Three-year evaluation of a program teaching social determinants of health in community-based medical education: a general inductive approach for qualitative data analysis.

BACKGROUND: Social determinants of health (SDH) are intricately intertwined with various social and economic factors. Reflection is essential for learning about SDH. However, only a few reports have focused on reflection in SDH programs; most were cross-sectional studies. We aimed to longitudinally evaluate a SDH program in a community-based medical education (CBME) curriculum that we introduced in 2018 based on the level of reflection and content on SDH in students' reports. METHODS: Study design: General inductive approach for qualitative data analysis. Education program: A 4-week mandatory clinical clerkship in general medicine and primary care at the University of Tsukuba School of Medicine in Japan was provided to all fifth- and sixth-year medical students. Students underwent a 3-week rotation in community clinics and hospitals in suburban and rural areas of Ibaraki Prefecture. After a lecture on SDH on the first day, students were instructed to prepare a structural case description based on encounters during the curriculum. On the final day, students shared their experiences in a small group session and submitted a report on SDH. The program was continuously improved and faculty development was provided. STUDY PARTICIPANTS: Students who completed the program during October 2018-June 2021. ANALYSIS: Levels of reflection were categorized as reflective, analytical, or descriptive. The content was analyzed based on the Solid Facts framework. RESULTS: We analyzed 118 reports from 2018-19, 101 reports from 2019-20, and 142 reports from 2020-21. There were 2 (1.7%), 6 (5.9%), and 7 (4.8%) reflective reports; 9 (7.6%), 24 (23.8%), and 52 (35.9%) analytical reports; and 36 (30.5%), 48 (47.5%), and 79 (54.5%) descriptive reports, respectively. The others were not evaluable. The number of Solid Facts framework items in reports were 2.0 ± 1.2, 2.6 ± 1.3, and 3.3 ± 1.4, respectively. CONCLUSIONS: Students' understanding of SDH deepened as the SDH program in the CBME curriculum improved. Faculty development might have contributed to the results. Reflective understanding of SDH might require more faculty development and integrated education of social science and medicine.

Factors associated with decreased physical activity levels among community-dwelling residents during the coronavirus disease 2019 pandemic: a long-term observational study.

[Purpose] The purpose of this study was to determine the factors associated with decreased physical activity levels among community residents over a long-term observation period during the coronavirus disease 2019 (COVID-19) pandemic. [Participants and Methods] We conducted a cross-sectional study using a self-administered questionnaire and daily steps as an indicator of physical activity levels. The study population consisted of 704 community-dwelling residents aged 40 years and older who participated in the health program from 2019 to 2020. We compared the daily steps from March-December 2019 to March-December 2020 and performed multivariate analysis to identify the factors associated with decreased daily steps. [Results] Of all participants, 447 (63.5%) returned the questionnaire and 309 (43.9%) were included in the analysis. During the COVID-19 pandemic, 133 (43.0%) respondents had decreased physical activity levels. The multivariate analysis showed that working (odds ratio, 2.08; 95% confidence interval, 1.10-3.94) was significantly associated with decreased daily steps during the COVID-19 pandemic. [Conclusion] There was a significant association between decreased physical activity levels and working during the COVID-19 pandemic. When restrictive measures such as teleworking are implemented, it may be necessary to take measures to prevent a decline in physical activity levels.

How do medical students learn about SDH in the community? A qualitative study with a realist approach.

INTRODUCTION: The need to learn social determinants of health (SDH) is increasing in disparate societies, but educational interventions are complex and learning mechanisms are unclear. Therefore, this study used a realist approach to identify SDH learning patterns, namely context (C), mechanism (M), and outcomes (O) in communities. METHODS: A 4-week clinical practice program was conducted for 5th- and 6th-year medical students in Japan. The program included SDH lectures and group activities to explore cases linked to SDH in the community. The medical students' structural reflection reports for learning SDH were thematically analyzed through CMO perspectives. RESULTS: First, medical students anticipated the concept of SDH and participated in a community in which a social model was central. They then transformed their perspective through observational learning and explanations from role models. Second, medical students' confrontation of contradictions in the medical model triggered integrated explanations of solid facts. Third, conceptual understanding of SDH was deepened through comparison and verbalization of concrete experiences in multiple regions. Fourth, empathy for lay people was fostered by participating from a non-authoritative position, which differed from that in medical settings. CONCLUSION: Medical students can learn about the connections between society and medicine through four types of SDH learning patterns.

