Scale Development for "Great Research Mentors" and Its Relationship to Mentees' Psychological Burnout in Young Physician Researchers.

Fostering the research skills of young physician scientists is essential to increase the level of medical research in Japan. We aimed to clarify the mentor characteristics associated with a decreased risk of mentees' psychological burnout. A task team comprising medical doctors, researchers, nurses, and other healthcare professionals developed 35 items related to the characteristics of research mentors. In 2015, we recruited 258 physician researchers who were awarded a new Grant-in-Aid for Young Scientists between 2014-2015 and asked them to score 35 items on a five-point Likert scale. We developed a large research mentor scale using factor analysis and investigated which characteristics (i.e., domains) of the developed scale would be associated with a decreased level of psychological burnout measured by the Copenhagen Burnout Inventory. Maximum likelihood factor analysis with varimax rotation found three domains with 16 items. The three domains were labeled "Building a good trust relationship" (6 items, Cronbach's alpha = 0.889), "Mentorship in research" (6 items, alpha = 0.853), and "Established and authorized mentor" (3 items, alpha = 0.882). Multivariate linear regression models demonstrated that "Mentorship in research" was inversely associated with personal burnout (PBO) (beta = -6.25, p = 0.014) and work-related burnout (WBO) (beta = -4.76, p = 0.029); and "Building a good trust relationship" was inversely associated with client-related burnout (CBO) (beta = -4.91, p = 0.014). A great research mentor may be encouraged to have mentorship in research and a trusting relationship with mentees for mental health support.

Pharmacologic Management of Excessive Daytime Sleepiness.

Excessive daytime sleepiness (EDS) is defined as "irresistible sleepiness in a situation when an individual would be expected to be awake, and alert." EDS has been a big concern not only from a medical but also from a public health point of view. Patients with EDS have the possibility of falling asleep even when they should wake up and concentrate, for example, when they drive, play sports, or walk outside. In this article, clinical characteristics of common hypersomnia and pharmacologic treatments of each hypersomnia are described.

Genetic and demographic predisposing factors associated with pediatric sleepwalking in the Philadelphia Neurodevelopmental Cohort.

OBJECTIVES: Sleepwalking is a parasomnia associated with non-rapid eye movement (NREM) sleep and is formally diagnosed using polysomnography (PSG). However, PSG are difficult to perform on children or adolescents due to needed compliance. To understand this condition in youth, few studies have been conducted on a large cohort of youths with a diverse distribution of ages and races to characterize it better in the absence of PSG. The present study aimed to evaluate the prevalence of sleepwalking in youth, as well as associated demographic and genetic characteristics, using questionnaires in a large pediatric cohort. METHODS: Data from the Philadelphia Neurodevelopmental Cohort (PNC) of 7515 youths aged between 8 and 22 years were used in analyses. Demographic and clinical data, including age, sex, and race, and genetic data from 2753 African American (AA) and 4762 European American (EA) subjects were investigated. The age-wise prevalence of sleepwalking in AA and EA subjects was evaluated. Finally, race-specific genome-wide association (GWAS) analyses of sleepwalking were also performed (N = 155 AA cases and 2598 AA controls; N = 512 EA cases and 4250 EA controls). RESULTS: Lifetime history of sleepwalking correlated with male sex and EA race. A genetic risk locus that reached genome-wide significance was detected at rs73450744 on chromosome 18 in AA, but not EA youth. CONCLUSION: The present results suggest that male sex, EA race, and genetic factors may be associated with higher rates of sleepwalking among youth. Future studies should consider these variables to advance understanding of the complex pathogenesis of sleepwalking.

Experiences of Negotiations for Improving Research Environment and Burnout among Young Physician Researchers in Japan.

Physician scientists in Japan are often too busy to be sufficiently involved in research work. This cross-sectional study aimed to investigate their experiences negotiating with their superiors to improve their research environment and determine its relationship with psychological burnout. Among 1790 physician awardees of Grants-in-Aid for Young Scientists in 2014-2015, 490 responded (response rate 27.4%) and 408 were eligible for analysis. Outcome measures included two negotiation experiences: for reduction of clinical duty hours/promotion opportunities and for increased space or equipment/increased research budget. The main explanatory variables were personal, patient-related, and work-related burnout measured by the Copenhagen Burnout Inventory. The percentages of the above-mentioned two types of negotiations were 20-24% in women and 17-20% in men. Multivariable stepwise logistic regression analyses demonstrated that (1) the negotiation for reduction of clinical duty hours/promotion opportunities was significantly associated with physician scientists who had a short amount of weekly research time and high patient-related burnout score, and (2) the negotiation for increased space or equipment/increased research budget was significantly associated with older age, single status, and high personal and patient-related burnout scores. High burnout is related to negotiation experiences among physician researchers in Japan.

