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1.
Geriatr Gerontol Int ; 2019 Nov 06.
Artículo en Inglés | MEDLINE | ID: mdl-31691507

RESUMEN

AIM: To assess factors associated with home deaths in non-cancer elderly patients receiving home medical care by general practitioners. METHODS: A retrospective observational study was carried out in a primary care clinic in Tokyo. Patients who received home medical care and died between January 2010 and September 2017 were included in the analysis. Data from 119 non-cancer patients aged ≥65 years were collected between September and December 2017 using medical records. Patient characteristics, comorbidities, cognitive impairment, duration of home medical care, number of household members, patient's relationship with their primary caregiver, use of home care nursing services, and patient and family preference on place of death were obtained as independent variables. The main outcome was the place of death. RESULTS: Among the analyzed patients, 59.7% had impaired cognition and 47.1% expressed a preference for place of death. Patient-family congruence on the preferred place of death was 57.1% (kappa coefficient 0.39). Multivariate analysis showed that family preference for home death (adjusted odds ratio [aOR] 137.0, 95% CI 13.0-1443.8), cognitive impairment (aOR 4.26, 95% CI 1.12-16.2), death by non-infectious diseases (aOR 13.7, 95% CI 2.50-74.7) and living with more than two family members (aOR 4.79, 95%CI 1.38-16.7) were significantly associated with home deaths. CONCLUSIONS: Family preference, rather than patient preference, was a facilitating factor for home death among non-cancer older patients receiving home medical care. As many patients receiving home medical care have impaired cognition, early end-of-life discussions with patients and decision-making support for caregivers should be promoted to realize their preferences on place of death. Geriatr Gerontol Int 2019; ••: ••-••.

2.
Infect Dis Health ; 24(4): 212-221, 2019 11.
Artículo en Inglés | MEDLINE | ID: mdl-31402297

RESUMEN

BACKGROUND: Elderly patients benefit from influenza vaccination, but the number of Japanese elderly patients who are vaccinated is insufficient. Several factors are associated with influenza vaccination acceptance, but little is known about Japanese elderly outpatients. The purpose of this study was to examine factors associated with influenza vaccination in elderly outpatients in Japan. METHODS: During the 2017-2018 influenza season, outpatients from one hospital and one clinic in Kitaibaraki City, Ibaraki, Japan, participated in this study. Patients answered a self-report questionnaire exploring factors such as their vaccination status during the 2017-2018 season, past influenza vaccination, perceived susceptibility to influenza and adverse events of the vaccine, perceived vaccine efficacy, physician recommendations. Multivariable logistic regression analyses were conducted to identify factors associated with vaccination. RESULTS: Of 377 patients, 316 (83.8%) responded, and the vaccination rate was 57%. Eighty-three patients (27.0%) reported that their physician recommended the influenza vaccine. In multivariate analysis, influenza vaccination was associated with higher age (odds ratio (OR) 1.09, 95% confidence interval (CI) 1.03-1.14), physician recommendations (OR 2.49, 95% CI 1.18-5.25), low perceived susceptibility to vaccine-related adverse events (OR 0.33, 95% CI 0.15-0.74), and belief in vaccine efficacy (OR 4.73, 95% CI 2.08-10.8). CONCLUSIONS: Influenza vaccination was associated with belief in vaccine efficacy, perceived susceptibility to vaccine-related adverse events, physician recommendations, and older age. Increasing the frequency of physician recommendations may lead to increased vaccination coverage.

3.
PLoS One ; 14(1): e0210912, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30653563

RESUMEN

Interprofessional education (IPE) for medical students is becoming increasingly important, as reflected in the increasing number of medical schools adopting IPE. However, the current status of and barriers to pre-registration IPE implementation in Japanese medical schools remain unknown. The purpose of this study was to clarify the status and barriers of IPE implementation in medical schools in Japan. We conducted a curriculum survey from September to December 2016 of all 81 medical schools in Japan. We mailed the questionnaire and asked the schools' undergraduate education staff to respond. The survey items were the IPE implementation status and barriers to program implementation. Sixty-four of the 81 schools responded (response rate 79.0%), of which 46 (71.9%) had implemented IPE, 42 (89.1%) as compulsory programs. Half of IPE programs were implemented in the first 2 years, while less than 10% were implemented in the latter years of medical programs. As part of the IPE programs, medical students collaborated with a wide range of professional student groups. The most common learning strategy was lectures. However, one-third of IPE programs used didactic lectures without interaction between multi-professional students. The most common perceived major barrier to implementing IPE was adjustment of the academic calendar and schedule (82.8%), followed by insufficient staff numbers (73.4%). Our findings indicate that IPE is being promoted in undergraduate education at medical schools in Japan. IPE programs differed according to the circumstances of each school. Barriers to IPE may be resolved by improving learning methods, introducing group discussions between multi-professional students in lectures or introducing IPE programs using team-based learning. In summary, we demonstrated the current status and barriers of IPE implementation in Japanese medical schools. Our findings will likely lead to the promotion of IPE programs in Japan.