[Relationship between the use of home-visit nursing services and family caregivers' experience of interprofessional care].

AIM: To examine the relationship between the use of home-visit nursing services (VNS) for patients and their family caregivers' experience of interprofessional care, which is an indicator of the care process. METHODS: We used data from a cross-sectional survey in Japan, 2020. Family caregivers 40-74 years old and caring for community-dwelling patients with chronic conditions were recruited. The outcome variable was family caregivers' experience, reflecting the quality of interprofessional care for patients and their caregivers. We used the Japanese version of the Caregivers' Experience Instrument (J-IEXPAC CAREGIVERS), which includes two domains: attention for the patient and attention for the caregiver. The main factor was the use of VNS, and covariates were socioeconomic factors of the caregivers and the use of other health and social care services. J-IEXPAC CAREGIVERS scores were divided into two groups by median values and analyzed by multivariate logistic regression analyses. RESULTS: A total of 566 caregivers were included in the analysis. The median age was 62 years old. VNS was used in 86 cases (15.2%). Logistic regression analyses revealed that the use of VNS was significantly associated with a higher total score group for J-IEXPAC CAREGIVERS (odds ratio = 3.02; 95% confidence interval 1.54-5.91). Of the J-IEXPAC CAREGIVERS domains, attention for the patient was significant. CONCLUSIONS: We found that the use of VNS was likely to provide a better experience among family caregivers. Our findings suggest that visiting nurses fulfill their expected role as core members of a multidisciplinary team.

What resources do elderly people choose for managing their symptoms? Clarification of rural older people's choices of help-seeking behaviors in Japan.

BACKGROUND: Appropriate help-seeking behavior (HSB) that involves lay and professional care may moderate the usage of medical resources and promote good health, especially among the rural elderly. However, there is little evidence regarding the rural elderly's HSB choices for mild symptoms. Therefore, this study attempts to bridge this gap. METHODS: The participants were patients living in rural areas and over the age of 65, who attended Japanese clinics and general hospitals. In Phase 1, monthly diaries and one-on-one interviews about their mild symptoms and HSB were used to establish HSB items and assess its content validity. Content analysis helped determine the items. In Phase 2, participants were asked to complete the list to measure HSB. The answers to the list and HSB mentioned in the diaries were compared to evaluate concurrent validity. Retests were conducted to examine the content's reliability and test-retest reliability. RESULTS: Phase 1 included 267 participants (average age = 75.1 years, standard deviation [SD] = 4.3; 50.1% male). The diary collection rate was 97.6%. Of the participants, 70.4% used lay care and 25.4% used professional care. Content analysis identified eight types of lay care and four types of professional care. Phase 2 included 315 participants (average age = 77.7 years, SD = 8.27; 46.0% male). In terms of validity, the results of the list and the diaries were correlated (Spearman r 0.704; p < 0.001). The most common behavior with mild symptoms was consulting with primary care physicians, followed by self-care and using home medicine. The test-retest reliability for mild symptoms found kappa values of 0.836 for lay care and 0.808 for professional care. CONCLUSIONS: The choices of HSB for mild symptoms clarified identified in this study have high validity and reliability. Therefore, it can be used to assess the relationships between HSB and health conditions and the effectiveness of health promotion on rural older people's HSB.

What role conceptions do multi-healthcare professionals have of physicians and what role expectation do they have of physicians in a community?

