 women evaluated the program through 158 surveys after the sessions. Participants evaluated multiple parameters positively: being with other pregnant women (98%), improving their understanding about prenatal care (96%), preparation for labor and delivery (96%), organization of visits (94%), and preparation for newborn care (85%). In final evaluations, 96% to 100% of participants rated 7 educational topics as "covered" or "covered well." Qualitative interviews with 20 women revealed positive views of social support from prenatal group visits and group facilitation but mixed enthusiasm for clinical assessments in the prenatal group visit setting and partner and children attendance at the sessions. CONCLUSIONS: This research demonstrates the feasibility and cultural acceptability of prenatal group visits for Japanese women. Prenatal group visits provided education and social support for Japanese women during the perinatal and postpartum periods that were not otherwise accessible in Japanese. This study confirms the feasibility of family physicians providing prenatal group visits and extends the literature of the applicability of prenatal group visits for patients with limited English skills.

The prevalence of antimicrobial-resistant Escherichia coli in two species of invasive alien mammals in Japan.

The prevalence of antimicrobial resistance in 128 Escherichia coli isolates was investigated in two species of invasive alien mammals (IAMs): the small Asian mongoose (SAM) and Japanese weasel (JW). The SAM is found on the main island of Okinawa, Japan, where a large number of livestock is available, and the JW is present on a small island, where is isolated from the main island, and have a small number of livestock. We focused on the two IAMs, inhabiting under the different environments, and compared their prevalence of antimicrobial-resistant E. coli. In the comparison of the frequencies of antimicrobial-resistant E. coli isolates between the SAM and JW, JW showed significantly higher prevalence of resistance against three drugs, ampicillin, chlortetracycline and nalidixic acid, compared with SAM's test results (P<0.05). The bla(TEM) gene and the aph1 gene were detected in 35 subjects (91%) of ampicillin-resistant isolates and 6 subjects (100%) of kanamycin-resistant isolates, respectively. The tet (A) gene was detected in 62 subjects (46%) of CTC-resistant isolates, and the tet (B) gene was detected in 25 subjects (8%) of those in IAM. The present results suggest that some IAMs were the carrier of antimicrobial-resistant bacteria and their genes, and the frequencies of these resistances were different between two IAM species.

Attitudes of Japanese primary care physicians toward publicly endorsed periodic health examinations: a cross sectional survey.

BACKGROUND: Despite the lack of evidence for efficacy, an annual health examination has been advocated for the general population by the Japanese government. We conducted a cross-sectional survey to understand the attitudes of Japanese physicians toward the annual examinations. METHODS: In October 2003, a questionnaire was mailed to 1971 physicians registered with Aichi Prefecture Medical Association as internists. The survey was designed to determine their opinions about the effectiveness of the periodic health examination and each of its components. RESULTS: The response rate was 37%. Eighty-five percent believed that a periodic health examination was effective. Nearly 80% believed that height and weight should be measured, and more than 90% supported blood pressure measurements. Nearly 70% supported a physical examination of chest and abdomen. About half believed that vision and hearing tests should be performed for all ages. More than 90% considered performing a variety of laboratory tests valuable. Three-quarters supported hepatitis B surface antigen and hepatitis C antibody determinations. Seventy to eighty percent valued the screening tests for lung, stomach, colon, breast and cervical cancer. CONCLUSIONS: Most Japanese primary care physicians believe that a comprehensive annual health examination as currently endorsed by public health authorities is effective.