Workplace resources, mentorship, and burnout in early career physician-scientists: a cross sectional study in Japan.

BACKGROUND: Physician-scientists are a vital segment of the healthcare workforce, but they may face significant challenges balancing and integrating clinical responsibilities, scientific research, and domestic responsibilities. This study investigates factors associated with burnout among highly successful early career physician-researchers in Japan. METHOD: Among 1790 physician awardees of Grant-in-Aid for Young Scientists by the Japanese Ministry in 2014-2015, 490 participated in this cross-sectional survey in 2016 (usable response rate 23.8%). The primary outcome was psychological burnout, measured by the Copenhagen Burnout Inventory (i.e., personal burnout, work-related burnout, and patient-related burnout). "Workplace resources" in our study refers to the presence of career education in the workplace, promotion of gender equity, well-being consultation services on "career and work," "research," "harassment," and/or "mental health," as well as the presence of a role model in the workplace who has perceived good work-life balance. RESULTS: Among 408 physician-researchers (75% male, mean age 37 yrs), personal burnout scores were slightly higher in women than in men (mean score, 41.9 points vs. 36.7 points, difference, 5.2, 95% confidence interval, 0.5-9.9, p = 0.029), but work-related and patient-related burnout scores did not differ significantly between genders. Over half of women (64%) and men (58%) had a mentor (p = 0.374). In multivariable general linear regression models, personal burnout scores were higher for women (ß = 4.98, p = 0.045), and lower among those who had a mentor (ß = - 5.82, p = 0.010) and whose workplaces had well-being consultation services (ß = - 0.79, p = 0.022). Work-related burnout scores were lower among those with larger amounts of grant funding (ß = - 4.70, p = 0.013), a mentor (ß = - 6.12, p = 0.002), well-being consultation services (ß = - 0.78, p = 0.008) and a role model with a perceived good work-life balance (ß = - 4.00, p = 0.038). Patient-related burnout scores were higher among physician-scientists aged older than 37 years (ß = 6.25, p = 0.002) and those who had board certification (ß = 9.01, p = 0.017), while these scores were lower among those had larger amounts of funding (ß = - 5.01, p = 0.006) or a mentor (ß = - 5.35, p = 0.006). CONCLUSIONS: Workplace resources and mentorship appear to be associated with lower levels of psychological burnout for both men and women early career physician-scientists.

Pharmacologic Management of Excessive Daytime Sleepiness.

Excessive daytime sleepiness (EDS) is related to medical and social problems, including mental disorders, physical diseases, poor quality of life, and so forth. According to the International Classification of Sleep Disorders, Third Edition, diseases that result from EDS are narcolepsy type 1, narcolepsy type 2, idiopathic hypersomnia, hypersomnia due to a medical disorder, and others. EDS is usually treated using amphetamine-like central nervous system stimulants or modafinil and its R-enantiomer, armodafinil, wake-promoting compounds unrelated to amphetamines; a variety of new drugs are under development. The side effects of some stimulants are potent and careful selection and management are required.

[Scale Development on Perception of Academic Harassment among Medical University Faculties].

OBJECTIVES: In academia, harassment may often occur and remain unrevealed in Japan, which discourages young researchers from pursuing their career. It is necessary to estimate and improve the perception of "academic harassment" among university faculties. Therefore, in this study, we aim to develop a scale of perception of academic harassment. METHODS: Prior to a quantitative survey, a task team consisting of medical doctors, researchers, nurses, hospital workers, and managers in general affairs division identified 36 items related to academic harassment. In February 2016, we sent a self-administered questionnaire to 1,126 academic faculty members who worked in a medical university located in Tokyo, Japan. We instructed them to score the extent to which they consider each item as related to academic harassment based on a Likert scale. We carried out maximum likelihood factor analyses with promax rotation and computed Cronbach's alpha to develop a scale and investigate the reliability of the scale. RESULTS: In total, 377 returned the questionnaires (response rate, 33.5%; male, 73.8%). In factor analyses, we removed 17 items owing to low factor loadings, and four factors were eventually extracted. The first factor was termed "Harassment in organization (7 items)" because it included conditions of forcing a particular person to work on chores or lectures for students that may prevent one's academic research outputs. The second factor was termed "Violence and denying personal character (4 items)". The third factor was termed "Research misconduct (5 items)" including conditions of excluding a particular person from the coauthor list of research outputs or pressuring a person to fabricate, falsify, or plagiarize research outputs. The fourth factor was termed "Research interference (3 items)" including a condition of interference with conference attendance. Cronbach's alpha values of these four factors ranged from 0.83 to 0.91, suggesting that the scale had high reliability. The means of these factors did not differ according to gender but were higher in participants aged 50 or older than in younger participants. CONCLUSIONS: The results suggest that the scale of perception on academic harassment consisting of four factors with 19 items is valid and reliable to some extent.