Asunto(s)
Educación de Pregrado en Medicina/métodos , Relaciones Interprofesionales , Facultades de Medicina , Curriculum , Humanos , Japón , Encuestas y Cuestionarios
4.
BMC Med Educ ; 18(1): 286, 2018 Dec 04.
Artículo en Inglés | MEDLINE | ID: mdl-30509273

RESUMEN

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.

5.
PLoS One ; 13(11): e0206543, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-30388150

RESUMEN

Interaction of medical students with the pharmaceutical industry is common. However, students are thought to be vulnerable to the influence of this interaction, and regulations to limit such interactions are required. The Japan Pharmaceutical Manufacturers Association revised its promotion code in 2013 and specified upper limits for promotional aids. We aimed to investigate whether Japanese medical students' interactions with the pharmaceutical industry changed from 2012 to 2016. This study solicited the participation of all medical schools in Japan. An anonymous cross-sectional survey was administered to medical students from May 2016 to March 2017 to investigate their interactions with the pharmaceutical industry. The results were compared with those of a previous study conducted in 2012. Forty of the 80 medical schools in Japan participated. The student response rate was 74.1%, with 6771 (3395 preclinical, 3376 clinical) evaluable responses. More than 98% of clinical students had previously accepted stationery, a brochure, or a lunch, and significantly higher percentages of clinical students had accepted these items in 2016 than in 2012 (p < .001). The interactions between clinical students and pharmaceutical companies increased slightly between 2012 and 2016. This study will hopefully promote discussion regarding the regulation of student-industry interactions.

6.
Rural Remote Health ; 18(4): 4840, 2018 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-30365899

RESUMEN

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.

7.
J Clin Med Res ; 10(9): 715-721, 2018 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-30116442

RESUMEN

Background: Depression among medical residents is a critical issue. The early detection of depression and provision of appropriate care is necessary for fostering healthy conditions during clinical training. To investigate whether Sense of Coherence (SOC), an indicator of stress coping ability, could be a predictor of depression 2 years after the start of clinical training, we conducted a national longitudinal study. Methods: We distributed self-administered questionnaires to residents in 251 postgraduate educational 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 demographic factors. After 2 years, we distributed questionnaires to residents who responded to the first survey. The second questionnaire contained the CES-D scale and questions about working conditions. We categorized respondents into three groups according to their SOC score and analyzed the relationship between SOC groups (low, middle, high) and depressive symptoms on the follow-up survey. Results: In total, 1,738 of 2,935 residents (59.2%) responded to the first survey. Of these, 1,169 residents (67.3%) also responded to the follow-up survey. A total of 169 residents were excluded because they screened positive for depressive symptoms at the time of the first survey. On the follow-up survey, 187 residents (19.5%) had new-onset depressive symptoms: 33.3% in the low SOC group, 18.2% in the middle SOC group, and 11.4% in the high SOC group (P < 0.01). Compared with the high SOC group, the odds ratio for new-onset depressive symptoms in the low SOC group was 2.04 (95% confidence interval, 1.02 - 4.05) after adjusting for demographic factors, baseline CES-D score, and mean working time. Conclusions: SOC score is significantly associated with future depressive symptoms among residents after 2 years. Residents in the low SOC group had a 2-fold higher risk of future depressive symptoms than those in the high SOC group. The SOC scale might be a useful predictor of future depression and allow for the provision of appropriate support to residents during clinical training.