BACKGROUND: To create an effective community-based integrated care system, interprofessional collaboration based on healthcare professionals' mutual understanding of their respective roles must be promoted. This study aimed to identify the role conception and role expectation that other healthcare professionals have towards physicians in the context of a community-based integrated care system. METHODS: We organized focus groups and adopted 'Role Theory' as a theoretical framework. We collected data from healthcare professionals attending a conference on community-based integrated care systems in Japan. Fifty-four non-physician healthcare professionals consented to participate in 7 focus groups. Theme analysis based on the verbatim recorded transcripts was conducted in accordance with the framework of "Role Theory". RESULTS: The role conception of physicians is as a figure of intellectual authority positioned at the top of a traditional hierarchy, with a personal character of criticism/autonomy/closedness, not accommodative of interference from others, and upholding the Biomedical Model as an absolute standard. In response to this, the role expectation of physicians in the community is that they undertake actions that only physicians can undertake to ensure that a flat organization functions properly in providing medical explanations during patient transitions, and to offer healthcare support for patients who are difficult to access. This role expectation also includes the perception of patients as human beings, with physicians adapting to the Bio-Psycho-Social Model, explaining to patients about their disease as an authoritative voice based on an understanding of psychosocial circumstances, and sharing the prognosis of disease or disability. The expected personal character is a person with an open mind who allows others to seek advice, as well as a sense of approachableness which facilitates such seeking of advice. CONCLUSION: In the context of a community-based integrated care system, physicians should consider the understanding of their role conception and role expectation that other professionals have of them, and endeavor to create an open relationship with all healthcare professionals while giving careful consideration to their own role.

Measuring family caregivers' experience of interprofessional care for patients and families: development of the Japanese version of the Caregivers' Experience Instrument.

BACKGROUND: Improving individuals' experience of care is now a critical goal of health care systems. Although a number of instruments have been developed to measure experience of care, few instruments measure family caregivers' experience of interprofessional care for patients and families. OBJECTIVE: To develop the Japanese version of the Caregivers' Experience Instrument (J-IEXPAC CAREGIVERS) and to investigate its validity in assessing quality of integrated care for both patients with chronic conditions and their family caregivers, from the caregivers' perspective, in Japan. METHODS: We used a cross-sectional questionnaire survey to test the validity and internal consistency of J-IEXPAC CAREGIVERS. Four hundred family caregivers were recruited in three municipalities. We evaluated the feasibility, structural validity, internal consistency and hypothesis testing for construct validity of the scale. RESULTS: A total of 274 (68.5%) questionnaires were analysed. Confirmatory factor analysis showed acceptable model fit for the hypothesized two-factor model according to fit indices, as identified for the original version: attention for the patient and attention for the caregiver. Cronbach's alpha for score in J-IEXPAC CAREGIVERS with 12 items was high (0.92). Spearman's rank correlation coefficient between overall caregiver satisfaction and J-IEXPAC CAREGIVERS score was 0.71. Family caregivers who experienced home-visit services had significantly (P = 0.001) higher total scores than those who did not. CONCLUSIONS: This pilot study showed that the J-IEXPAC CAREGIVERS is valid and reliable. This scale can be useful for evaluating quality of integrated care, with focus on family caregivers and patients with chronic conditions in Japan.

Students' understanding of social determinants of health in a community-based curriculum: a general inductive approach for qualitative data analysis.

