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1.
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.

2.
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.

3.
PLoS One ; 9(9): e106586, 2014.
Artículo en Inglés | MEDLINE | ID: mdl-25238544

RESUMEN

BACKGROUND: Recent qualitative studies indicated that physicians interact with pharmaceutical representatives depending on the relative weight of the benefits to the risks and are also influenced by a variety of experiences and circumstances. However, these studies do not provide enough information about if, when, how and why their attitudes and behaviors change over time. METHODS AND FINDINGS: A qualitative study using semi-structured face-to-face individual interviews was conducted on 9 Japanese physicians who attended a symposium on conflicts of interest held in Tokyo. Interviews were designed to explore chronological changes in individual physicians' attitude and behavior concerning relationships with pharmaceutical representatives and factors affecting such changes. Their early interaction with pharmaceutical representatives was passive as physicians were not explicitly aware of the meaning of such interaction. They began to think on their own about how to interact with pharmaceutical representatives as they progressed in their careers. Their attitude toward pharmaceutical representatives changed over time. Factors affecting attitudinal change included work environment (local regulations and job position), role models, views of patients and the public, acquisition of skills in information seeking and evidence-based medicine, and learning about the concepts of professionalism and conflict of interest. However, the change in attitude was not necessarily followed by behavioral change, apparently due to rationalization and conformity to social norms. CONCLUSIONS: Physicians' attitudes toward relationships with pharmaceutical representatives changed over time and factors affecting such changes were various. Paying attention to these factors and creating new social norms may be both necessary to produce change in behavior consistent with change in attitude.


Asunto(s)
Actitud del Personal de Salud , Conflicto de Intereses , Industria Farmacéutica , Relaciones Interprofesionales/ética , Médicos/psicología , Medicina Basada en la Evidencia , Humanos , Japón , Investigación Cualitativa , Factores de Tiempo
4.
PLoS One ; 5(8): e12193, 2010 Aug 13.
Artículo en Inglés | MEDLINE | ID: mdl-20730093

RESUMEN

BACKGROUND: Previous surveys on the relationship between physicians and pharmaceutical representatives (PRs) have been of limited quality. The purpose of our survey of practicing physicians in Japan was to assess the extent of their involvement in pharmaceutical promotional activities, physician characteristics that predict such involvement, attitudes toward relationships with PRs, correlations between the extent of involvement and attitudes, and differences in the extent of involvement according to self-reported prescribing behaviors. METHODS AND FINDINGS: From January to March 2008, we conducted a national survey of 2621 practicing physicians in seven specialties: internal medicine, general surgery, orthopedic surgery, pediatrics, obstetrics-gynecology, psychiatry, and ophthalmology. The response rate was 54%. Most physicians met with PRs (98%), received drug samples (85%) and stationery (96%), and participated in industry-sponsored continuing medical education (CME) events at the workplace (80%) and outside the workplace (93%). Half accepted meals outside the workplace (49%) and financial subsidies to attend CME events (49%). Rules at the workplace banning both meetings with PRs and gifts predicted less involvement of physicians in promotional activities. Physicians valued information from PRs. They believed that they were unlikely to be influenced by promotional activities, but that their colleagues were more susceptible to such influence than themselves. They were divided about the appropriateness of low-value gifts. The extent of physician involvement in promotional activities was positively correlated with the attitudes that PRs are a valuable source of information and that gifts are appropriate. The extent of such involvement was higher among physicians who prefer to ask PRs for information when a new medication becomes available, physicians who are not satisfied with patient encounters ending only with advice, and physicians who prefer to prescribe brand-name medications. CONCLUSIONS: Involvement in pharmaceutical promotional activities is widespread among practicing physicians in Japan. The extent of such involvement varies according to certain physician characteristics. As a group, they are at risk for influence by promotional activities.


Asunto(s)
Recolección de Datos , Industria Farmacéutica , Médicos/estadística & datos numéricos , Publicidad como Asunto , Actitud , Prescripciones de Medicamentos/estadística & datos numéricos , Donaciones/ética , Características Humanas , Japón , Médicos/ética , Médicos/psicología
5.
Intern Med ; 47(14): 1325-7, 2008.
Artículo en Inglés | MEDLINE | ID: mdl-18628580

RESUMEN

BACKGROUND: Many women's health centers (WHC) in Japan use female obstetrician-gynecologists, not trained in primary care medicine, as providers. It is not known whether the clinical needs of patients at WHC are met by these providers. OBJECTIVE: To identify the clinical needs of patients attending a WHC in Japan by examining their presenting problems and diagnoses. METHODS: We performed a case-series study of 53 patients at a WHC in a public medical center in Chiba Prefecture, Japan. Charts were reviewed for the presenting problems and diagnoses. RESULTS: The most common presenting complaints were related to the female genital system or the breast (42%) and psychological problems (13%). At discharge, the most common diagnoses were psychological (42%). The next most common diagnoses were related to the female genital system or the breast (36%). The remainder (22%) were related to a variety of organ systems. CONCLUSION: Patients at the WHC presented with not only gynecological but also general medical and psychological problems and had discharge diagnoses involving a variety of organ systems. Physicians at WHCs should be trained in primary care medicine to meet the clinical needs of patients.