8.
J Nutr Sci Vitaminol (Tokyo) ; 64(3): 209-214, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-29962432

RESUMEN

The association between advanced age and the thiamine concentration has not been conclusively determined. A recent report from Japan showed that more than half of nursing home elderly residents at an institution had a low whole-blood thiamine concentration (<20 ng/mL). Therefore, a high incidence of low thiamine concentrations among hospitalized elderly has been anticipated in the Japanese population but never investigated. We evaluated the whole thiamine concentration in newly hospitalized elderly patients (≥65 y old) with infectious diseases. Evaluations were performed on admission and at days 6-8 of hospitalization with liquid chromatography tandem mass spectrometry (LC/MS/MS). As a result, we enrolled a total of 471 patients from September 2015 to December 2016. The median thiamine concentration was 46 ng/mL (IQR, 37-58 ng/mL). Only 7 patients (1%) had thiamine concentrations below 20 ng/mL (66 nmol/L) on admission. Five of these patients were bedridden and unable to eat food by themselves, and the other two patients used loop diuretics for chronic heart failure. The thiamine concentration declined in most patients (84%) at days 6-8 of admission, regardless of their dietary intake during hospitalization. In conclusion, a low thiamine concentration was not prevalent among newly hospitalized elderly patients with infectious diseases. However, the thiamine concentration significantly decreased during the 6-8 d of hospitalization.


Asunto(s)
Envejecimiento/sangre , Hospitalización , Infección/sangre , Tiamina/sangre , Anciano , Anciano de 80 o más Años , Femenino , Hospitales Comunitarios/estadística & datos numéricos , Humanos , Japón/epidemiología , Masculino , Deficiencia de Tiamina/epidemiología
9.
J Gen Fam Med ; 19(3): 97-101, 2018 May.
Artículo en Inglés | MEDLINE | ID: mdl-29744263

RESUMEN

Objective: To assess the extent to which long-term care facilities in Japan adhere to blood pressure (BP) measurement guidelines. Design: Cross-sectional, observational survey. Setting: Japan (nationwide). Participants: Geriatric health service facilities that responded to a questionnaire among 701 facilities that provide short-time daycare rehabilitation services in Japan. Methods: A written questionnaire that asked about types of measurement devices, number of measurements used to obtain an average BP, resting time prior to measurement, and measurement methods when patients' arms were covered with thin (eg, a light shirt) or thick sleeves (eg, a sweater) was administered. Main outcome measure: Proportion of geriatric health service facilities adherent to BP measurement guidelines. Results: The response rate was 63.2% (443/701). Appropriate upper-arm BP measurement devices were used at 302 facilities (68.2%). The number of measurements was appropriate at 7 facilities (1.6%). Pre-measurement resting time was appropriate (≥5 minutes) at 205 facilities (46.3%). Of the 302 facilities that used appropriate BP measurement devices, 4 (1.3%) measured BP on a bare arm if it was covered with a thin sleeve, while 266 (88.1%) measured BP over a thin sleeve. When arms were covered with thick sleeves, BP was measured on a bare arm at 127 facilities (42.1%) and over a sleeve at 78 facilities (25.8%). Conclusions: BP measurement guidelines were not necessarily followed by long-term care service facilities in Japan. Modification of guidelines regarding removing thick sweaters and assessing BP on a visit-to-visit basis might be needed.

10.
Tohoku J Exp Med ; 244(4): 305-315, 2018 04.
Artículo en Inglés | MEDLINE | ID: mdl-29657235

RESUMEN

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.


Asunto(s)
Infarto del Miocardio/diagnóstico , Grupo de Atención al Paciente/organización & administración , Intervención Coronaria Percutánea , Tiempo de Tratamiento , Anciano , Cardiología , Electrocardiografía , Servicio de Urgencia en Hospital , Femenino , Hospitales Comunitarios , Humanos , Japón , Masculino , Persona de Mediana Edad , Evaluación de Procesos y Resultados (Atención de Salud) , Factores de Tiempo , Resultado del Tratamiento
11.
Geriatr Gerontol Int ; 18(7): 1064-1070, 2018 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-29582533

