Agricultural workers in a cohort of middle-aged Japanese women showed better health status than did women with other occupations / Journal of Rural Medicine

Objective: This study investigated the relationship between occupations and health status to obtain an overall understanding of a cohort of Japanese middle-aged women, including unemployed women, who comprised approximately 30% of the sample.Participants and Methods: Participants of this study were 4,454 women aged 40–69 years, classified into the following five groups based on their occupation: unemployed, 1,432; agriculture, 439; self-employed, 1,596; white collared, 793; and blue collared, 194. Participants’ perceived health was assessed using a symptoms checklist called the Todai Health Index (THI, later renamed as the Total Health Index) in a baseline survey conducted in 1993. The mortality risk of the participants was assessed using the Cox’s Proportional Hazards Model.Results: The means of the percentile values on the Total Scale 1 in the THI were as follows: agriculture, 43.7; unemployed, 50.8; self-employed, 52.5; white collared, 53.0; and blue collared, 56.1, with lower percentile values indicating better perceived health. The results showed that women engaged in agriculture were in significantly better health than were those in the other four occupations. The hazard ratios (HRs) and 95% confidence intervals of the occupational groups adjusted for age, area of residence, and Total Scale 1 scores were as follows: agriculture (reference group), 1; white collared, 1.16 (0.77–1.74); self-employed, 1.25 (0.87–1.78); unemployed, 1.27 (0.91–1.77); and blue collared, 1.50 (0.86–2.60).Conclusions: Women engaged in agriculture had a significantly higher tendency to have a better health status on the THI as compared to those from the other four occupational groups, and they exhibited the lowest HR as compared to their counterparts, though not statistically significant. We concluded that the perceived health status of unemployed women was similar to that of women engaged in agriculture.

Alendronate and Raloxifene Therapy in the Early Period after Hip Fracture / Journal of Rural Medicine

Objective: The purpose of the present study was to clarify the efficacy of alendronate and raloxifene for preventing bone loss in patients with hip fracture by monitoring bone mineral densities (BMDs) and biochemical markers during the 9-month period after fracture. Patients and Methods: Eighty-two female hip fracture patients from 50 to 99 years old (mean ± SD: 81.6 ± 9.5) were randomly divided into two groups; there were 46 patients in the alendronate-treated group (group ALN) and 36 patients in the raloxifene-treated group (group RLX). Drugs were administered to patients six weeks after their operations. Lumbar spine BMD and neck, trochanter, Ward's and total BMDs of the contralateral proximal femur, serum intact osteocalcin (intact OC), bone-specific alkaline phosphatase (BAP) and urinary N-terminal telopeptide of type I collagen (NTX) were measured just before the start of drug administration and at 9 months thereafter. Results: Twenty-two out of 46 patients in group ALN and 23 out of 36 patients in group RLX completed the study. The most common reason for dropping out was the patient's failure to visit the outpatient clinic. Trochanter BMD in group ALN tended to increase by 8.4% compared with the baseline, and total hip BMD in group RLX showed a significant increase (5.7%), although neck BMD in both groups decreased during the 9 months of treatment (–8.7% for group ALN and –4.2% for group RLX compared with the baseline). Spine BMD did not change significantly in eithr group. Serum BAP and urinary NTX decreased significantly in both groups. Serum intact OC did not change significantly. Conclusions: Both alendronate and raloxifene have a favorable effect on trochanter and total BMDs of the contralateral proximal femur in the short period after hip fracture. However, both drugs could not prevent bone loss in the femoral neck during the 9 months of treatment.

Maternity leave policies for medical students in Japan / 医学教育

1) Although maternity leave can facilitate the professional success of female students.The extent to which maternity leave is implemented remains unknown.A cross-sectional questionnaire survey of all Japanese medical schools and postgraduate schools in medicine (N=81) was performed.Responses were received from 55 medical schools and postgraduate medical schools (response rate=67.9%).The results showed that no school had formally established a maternity leave policy for students.<BR>2) We found that medical educators had reorganized clinical clerkship programs to accommodate the pregnancies of students but expressed confusion about how to manage such situations.<BR>3) We also found that many female postgraduate students drop out because of pregnancy or child-care responsibilities. Medical schools and postgraduate schools should recognize the importance of maternity leave and should not close their doors to pregnant students who are contending with both motherhood and academic achievement.

Current Situation of Medical Student Abuse / 医学教育

1) To our knowledge, medical student abuse has not previously been studied in Japan.<BR>2) In our survey, 68.5% of respondents experienced medical student abuse.<BR>3) Several students reported that they had been frequently neglected or ignored by teaching physicians during clinical clerkships and that such attitudes discouraged them and decreased their motivation.<BR>4) To improve the learning environment, medical educators must take action to resolve this serious issue.

A Review of Research on the Clinical Effectiveness of Therapeutic Practice Guidelines, 1991-2000: the Need for Standardization of Reporting Style / General Medicine

<B>BACKGROUND</B>: Practice guidelines have been increasingly recognized as an important tool for improving the quality of medical care. However, few studies have evaluated the clinical effectiveness of practice guidelines.<BR><B>PURPOSE</B>: To gain an insight into the clinical impact of practice guidelines.<BR><B>METHODS</B>: MEDLINE was searched in order to review experimental or quasi-experimental studies on the clinical impact of therapeutic practice guideline developed by specialist organizations or national/regional agencies.<BR><B>RESULTS</B>: A total of 17 studies was found, 10 (59%) of which reported positive clinical impacts and seven did not. Among the seven negative studies, two reported poor adherence by providers to guideline recommendations and three did not mention adherence. It was thus not possible to determine whether negative results reflected poor adherence by the providers or ineffectiveness of the practice guidelines themselves. The studies varied so widely that a formal meta-analysis was impossible.<BR><B>CONCLUSION</B>: The use of practice guidelines tended to have a positive clinical impact. However, sub-optimal study design and/or lack of data on key items such as the extent of adherence to guideline recommendations at the provider's level made the interpretation of study findings difficult.