[Association between Job Stress and Number of Physical Symptoms among Female Nurses of Medical-university-affiliated Hospitals].

OBJECTIVES: To clarify the association between job stress and the number of physical symptoms among newly certified female nurses. METHODS: In this cross-sectional self-administered survey, we investigated 313 female nurses working at three medical-university-affiliated hospitals in February 2016. We investigated working conditions including numbers of working and on-call hours, work-life balance, Job Content Questionnaire (JCQ) scores, and 16 physical symptoms perceived more often than once a week. RESULTS: Among the 313 participants (mean age, 31.9), 57% were aged 21-29 years and 70% were single. Of the 16 physical symptoms investigated, fatigability was the most frequent complaint (66.1%), followed by lower back pain (44.7%). Univariate analysis showed that significant factors related to physical symptoms are job demands (p<0.001) and social support (p<0.001) in JCQ, binary index of supports (p<0.001), and total working hours per day (p =0.025). Multivariable-adjusted logistic regression analyses demonstrated that the likelihood of reporting a greater number (n≥3) of physical symptoms increased by 7% [95% confidence interval (CI), 2-13%] with a one-unit increase in job demand degree, and decreased by 16% (95% CI, 10-22%) in social support degree. When binary JCQ indexes were assessed, the high-support group [odds ratio (OR) 0.36; 95% CI, 0.23-0.59] was protectively associated with a greater number of physical symptoms while long working hours was significantly associated with a higher risk (OR 18%, 95% CI, 1-38%). CONCLUSIONS: Reporting a greater number of physical symptoms may be a good indicator of job stress perceived by a nurse in a university hospital setting.

An overview of hypocretin based therapy in narcolepsy.

INTRODUCTION: Narcolepsy with cataplexy is most commonly caused by a loss of hypocretin/orexin peptide-producing neurons in the hypothalamus (i.e., Narcolepsy Type 1). Since hypocretin deficiency is assumed to be the main cause of narcoleptic symptoms, hypocretin replacement will be the most essential treatment for narcolepsy. Unfortunately, this option is still not available clinically. There are many potential approaches to replace hypocretin in the brain for narcolepsy such as intranasal administration of hypocretin peptides, developing small molecule hypocretin receptor agonists, hypocretin neuronal transplantation, transforming hypocretin stem cells into hypothalamic neurons, and hypocretin gene therapy. Together with these options, immunotherapy treatments to prevent hypocretin neuronal death should also be developed. AREAS COVERED: In this review, we overview the pathophysiology of narcolepsy and the current and emerging treatments of narcolepsy especially focusing on hypocretin receptor based treatments. EXPERT OPINION: Among hypocretin replacement strategies, developing non-peptide hypocretin receptor agonists is currently the most encouraging since systemic administration of a newly synthesized, selective hypocretin receptor 2 agonist (YNT-185) has been shown to ameliorate symptoms of narcolepsy in murine models. If this option is effective in humans, hypocretin cell transplants or gene therapy technology may become realistic in the future.

Effects of gaps in priorities between ideal and real lives on psychological burnout among academic faculty members at a medical university in Japan: a cross-sectional study.

BACKGROUND: Accumulating evidence from medical workforce research indicates that poor work/life balance and increased work/home conflict induce psychological distress. In this study we aim to examine the existence of a priority gap between ideal and real lives, and its association with psychological burnout among academic professionals. METHODS: This cross-sectional survey, conducted in 2014, included faculty members (228 men, 102 women) at a single medical university in Tokyo, Japan. The outcome of interest was psychological burnout, measured with a validated inventory. Discordance between ideal- and real-life priorities, based on participants' responses (work, family, individual life, combinations thereof), was defined as a priority gap. RESULTS: The majority (64%) of participants chose "work" as the greatest priority in real life, but only 28% chose "work" as the greatest priority in their conception of an ideal life. Priority gaps were identified in 59.5% of respondents. A stepwise multivariable general linear model demonstrated that burnout scores were associated positively with respondents' current position (P < 0.0018) and the presence of a priority gap (P < 0.0001), and negatively with the presence of social support (P < 0.0001). Among participants reporting priority gaps, burnout scores were significantly lower in those with children than in those with no children (P interaction = 0.011); no such trend was observed in participants with no priority gap. CONCLUSIONS: A gap in priorities between an ideal and real life was associated with an increased risk of burnout, and the presence of children, which is a type of "family" social support, had a mitigating effect on burnout among those reporting priority gaps.