BACKGROUND: A community-based medical education (CBME) curriculum may provide opportunities to learn about the social determinants of health (SDH) by encouraging reflection on context, but the categories that students can learn about and their level of reflection are unclear. We aimed to analyze medical students' understanding and level of reflection about SDH in a CBME curriculum. METHODS: Study design: General inductive approach for qualitative data analysis. Education Program: All 5th-year and 6th-year medical students at the University of Tsukuba School of Medicine in Japan who completed a mandatory 4-week clinical clerkship in general medicine and primary care during October 2018 and May 2019 were included. The curriculum included 3 weeks of rotations in community clinics and hospitals in suburban and rural areas of Ibaraki Prefecture. On the first day, students learned about SDH through a lecture and a group activity. As an SDH assignment, they were instructed to prepare a structural case description using the Solid Facts framework based on encounters during the curriculum. On the final day, they submitted the structural reflection report. ANALYSIS: Content analysis was based on the Solid Facts framework. Levels of reflection were categorized as reflective, analytical, or descriptive. RESULTS: We analyzed 113 SDH case descriptions and 118 reports. On the SDH assignments, the students frequently reported on social support (85%), stress (75%), and food (58%), but less frequently on early life (15%), unemployment (14%), and social gradient (6%). Of the 118 reports, 2 were reflective, 9 were analytical, and 36 were descriptive. The others were not evaluable. CONCLUSIONS: The CBME curriculum enabled medical students to understand the factors of SDH to some extent. Further work is needed to deepen their levels of reflection.

Factors associated with the use of dietary supplements and over-the-counter medications in Japanese elderly patients.

BACKGROUND: The use of dietary supplements and over-the-counter (OTC) drugs is increasing, and there is adequate concern about potential harmful effects. However, there are limited reports on the concurrent use of nonprescription medications with prescription medications in elderly patients. Therefore, this study was conducted to describe the use of dietary supplements and OTC drugs, and to identify predictors for their use in elderly patients using medications prescribed for chronic diseases. METHODS: This was a cross-sectional study that enrolled 729 patients aged ≥65 years with chronic diseases, between January and March 2016. Data regarding socio-demographic status, medical condition, number of prescriptions, use of nonprescription medications, and psychological status were collected using a self-administered questionnaire and by review of medical records. Data regarding use of dietary supplements and OTC drugs were analyzed using descriptive statistics. Logistic regression analysis was applied to investigate factors associated with the use of dietary supplements and OTC drugs. RESULTS: The regular use of nonprescription drugs was reported by 32.5% of patients. Vitamins were the most commonly used dietary supplements in elderly patients. Female sex, higher educational qualifications, and good economic status were identified as predictors for the use of nonprescription medications. Concurrent use of nonprescription medications with more than 5 prescription medications was detected in 12.2% of participants. The disclosure rate of the use of nonprescription medications by patients to the physician was 30.3%. CONCLUSION: The use of dietary supplements and OTC drugs was common in elderly patients with chronic diseases, and its use is associated with sex, education, and economic status. General practitioners (GPs) need to recognize the potential use of nonprescription medications, considering that polypharmacy was common and disclosure rate was low in this study.

Reduction in Door-to-Balloon Time with Training for Effective and Efficient Action in Medical Service-Better Process (TEAMS-BP) at a Community Hospital in Japan.

ST-elevation myocardial infarction (STEMI) is a fatal condition. Prompt primary percutaneous coronary intervention is associated with lower mortality. However, community hospitals in Japan lack human and medical resources, and implementation of the same strategies as those used in the USA, such as an on-call cardiologist at the hospital, to achieve a door-to-balloon time of ≤ 90 min appears particularly challenging. Therefore, we used Training for Effective and Efficient Action in Medical Service-Better Process (TEAMS-BP) to develop a new process and assessed its effectiveness in reducing door-to-balloon time. TEAMS-BP can optimize the process by making the best use of available materials, machines, facilities and manpower. All processes conducted by physicians, nurses, electrocardiogram technicians, radiological technologists, and clerical staff in the emergency room were reviewed, documented, and standardized using the four steps of TEAMS-BP. The following processes were implemented: setting time goals, calling an electrocardiogram technician beforehand, minimizing tasks before calling a cardiologist, confirming the checklist, and providing data feedback. Forty-four STEMI patients who were treated after TEAMS-BP implementation were compared with 58 who were treated before implementation. Median door-to-balloon, door-to-electrocardiogram and door-to-laboratory times were significantly reduced after TEAMS-BP implementation, decreasing from 106 to 82 min, 14 to 6 min, and 67 to 45 min, respectively. In conclusion, implementation of TEAMS-BP improved the door-to-balloon time of STEMI cases without additional resources or costs incurred by the hospital. TEAMS-BP can be implemented by any hospital wishing to develop a new process that accommodates local working conditions.