RESUMEN

AIM: We aimed to evaluate whether potentially inappropriate medications (PIMs) increase the risk for adverse clinical outcomes including falls, emergency department (ED) visits and unplanned hospitalizations in older Japanese patients with chronic diseases, comparing the difference between patients with and without polypharmacy. METHODS: A prospective observational cohort study was carried out in a Japanese outpatient primary care clinic. Baseline data was collected from January to March 2016. A total of 740 patients aged ≥65 years with chronic diseases were enrolled and were followed up at 1 year; falls, ED visits and unplanned hospitalizations were recorded. A questionnaire and review of the patients' medical records were used to collect information regarding sociodemographic status, comorbidities and medication prescriptions. PIMs were defined using the Screening Tool of Older Person's Prescriptions criteria version 2. Using logistic regression analysis, the incidence of falls, and ED visits and hospitalizations were compared between patients with and without PIMs, stratifying by number of prescriptions: those with five or more prescriptions and those with fewer than five prescriptions. RESULTS: PIMs were identified in 32.3% of enrolled patients. After stratification by number of prescriptions, PIMs were significantly associated with falls in the group with polypharmacy (OR 2.03, 95% CI 1.11-3.69). This association was not seen in the group without polypharmacy. PIMs were not associated with ED visits or hospitalizations at the 1-year follow up upon multivariate analysis. CONCLUSIONS: The combination of PIMs and polypharmacy might increase the risk of falls, therefore clinicians need to pay attention to both PIMs and polypharmacy. Geriatr Gerontol Int 2018; 18: 1064-1070.

12.
BMC Med Educ ; 18(1): 50, 2018 Mar 27.
Artículo en Inglés | MEDLINE | ID: mdl-29587738

RESUMEN

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.


Asunto(s)
Depresión/diagnóstico , Internado y Residencia , Cuerpo Médico de Hospitales/psicología , Admisión y Programación de Personal , Estrés Psicológico/diagnóstico , Tolerancia al Trabajo Programado/psicología , Depresión/etiología , Femenino , Humanos , Internado y Residencia/estadística & datos numéricos , Japón , Masculino , Cuerpo Médico de Hospitales/estadística & datos numéricos , Admisión y Programación de Personal/estadística & datos numéricos , Factores de Tiempo , Carga de Trabajo , Lugar de Trabajo/psicología
13.
J Clin Med Res ; 10(3): 202-209, 2018 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-29416578

RESUMEN

Background: The burden from depression is affected by the public's beliefs, stigma, and resulting behavior. Lack of knowledge, misunderstanding, and stigma about depressed people and their surroundings are barriers to improving their mental health. This study aimed to examine public beliefs regarding depression, especially how to recognize depression, treatment, and stigma. Methods: A self-administered questionnaire was distributed to participants receiving an annual health checkup. We asked whether they agreed with four short sentences: "it is not necessary to worry about depression in a person behaving brightly" (misunderstanding about the behavior of depressed people), "rest is important for treating depression" (belief about the necessity of rest), "medicine is effective for treating depression" (belief about the effectiveness of pharmacotherapy) and "a weak personality causes depression" (stigma about the cause of depression). We also analyzed the association between these beliefs and factors such as health literacy, regularly visiting an outpatient clinic, history of depression, and demographic variables. Results: Among 1,085 respondents (75.0% response rate), 54.5%, 75.6%, 58.9%, and 70.8% responded appropriately to the "misunderstanding about the behavior of depressed people", "necessity of rest", "effectiveness of pharmacotherapy", and "stigma about the cause of depression" items, respectively. Regarding stigma about the cause of depression, 30.7% of respondents agreed that a weak personality caused depression. Female sex and younger age group were associated with appropriate answers. Health literacy was only associated with appropriate beliefs about the effectiveness of pharmacotherapy. Conclusions: Thirty percent of participants had the stigmatizing belief that a weak personality causes depression and only 58.9% believed in the effectiveness of pharmacotherapy for depression. Over 70% understood the necessity of rest and knew that depression is possible in those who act brighter. General health literacy alone might not improve knowledge and beliefs about depression. An educational intervention or campaign to reduce stigma toward depression and improve knowledge about the treatment of depression is needed.