Asunto(s)
Evaluación de Necesidades , Servicios de Salud para Mujeres , Adolescente , Adulto , Anciano , Femenino , Humanos , Japón , Auditoría Médica , Persona de Mediana Edad , Atención Primaria de Salud
6.
Asian Pac J Cancer Prev ; 8(2): 258-62, 2007 Apr-Jun.
Artículo en Inglés | MEDLINE | ID: mdl-17696742

RESUMEN

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


Asunto(s)
Actitud Frente a la Salud , Examen Físico , Médicos de Familia/psicología , Salud Pública/estadística & datos numéricos , Adulto , Anciano , Estudios Transversales , Femenino , Encuestas Epidemiológicas , Humanos , Japón , Masculino , Persona de Mediana Edad , Encuestas y Cuestionarios
7.
Fertil Steril ; 88(4): 969.e7-9, 2007 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-17493620

RESUMEN

OBJECTIVE: To report a rare complication of GnRH agonist therapy for intestinal endometriosis. DESIGN: Case report. SETTING: University hospital. PATIENT(S): A 45-year-old nulliparous Japanese woman with catamenial digestive symptoms. INTERVENTION(S): GnRH agonist therapy. MAIN OUTCOME MEASURE(S): Acute abdomenal crisis with free air in the abdominal X-ray. RESULT(S): An emergency laparotomy showed both an ileal constriction and perforation. An ileocecal enterectomy with an end-to-end anastomosis was performed. A pathological examination of the ileum revealed ileal endometriosis. CONCLUSION(S): Flare-up of intestinal endometriosis induced by GnRH agonist has the potential to lead to intestinal perforation. Careful diagnosis and treatment are necessary for cyclic and periodic gastrointestinal manifestation.


Asunto(s)
Abdomen Agudo/inducido químicamente , Endometriosis/complicaciones , Hormona Liberadora de Gonadotropina/agonistas , Enfermedades del Íleon/etiología , Perforación Intestinal/etiología , Leuprolida/efectos adversos , Endometriosis/inducido químicamente , Femenino , Humanos , Persona de Mediana Edad
8.
Toxicology ; 184(1): 1-9, 2003 Feb 14.
Artículo en Inglés | MEDLINE | ID: mdl-12505371

RESUMEN

Mercurial compounds modulate immunologic functions by inducing cytotoxicity. Although mercury chloride (HgCl(2)) is known to induce apoptosis in various immune system cells, the mechanism of the induction of apoptosis is poorly understood. In this study, we examined the activation of caspase-3, an important cysteine aspartic protease, during HgCl(2)-induced apoptosis in a human leukemia cell line (HL-60 cells). Both DNA fragmentation, a characteristic of apoptotic cells, and proteolysis of poly(ADP-ribose) polymerase (PARP), a substrate of caspase-3, occurred at 6 h after HgCl(2) treatment in HL-60 cells. These results suggest that the activation of caspase-3 was involved in HgCl(2)-induced apoptosis. The release of cytochrome c (Cyt c) from mitochondria into the cytosol, which is an initiator of the activation of caspase cascades, was also observed in HgCl(2)-treated HL-60 cells. Moreover, the release of Cyt c from mitochondria was observed in HgCl(2)-treated mitochondria isolated from mice liver, and this was followed by mitochondrial permeability transition (PT). The PT was inhibited by cyclosporin A (CsA), a potent inhibitor of PT. CsA also suppressed the occurrence of DNA fragmentation induced by HgCl(2) treatment in HL-60 cells. Taken together, these findings indicate that HgCl(2) is a potent inducer of apoptosis via Cyt c release from the mitochondria in HL-60 cells.


Asunto(s)
Apoptosis/efectos de los fármacos , Leucemia Promielocítica Aguda/patología , Cloruro de Mercurio/toxicidad , Mitocondrias/efectos de los fármacos , Animales , Western Blotting , Sistema Libre de Células , Grupo Citocromo c/metabolismo , Fragmentación del ADN/efectos de los fármacos , Células HL-60 , Humanos , Leucemia Promielocítica Aguda/etnología , Ratones , Mitocondrias/enzimología , Mitocondrias/fisiología , Permeabilidad/efectos de los fármacos , Poli Adenosina Difosfato Ribosa/farmacología
9.
Chem Pharm Bull (Tokyo) ; 50(6): 808-13, 2002 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-12045336

RESUMEN

Five new ent-kaurane-type diterpenoids and a new gymnomitrane (=barbatane)-type sesquiterpenoid have been isolated from the Japanese liverwort Jungermannia truncata NEES, together with twelve previously known ent-kaurane-type diterpenoids. The structures of the new compounds were elucidated by two-dimensional (2D) NMR experiments and chemical reaction. Some of the isolated compounds showed cytotoxicity against human leukemia cell lines and induced apoptosis.


Asunto(s)
Apoptosis , Diterpenos/aislamiento & purificación , Plantas Medicinales/química , Diterpenos/química , Diterpenos/farmacología , Células HL-60 , Humanos , Japón , Conformación Molecular
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