Medical students' attitudes toward interactions with the pharmaceutical industry: a national survey in Japan.

BACKGROUND: The relationship between students and the pharmaceutical industry has received substantial attention for decades. However, there have been few reports on this issue from East Asia. We aimed to investigate Japanese medical students' interactions with and attitudes toward the pharmaceutical industry, and to assess the correlation between exposures to a formal curriculum on drug promotion and perceptions of the appropriateness of the physician-industry relationship. METHOD: We invited all 80 medical schools in Japan to participate. A cross-sectional anonymous survey was administered to medical students and school staff at the 40 schools that participated. The questionnaire for students assessed interactions with and attitudes toward the pharmaceutical industry. The questionnaire for school staff assessed the formal undergraduate curriculum. RESULTS: Forty of the 80 medical schools in Japan participated. The response rate to the medical student survey was 74.1%, with 6771 evaluable responses. More than 98% of clinical students had previously accepted a small gift of stationery, a brochure, or lunch, and significantly higher percentages of clinical than preclinical students had accepted one or more gifts (P < .001). Among preclinical and clinical students, respectively, 62.7 and 71.9% believed it was appropriate to accept stationery, and 60.5 and 71.0% thought that attending an industry-sponsored lunch did not influence clinical practice. Of the 40 participating schools, 13 (33.0%) had a formal curriculum on drug promotion. A multivariate analysis showed an association between exposure to a formal curriculum and students' perceptions of the appropriateness of the physician-industry relationship only for gifts of stationery, which were perceived as inappropriate (OR: 0.81, 95% CI: 0.69-0.95, P = .02). CONCLUSIONS: Most Japanese medical students interact with the pharmaceutical industry and believe that gift acceptance is appropriate and not influential. This study demonstrated a limited association between students' perceptions of gift appropriateness and exposure to a formal curriculum.

The relationship between long working hours and depression among first-year residents in Japan.

BACKGROUND: In Japan, some residents develop mental health problems. In previous studies, it was reported that long working hours might be a cause of stress reaction such as depression. There were some reports that compared residents with 80 or more working hours with those with less than 80 working hours. However, many residents are practically detained for extra-long time, designated as 100 h or more per week, for medical practice, training, self-study, etc. There have been few reports on extra-long hours of work. This study evaluated the working environment and the amount of stress experienced by first-year residents, and examined the relationship between long working hours and depression, especially in the group of extra-long working hours. METHODS: The study included 1241 first-year residents employed at 250 training hospitals in 2011. A self-report questionnaire was administered at the beginning of the residency and 3 months later to collect data on demographics, depressive symptoms, and training conditions (e.g., duration of work, sleep, disposable time, and night shift). Depressive symptoms were rated using the Center for Epidemiologic Studies Depression Scale. RESULTS: The mean duration of work per week was 79.4 h, with 97 residents (7.8%) working 100 h or more. At 3 months, clinically significant depressive symptoms were reported by 45.5% of residents working 100 or more h per week, which proportion was significantly greater than that for respondents working less than 60 h (P < 0.001). Multivariate logistic regression analysis showed that a working week of 80 to 99.9 h was associated with a 2.83 fold higher risk and 100 h or more was associated with a 6.96-fold higher risk of developing depressive symptoms compared with a working week of less than 60 h. CONCLUSION: Working excessively long hours was significantly associated with development of depressive symptoms. Proper management of resident physicians' working hours is critical to maintaining their physical and mental health and to improve the quality of care they provide.

Japanese regional-quota medical students in their final year are less motivated to work in medically underserved areas than they were in their first year: a prospective observational study.