14.
J Clin Med Res ; 10(3): 226-232, 2018 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-29416582

RESUMEN

Background: Burnout in attending physicians is a crucial issue that may negatively impact patient outcomes, as well as affect the quality of training provided to residents. To investigate the association between burnout and stress-coping ability, we conducted a cross-sectional study of attending physicians. Methods: From April 2013 to March 2014, we distributed an anonymous, self-administered questionnaire to 1,897 attending physicians who attended teaching-related training sessions and workshops. The questionnaire included the Maslach Burnout Inventory General Survey (MBI-GS, Japanese version) to evaluate burnout; the sense of coherence scale (SOC, Japanese version) to measure stress-coping ability, with higher scores indicating higher stress-coping ability; the Brief Scales for Job Stress (BSJS) to assess stress and buffering factors; demographic factors; mean weekly working hours; and factors related to instructing residents. The MBI-GS was used to determine the presence of physician burnout. Subjects were divided into tertiles based on SOC scores. We conducted logistic regression analysis of burnout using the following independent variables: physician experience, sex, mean weekly working hours, SOC group, mental workload, and reward from work. Results: Of the 1,543 (81.3%) attending physicians who responded, 376 did not meet the inclusion criteria and 106 had missing data, thus 1,061 (55.9%) were analyzed. The prevalence of burnout was 17.2%. Physicians with burnout had significantly fewer years of experience as a doctor (P < 0.01), were more likely to be female (P < 0.01), worked more hours per week (P < 0.01), and had a lower SOC score (P < 0.01) than physicians without burnout. On the BSJS, the mean score of all stress factors was higher and that of buffering factors was lower in physicians with burnout (P < 0.01). The percentages of physicians with burnout were 35.7%, 12.8%, and 3.2% in the low, middle, and high SOC groups, respectively (P < 0.01). Using the high SOC group as a reference, the adjusted odds ratio for burnout in the low SOC group was 4.7 (95% confidence interval: 2.31 - 9.63) (P < 0.01). Conclusions: In this study, burnout among attending physicians was significantly associated with SOC scores after adjustment for stress factors and buffering factors.

15.
J Gen Fam Med ; 19(1): 20-26, 2018 01.
Artículo en Inglés | MEDLINE | ID: mdl-29340262

RESUMEN

Background: Depression among doctors in residency training can have significant impacts on the health of the residents and on patient safety. This study aimed to investigate factors associated with recovery from a depressive episode experienced during postgraduate residency training. Methods: A questionnaire was administered to 2935 first-year residents at the beginning of residency training in 2011; follow-up surveys were conducted after 3 months and at the end of the training in 2013. The questionnaire included the Center for Epidemiologic Studies Depression Scale and the Senior Doctor's Support Scale (SDSS). Logistic regression was used to identify associations between factors that may have been related to recovery from depressive episodes. Results: A total 182 residents experienced a depressive episode in the 3 months after starting residency training. When reassessed at the end of the 2-year training, 102 (56%) residents had recovered from the episode and 80 (44%) had not. Increased odds of recovery were associated with a middle or high score on the SDSS (middle score odds ratios [OR] 4.45, 95% confidence interval [CI] 1.0-18.0, P = .04; and high score OR 5.70, 95% CI 1.4-23.4, P = .02). Conclusions: Support from senior doctors should be enhanced to optimize recovery from depressive episodes experienced after the start of residency training.

16.
BMC Fam Pract ; 19(1): 20, 2018 Jan 24.
Artículo en Inglés | MEDLINE | ID: mdl-29368641

RESUMEN

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.

17.
Geriatr Gerontol Int ; 18(4): 615-622, 2018 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-29278290

RESUMEN

AIM: We investigated factors that predict the prognosis of activities of daily living (ADL) in elderly patients who had undergone rehabilitation during hospitalization for acute infectious disease. METHODS: The present prospective cohort study included 131 patients who were hospitalized due to acute infectious disease and who had undergone rehabilitation during hospitalization. Patient characteristics collected from medical records included age, sex and comorbidity score. The level of ADL 2 weeks before admission was assessed by interview at the start of rehabilitation. Grip strength testing, Short Physical Performance Battery as an assessment of lower limb function and the Mini-Mental State Examination as an assessment of cognitive status were carried out at the time of hospital discharge. The level of ADL at 6 months after discharge was assessed by telephone interview. Multivariate logistic regression analysis was used to identify factors that independently predict ADL dependence (defined as being dependent in one or more ADL items at 6 months after discharge). RESULTS: The average age of participants was 81.5 years, and 52.7% were women. A total of 22.1% of patients showed dependence in an ADL at 6-month follow-up. Factors that predicted an ADL dependence were comorbidity score (OR 4.19, 95% CI 1.19-14.69) and lower limb function (OR 0.51, 95% CI 0.36-0.72) at discharge. CONCLUSIONS: The present findings have implications for the healthcare planning and well-being of elderly patients during hospitalization and after discharge. Geriatr Gerontol Int 2018; 18: 615-622.