A relationship between a level of hemoglobin after delivery and exclusive breastfeeding initiation at a baby friendly hospital in Japan.

BACKGROUND: The recent National Nutrition Survey of 2013 demonstrated that 16.7% of women in childbearing age are underweight, and 5.0-10.0% of these women manifested a Hemoglobin (Hb) level less than 11.0 g/dl. The purpose of this study was to investigate if such maternal nutritional status affects success of exclusive breastfeeding (EBF) practice. METHODS: This cross-sectional study investigated 1532 dyads of mothers and infants with full-term singleton pregnancies delivered during 2011 at a perinatal center in Tokyo. Outcome is EBF initiation defined as the successful practice at discharge and 1 month after discharge. A logistic regression model was applied to investigate the impact of Hb levels (<9.0, 9.0-10.9, and ≥11.0 g/dl) measured within 2-3 days after delivery on successful EBF initiation adjusting for covariates including bleeding at delivery. RESULTS: Mean age was 34 years, 23.0% were underweight and 63.0% were nulliparous. The success rate for EBF initiation at discharge and at 1 month after discharge was 72.7 and 63.0% for a Hb level <9.0 g/dl, 81.9 and 68.9% for a Hb level of 9.0-10.9 g/dl, and 85.7 and 75.9% for a Hb level ≥11.0 g/dl, respectively. A logistic regression model showed that risk factors of unsuccessful EBF practice at discharge and 1 month after discharge included lower level Hb categories (P < 0.001 and P < 0.001), postpartum hemorrhage > 500 ml (P = 0.089 and P = 0.011), maternal age (P < 0.001 and P < 0.001), nulliparity (P < 0.0001 and P < 0.001), pregnancy-induced hypertension (P = 0.002 and P = 0.012), gestational week (P = 0.006 and P = 0.002), Low Birth Weight (LBW) (P < 0.001 and P < 0.001), and immediate separation (P < 0.001 and P = 0.020). After adjusting for the covariates, compared with a Hb level ≥11.0 g/dl, a Hb level <9.0 g/dl was significantly associated with unsuccessful EBF initiation at discharge [odds ratio (OR): 2.15; 95% confidence interval (CI): 1.37-3.39] and at 1 month after discharge (OR: 1.63; 95% CI: 1.10-2.42), and a Hb level of 9.0-10.9 g/dl also was significant at 1 month after discharge (OR: 1.35; 95% CI: 1.04-1.75). Pre-pregnancy underweight was not associated with success of EBF practice both at hospital discharge and 1 month after discharge. CONCLUSION: Maternal severe anemia after delivery was associated with the risk of unsuccessful initiation of EBF even after adjusting for bleeding at delivery, suggesting the importance of dietary management especially in the later trimester.

Pharmacologic Management of Excessive Daytime Sleepiness.

Excessive daytime sleepiness (EDS) is related to medical and social problems, including mental disorders, physical diseases, poor quality of life, and so forth. According to the International Classification of Sleep Disorders, Third Edition, diseases that result from EDS are narcolepsy type 1, narcolepsy type 2, idiopathic hypersomnia, hypersomnia due to a medical disorder, and others. EDS is usually treated using amphetamine-like central nervous system stimulants or modafinil and its R-enantiomer, armodafinil, wake-promoting compounds unrelated to amphetamines; a variety of new drugs are under development. The side effects of some stimulants are potent and careful selection and management are required.

Investigation of optimal weight gain during pregnancy for Japanese Women.