INTRODUCTION: In Japanese medical schools, a special regional quota (chiikiwaku) system has been widely implemented to increase the number of physicians in medically underserved areas (MUAs). Regional quota students are required to take out a student loan but are exempted from repayment after fulfilling an approximately 9-year obligatory practice period. This study investigated the anticipated willingness of final-year regional quota students to remain in MUAs after their obligatory practice period, as well as factors associated with this willingness during students' first year. METHODS: The participants in this prospective observational study were all regional quota students at Japanese medical schools. Baseline data were collected when students were in their first year, and their anticipated willingness to remain in MUAs after their obligatory practice period was the primary outcome, determined by questionnaire during the students' final year. The association between baseline data and willingness to remain in MUAs was analyzed by the Χ2 test and logistic regression analysis. RESULTS: At baseline, 405 first-year students in 38 medical schools answered the questionnaire; of these, 208 (51.4%) students were followed up 5 years later. The proportion of regional quota students who anticipated being willing to remain in MUAs decreased from 52.3% to 19.2% after 5 years. In multivariate analysis, anticipated willingness to remain in MUAs in the sixth year was associated with rural upbringing (odds ratio (OR) 2.1), influence of income on work preference (OR 0.3) and willingness to remain in MUAs as assessed during the first year (OR 3.3). CONCLUSIONS: Regional quota students' anticipated willingness to remain in MUAs decreased as they progressed through medical school. To increase the number of physicians in MUAs, it may be useful to recruit regional quota students who come from rural areas, who do not place a high priority on expected incomes, and who initially anticipate a willingness to remain in MUAs.

Association between Excessive Alcohol Use and Alcohol-Related Injuries in College Students: A Multi-Center Cross-Sectional Study in Japan.

Alcohol-related injuries in college students are a major public health problem worldwide. We clarified the association between excessive drinking and alcohol-related injuries in Japanese college students. This was a cross-sectional study with a self-administered questionnaire. From January to March 2013, we sampled all college students and graduate students aged 20 years or older during annual health examinations at three colleges in Mie Prefecture in Japan. The questionnaire assessed the frequency of alcohol drinking, amount of alcohol consumed per day, binge drinking during the past year, alcohol-related injuries during the past year, and demographic data. Logistic regression analysis was conducted on the association between excessive alcohol use and alcohol-related injuries. A total of 2,842 students underwent health examinations, of whom 2,177 (76.6%) completed the questionnaire. Subjects included 1,219 men (56.0%) and 958 women (44.0%). Eighty-eight men (7.2%) and 93 women (9.7%) were classified as excessive weekly drinkers, while 693 men (56.8%) and 458 women (47.8%) were determined to be binge drinkers. Eighty-one men (6.6%) and 26 women (2.7%) had experienced alcohol-related injuries during the past year. In the logistic regression analysis, binge drinkers (odds ratio 25.6 [8.05-81.4]) and excessive weekly drinkers (odds ratio 3.83 [2.41-6.09]) had a history of significantly more alcohol-related injuries, even after adjusting for age and sex. In conclusion, alcohol-related injuries in college students in Japan were strongly associated with excessive drinking. As a strategy for preventing such injuries in this population, an interventional study is required to identify effective methods for reducing excessive alcohol use.

Comparison of blood pressure measurements on the bare arm, over a sleeve and over a rolled-up sleeve in the elderly.