18.
Blood Press Monit ; 23(1): 9-11, 2018 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-28926363

RESUMEN

OBJECTIVE: Blood pressure (BP) measurement is recommended on bare arms, but undressing the arms for BP measurements is often difficult for frail elderly individuals. We aimed to assess the accuracy of BP measurements over arms with thin and thick clothing among the frail elderly. PARTICIPANTS AND METHODS: This is a cross-sectional study. Individuals aged 65 years or older were recruited from three long-term care facilities in Japan between April and May 2016. The main outcome measures were BP measurements (a) on a bare arm, (b) over a thin shirt, (c) over a thin shirt and a cardigan, and (d) over the sleeve of a thin shirt and a cardigan rolled up to the elbow. BP was compared across measurements using the paired t-test and multiple analysis of variance adjusting for sex and treatments for hypertension. RESULTS: Of 147 participants, 23.8% were men. The mean age of the participants was 87.2 years (SD: 7.8). The mean (SD) BP on a bare arm, over a shirt, over a shirt and a cardigan, and over a rolled-up sleeve were 128.8 (20.0)/69.3 (13.2), 131.0 (22.2)/73.9 (15.2), 136.9 (22.2)/78.9 (15.8), and 136.4 (26.0)/80.7 (15.9) mmHg, respectively. BP measurements over clothed arms were significantly higher than bare arm measurements. BP differences were significant when measured over a cardigan after adjusting for sex and treatments for hypertension. CONCLUSION: In the elderly, clothing has a significant effect on BP measurements. The arms should be undressed as much as possible for BP measurements in the elderly.


Asunto(s)
Brazo , Determinación de la Presión Sanguínea/métodos , Presión Sanguínea , Anciano Frágil , Anciano , Anciano de 80 o más Años , Brazo/fisiología , Vestuario , Estudios Transversales , Femenino , Humanos , Hipertensión/diagnóstico , Hipertensión/epidemiología , Hipertensión/fisiopatología , Japón/epidemiología , Masculino
19.
J Gen Fam Med ; 18(6): 336-340, 2017 12.
Artículo en Inglés | MEDLINE | ID: mdl-29264062

RESUMEN

Background: Many Japanese visit medical institutions for common cold treatment, which can cause congestion in these institutions and an increase in medical expenses, although the common cold can be treated sufficiently through self-medication. Therefore, to elucidate the reasons individuals with common colds do not use over-the-counter (OTC) medication, we conducted an investigation using a self-administered inquiry sheet to determine reasons for clinic visits and for the avoidance of OTC medication. Methods: The study was of patients with self-diagnosed common cold symptoms using an anonymous self-report questionnaire. Results: Of the 471 patients administered the questionnaire, 442 responded. The analysis was focused on the 37 patients who responded that they had considered using OTC medication before coming to the clinic but decided against it and came to the clinic instead. The majority responded positively saying that they felt reassured when seen by a physician (91.9%) and that their common cold was cured more rapidly (89.2%). Conclusions: It can be presumed that many patients with common colds visit medical institutions because they feel reassured and feel that their symptoms improve at a quicker rate. The findings of this study indicated that there is a need for accurate information and relief from anxiety for patients regarding the common cold.

20.
J Gen Fam Med ; 18(6): 403-408, 2017 12.
Artículo en Inglés | MEDLINE | ID: mdl-29264072

RESUMEN

Background: The progress in aging and the shortage of physicians is a significant problem in Japan. Hence, healthcare professionals including pharmacists should cooperate to provide medical services with limited resources. However, pharmacists might have inadequate skills in taking medical histories. Therefore, we developed an interview tool to collect accurate medical history. In this study, we aimed to validate the contents of medical histories taken by a pharmacist using the interview tool and investigate physician consultation length. Methods: Setting intervention days alternately, adult outpatients of the Kitaibaraki Center for Family Medicine who had new symptoms had their medical histories taken by one of two pharmacists before their physician visit during the study period. The contents of the medical history taken by a pharmacist using text analysis were validated on other four days. All sentences collected by a pharmacist or five physicians were divided into segments, and six other physicians assessed each segment. Differences in length of the physician consultation between those with and without (intervention and control groups, respectively) medical history taken by a pharmacist were investigated. Results: Of 23 patients' medical histories taken by a pharmacist using the interview tool, 84.4% of segments were related to the clinical diagnosis. The mean consultation length was 10.1±8.4 minutes in the intervention group (n=104) and 13.0±10.4 minutes in the control group (n=96) (p=0.048). Conclusions: Medical histories taken by a pharmacist using the interview tool had high content validity and might reduce physician consultation length.

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