This study aims to compare the US Institute of Medicine (IOM) and Japanese guidelines proposed by the Ministry and the Japan Society for the Study of Obesity on gestational weight gain (GWG), and to explore the optimal GWG range in Japanese women. We investigated 8,152 Japanese women who had full-term singleton babies between 2010 and 2013 at a single center in Tokyo. Logistic regression models showed that GWG below the recommendation of the IOM and Japanese guidelines was similarly associated with an increased risk of light-for-date (LFD), whereas GWG above these guidelines was similarly associated with an increased risk of heavy-for-date (HFD) in pre-pregnancy body mass index categories of underweight (<18.5 kg/m2, n = 1559), normal-weight (18.5-24.9 kg/m2, n = 4998), overweight (25.0-29.9 kg/m2, n = 270), and obese (30 ≤ kg/m2, n = 60). The receiver-operating characteristic curve demonstrated that the optimal cutoffs for LFD and HFD were 9.7 and 10.4 kg, respectively in normal-weight mothers. The IOM and Japanese guidelines identified the risk of LFD or HFD equally well. The optimal GWG range in normal-weight women observed in this study was more close to Japanese guideline (i.e., 7-12 kg) compared to the IOM guideline (i.e., 11.5-16 kg).

Organizational climate with gender equity and burnout among university academics in Japan.

We investigated relationships between the perception of organizational climate with gender equity and psychological health among 94 women and 211 men in a Japanese private university in 2015 using the Copenhagen Burnout Inventory (i.e., personal, work-related and student-related burnout). Perceptions of organizational climate with respect to gender equity were measured with two scales including organizational engagement with a gender equal society in the workplace (consisting of three domains of 'Women utilization', 'Organizational promotion of gender equal society' and 'Consultation service'); and a gender inequality in academia scale that had been previously developed. Multivariable linear models demonstrated significant statistical interactions between gender and perceptions of organizational climate; 'Women utilization' or lack of 'Inequality in academia' alleviated burnout only in women. In consequence of this gender difference, when 'Women utilization' was at a lower level, both personal (p=.038) and work-related (p=.010) burnout scores were higher in women, and the student-related burnout score was lower in women when they perceived less inequality in academia than in men (p=.030). As such, it is suggested organizational fairness for gender equity may be a useful tool to help mitigate psychological burnout among women in academia.

Having a Mentor or a Doctoral Degree Is Helpful for Mid-Career Physicians to Publish Papers in Peer-Reviewed Journals.

The evidence suggests that mentoring is one of useful teaching methods in academic medicine but it is not clear for which outcome mentoring is effective. In this study, the authors investigated the number of original research articles that the participants had published in peer-reviewed English-language journals (as a first or a corresponding author) within one year prior to investigation and what characteristics of the participants who published at least one paper would be like compared to those who did not. In March 2015, the authors recruit early- and mid-career Japanese physicians (238 men and 240 women; mean age 40.6 years old) in a web survey. In total, 23.9% of physicians had published at least one original research article as a first author, 10.0% had published as a corresponding author, and 23.4% had a research mentor. A multivariate logistic regression model adjusting for variables selected at p < 0.15 in univariable models showed that even after adjusting for their motivation levels for clinical research, physicians with a research mentor [odds ratio (OR) 6.68; 95% confidence interval (CI), 3.74-11.93], physicians who obtained DMSc, roughly equivalent to PhD in the West (OR, 2.17; 95% CI, 1.26-3.72), and physicians who worked at teaching hospitals (OR 6.39; 95% CI, 2.54-16.04) were more likely to publish an original paper in a peer-reviewed journal. Having a research mentor or DMSc is associated with an experience of successfully publishing original papers in peer-reviewed journals for young and mid-career physician-researchers.

Combination of parity and pre-pregnancy BMI and low birth weight infants among Japanese women of reproductive age.

This study aimed to examine the effects of parity and pre-pregnancy body mass index (BMI) on low birth weight (LBW) infants among Japanese women. Participants included 1,518 mothers (mean age 34.0 years) of singleton full-term infants in 2011. The incidence of LBW infants was 7.5% in primiparous women with BMI<18.5 (Group A; n=239), 4.0% in multiparous women with BMI<18.5 (Group B; n=124), 6.0% in primiparous women with 18.5≤BMI<25 (Group C; n=715), and 1.8% in multiparous women with 18.5≤BMI<25 (Group D; n=440). A multivariable logistic regression model revealed that mothers in Group A were more likely to deliver a LBW infant [odds ratio (OR) 6.41, 95% confidence interval (CI), 2.65-15.49] than were mothers in Group D. Being both underweight (OR 1.8, 95% CI: 1.05-3.11) and primiparous (OR 3.41, 95% CI: 1.82-6.44) were independently associated with LBW infants. This study demonstrated that the characteristics of primiparous and underweight in mothers are additively associated with LBW infants.