BACKGROUND: Although guidelines recommend that blood pressure (BP) should be measured on a bare arm, BP is sometimes measured over clothing in clinical settings. OBJECTIVE: To assess the accuracy of BP measurements over clothing rolled up to the elbow in clinical settings. METHODS: This was a cross-sectional study to a total of 186 individuals recruited from a primary care clinic and two day-care facilities between July and September 2014. Main outcome measures were BP measurements on (i) a bare arm, (ii) over the sleeve of a cardigan and (iii) over the sleeve of a cardigan rolled up to the elbow. BP was compared across measurement conditions using the paired t-test and multiple analysis of variance adjusting for age, sex, measurement order and interaction between clothing condition and measurement order. RESULTS: Of 186 subjects, 38.5% were male. Mean age was 74.6 years. Mean BP with a bare arm, over a sleeve and over a rolled-up sleeve was 128.9 (SD 19.1)/67.4 (10.8) mmHg, 132.8 (21.0)/72.6 (11.5) mmHg and 133.4 (21.3)/74.4 (12.1) mmHg, respectively. There were significant differences in BP between the bare arm and over a cardigan sleeve (P < 0.001) and the bare arm and over a rolled-up cardigan sleeve (P < 0.001). BP differences were significant even after adjusting for age group, sex, measurement order and interaction between clothing condition and measurement order. CONCLUSIONS: Although previous studies have suggested BP measurements over clothing are acceptable, our results suggest that BP should be measured on bare arms as recommended by guidelines whenever feasible.

Factors associated with the recovery of activities of daily living after hospitalization for acute medical illness: a prospective cohort study.

[Purpose] This study investigated the factors associated with the recovery rate of activities of daily living of elderly patients hospitalized for acute medical illness. [Subjects and Methods] A total of 238 elderly patients were enrolled in this study. The main outcome measure was the functional independence measure score which was used as an assessment of activities of daily living. The participants were divided into 2 groups based on their activities of daily living before onset: the independent group and the partially dependent group. The participants of each group were further divided into 2 subgroups based on recovery rates of activities of daily living: the high-recovery group (80%) and the low-recovery group (<80%). The factors associated with the recovery rate were examined using multivariate logistic regression analysis. [Results] The factors associated with the recovery rate were: days of inactivity and cognitive status at the start of rehabilitation for the independent group, and days of inactivity and nutritional status at the start of rehabilitation for the partially dependent group. [Conclusion] The results of this study suggest that the important factors for return to normal activities of daily living are: days of inactivity and cognitive status for the independent group; and days of inactivity and management of nutrition for the partially dependent group.

Can we predict future depression in residents before the start of clinical training?

CONTEXT: Depression among medical residents is a very serious problem. It is, however, very difficult to detect signs of depression early, despite the severity and frequency of depression. We designed a nationwide longitudinal study to investigate whether the Sense of Coherence (SOC) Scale, an indicator of ability to cope with stress, could predict future depressive symptoms among medical residents. METHODS: We distributed self-administered questionnaires to first-year residents in 251 postgraduate education hospitals just before the start of their clinical training. The questionnaire contained the Center for Epidemiologic Studies Depression (CES-D) Scale (a screening tool for depression), the SOC Scale, and items on demographic factors. After 3 months, we again distributed questionnaires to residents who had responded to the first survey. The second questionnaire contained the CES-D Scale and items on the respondents' working conditions. We categorised respondents into three groups according to their SOC scores and analysed the relationships between the three SOC groups (low, middle and high scores) and the occurrence of depressive symptoms at the follow-up survey. RESULTS: In all, 1738 of 2935 residents (59.2%) responded to the first survey. Of these, 1245 residents (71.6%) also responded to the follow-up survey. A total of 189 residents were excluded because they screened positive for depressive symptoms at the first survey. Data for a further 36 were excluded because they were incomplete. At the follow-up survey, 238 of the remaining 1020 residents (23.3%) had new-onset depressive symptoms. These included 61 (41.2%) respondents in the low SOC group, 159 (22.3%) in the middle SOC group, and 18 (11.3%) in the high SOC group (p < 0.01). The odds ratio of the low SOC group for new-onset depressive symptoms, adjusted for demographic factors, baseline CES-D score and mean working time, was 3.11 (95% confidence interval 1.48-6.53), using the high SOC group as the reference. CONCLUSIONS: The SOC score was significantly related to future depressive symptoms among medical residents. The SOC Scale might be a useful and easy-to-use predictor of future depression.

Self-care behavior when suffering from the common cold and health-related quality of life in individuals attending an annual checkup in Japan: a cross-sectional study.

BACKGROUND: The World Health Organization and several governments encourage medical self-care (including self-medication) for minor illnesses. Accordingly, the factors that influence self-care have received research attention, with socioeconomic status identified as one such predictor. Although studies have examined the relationship between socioeconomic status and quality of life (QOL) in patients suffering from respiratory allergies or chronic illnesses, the relationship between QOL and self-care behavior for the common cold, the most common illness seen in primary care, has not been examined. Therefore, we investigated the relationship between QOL and self-care behavior in individuals suffering from the common cold. METHODS: We distributed questionnaires to 499 people who attended an annual public health checkup in Kasama city, Japan. Valid questionnaires were received from 398 participants (mean age = 59.0, SD = 15.8, range = 24-87 years; 61.4 % women). The materials included a question relating to typical actions taken when treating a common cold (self-care or visiting a health clinic), demographics, and the Short Form-8™ (SF-8™)-an 8-item survey that assesses health-related quality of life (HRQOL). The association of care action and HRQOL were investigated using Mann-Whitney U tests with a significance level of p < 0.05. RESULTS: The mean scores for the Physical Functioning, Role-Physical, Bodily Pain, Social Functioning, Role-Emotional, and Physical Component Summary score of the SF-8™ were significantly higher among the self-care group than the group that preferred visiting a clinic. CONCLUSIONS: HRQOL among individuals who engage in self-care when treating the common cold was observed to be significantly higher than among individuals who preferred to attend a health clinic. It is unclear whether self-care behavior affects QOL, or whether QOL affects self-care behavior; however, this finding highlights the importance of the relationship between QOL and self-care behavior. Additional studies should be conducted in order to investigate the direction of causality between self-care behaviors and QOL further.

A Case of Odontoid Osteomyelitis.

Odontoid osteomyelitis is a rare infectious disease that manifests as fever and posterior neck pain, while crowned dens syndrome is a relatively common inflammatory disorder with similar signs and symptoms. We describe the case of a 90-year-old woman presenting with fever, posterior neck pain, throat pain, and headache. Crowned dens syndrome was initially diagnosed based on the clinical picture and calcification around the odontoid process on cervical spine CT. However, the diagnosis was revised to odontoid osteomyelitis following the detection of Staphylococcus aureus in blood cultures that were performed due to the presence of headache. Infectious complications included spinal epidural abscess extending to the hypoglossal canal and osteomyelitis spreading to the clivus. Nonetheless, the patient achieved complete recovery after 13 weeks of antimicrobial therapy. No reports of odontoid osteomyelitis with calcification around the odontoid process have been reported. This case underscores the importance of avoiding a hasty diagnosis of crowned dens syndrome when calcification around the odontoid process is observed in patients presenting with fever and posterior neck pain. It is crucial to perform a thorough medical history review and physical examination to exclude other conditions. In cases where infection is suspected, blood cultures and cervical spine MRI are essential to investigate odontoid osteomyelitis and other complications.

Hyperosmia and Hypergeusia As Potential Clues in Diagnosing Adrenal Insufficiency: A Case Report.

Adrenal insufficiency often presents with nonspecific symptoms, physical findings, and laboratory results, leading to diagnostic challenges. However, reports have indicated that specific symptoms such as hypergeusia (hypersensitivity to taste) and hyperosmia (hypersensitivity to smell) can also occur. We report the case of a 60-year-old male with loss of appetite, fatigue, and polyarthralgia, where a detailed medical history revealed the cause of anorexia to be hypergeusia and hyperosmia. These specific symptoms led to the diagnosis of adrenal insufficiency. Treatment with oral steroids for secondary adrenal insufficiency resulted in the improvement of his diverse symptoms. This case illustrates that in patients presenting with chronic nonspecific symptoms, inquiring about heightened taste and smell sensitivity can prompt suspicion of adrenal insufficiency. Moreover, this case serves as a reminder that careful medical history taking in patients with nonspecific symptoms can uncover specific findings that may be diagnostic clues.