International medical learners and their adjustment after returning to their countries of origin: a qualitative study.

INTRODUCTION: International medical trainees, including residents and fellows, must cope with many challenges, such as differences in cultural hierarchical systems, languages, and acceptance. Nonetheless, the need for adjustment perpetuates even after training is completed abroad. When some international trainees return to their countries of origin, they continue to face adjustment challenges due to reverse culture shock. Others must make many further readjustments. This study presents an exploration of the adjustment and coping strategies of international medical learners after returning to their countries of origin upon completion of their programs. METHOD: This study employed a qualitative approach grounded in interpretivism and utilised inductive thematic analysis following Braun and Clarke's method. Semi-structured, in-depth individual interviews were employed to explore the participants' coping strategies. Participants included international medical learners who were (1) international medical graduates who had already returned to their countries of origin, (2) non-Canadian citizens or nonpermanent residents by the start of the programs, and (3) previously enrolled in a residency or fellowship training programme at the University of Toronto, Ontario, Canada. RESULTS: Seventeen participants were included. Three main themes and seven subthemes were created from the analysis and are represented by the Ice Skater Landing Model. According to this model, there are three main forces in coping processes upon returning home: driving, stabilising, and situational forces. The sum and interaction of these forces impact the readjustment process. CONCLUSION: International medical learners who have trained abroad and returned to their countries of origin often struggle with readjustment. An equilibrium between the driving and stabilising forces is crucial for a smooth transition. The findings of this study can help stakeholders better understand coping processes. As healthy coping processes are related to job satisfaction and retention, efforts to support and shorten repatriation adjustment are worthwhile.

The Chinese Parenting Stress Scale for Preschoolers' Parents: Development and Initial Validation.

Parenting stress is the experience of discomfort or distress that results from the demands associated with the role of parenting. Although there are numerous parenting stress scales, relatively few scales have been developed with consideration of the Chinese cultural context. This study aimed to develop and validate the Chinese Parenting Stress Scale (CPSS) with a multidimensional and hierarchical structure for Mainland Chinese preschoolers' parents (N = 1,427, Mage = 35.63 years, SD = 4.69). In Study 1, a theoretical model and an initial 118 items were developed, drawing on prior research and existing measures of parenting stress. Exploratory factor analysis yielded 15 first-order factors with 60 items. In Study 2, confirmatory factor analyses supported a higher order solution consisting of 15 first-order factors covering four domains: Child Development (12 items), Difficult Child (16 items), Parent-Child Interaction (12 items), and Parent's Readjustment to Life (20 items). Measurement invariance indicated no gender differences between parents for the scale scores. The convergent, discriminant, and criteria validity of the CPSS scores was supported by its association with related variables in the expected directions. Moreover, the CPSS scores added significant incremental variance in predicting somatization, anxiety, and child's emotional symptoms more so than the Parenting Stress Index-Short Form-15. The CPSS total and subscale scores all had acceptable Cronbach's αs in both samples. The overall findings support the CPSS as a psychometrically sound tool.

Dynamic Service Function Chain Deployment and Readjustment Method Based on Deep Reinforcement Learning.

With the advent of Software Defined Network (SDN) and Network Functions Virtualization (NFV), network operators can offer Service Function Chain (SFC) flexibly to accommodate the diverse network function (NF) requirements of their users. However, deploying SFCs efficiently on the underlying network in response to dynamic SFC requests poses significant challenges and complexities. This paper proposes a dynamic SFC deployment and readjustment method based on deep Q network (DQN) and M Shortest Path Algorithm (MQDR) to address this problem. We develop a model of the dynamic deployment and readjustment of the SFC problem on the basis of the NFV/SFC network to maximize the request acceptance rate. We transform the problem into a Markov Decision Process (MDP) and further apply Reinforcement Learning (RL) to achieve this goal. In our proposed method (MQDR), we employ two agents that dynamically deploy and readjust SFCs collaboratively to enhance the service request acceptance rate. We reduce the action space for dynamic deployment by applying the M Shortest Path Algorithm (MSPA) and decrease the action space for readjustment from two dimensions to one. By reducing the action space, we decrease the training difficulty and improve the actual training effect of our proposed algorithm. The simulation experiments show that MDQR improves the request acceptance rate by approximately 25% compared with the original DQN algorithm and 9.3% compared with the Load Balancing Shortest Path (LBSP) algorithm.

Longitudinal Changes in Occupational Balance among Baby Boomers in Japan (1996-2016).

In Japan, the proportion of the older adult population-the post-war baby boomer generation-is increasing rapidly and presenting new problems, such as suicide among baby boomers and the burden of family care. The purpose of this study was to clarify how baby boomers changed their occupational balance between their 40s and 60s. This study used public statistical data from the Survey on Time Use and Leisure Activities published by the Statistics Bureau of Japan to analyze the longitudinal characteristics of the time allocation of baby boomers. The findings of this study showed gender differences in occupational balance among the study population. The occupational balance of men changed due to occupational transition after mandatory retirement, but that of women did not change significantly. Longitudinally examining the time allocation changes of one generation revealed that the readjustment of occupational balance is necessary during life role changes, such as retirement. Moreover, if this readjustment is not carried out properly, individuals will experience role overload and loss.

Posttraumatic Growth Experiences of Adolescents With Parental Loss: A Phenomenological Study.

This study examines the post-traumatic growth of adolescents who have lost their parents about their experiences. Eight adolescents whose parents had died participated in the study conducted in the phenomenological design. The data were collected with three-step semi-structured interviews and analyzed using the phenomenological analysis technique performed in five stages. The findings were grouped into three main themes as "reactions to loss," "readjustment," and "post-traumatic growth," and nine subthemes under each, and these sub-themes were categorized into forty-five codes.

Unusual Experience in the COVID-19 Pandemic: Young Children's Readjustment from Home to Preschool following School Closures in Different Risk Regions.

Children's readjustment to preschool following long-term school closures during the COVID-19 pandemic merits special attention. This study examined children's preschool readjustment using a survey of 1008 teachers in a high-risk region and 1399 teachers in a fluctuating-risk region of China. Results found are as follows. (1) children's preschool readjustment was at a medium level after the long-term school closures. However, children's preschool readjustment scores in the fluctuating-risk region were significantly lower than those in the high-risk region. (2) Children in both regions were divided into four profiles based on their preschool readjustment: low-level, middle-level, upper-middle-level, and high-level groups. (3) Preschool transition practices and teachers' turnover intention are common factors relating to preschool readjustment in both regions. Teachers' professional development support impacted children's preschool readjustment only in the high-risk region. The findings inform the design of targeted interventions to help children readjust to preschool across different risk regions.

Mindfulness-based stress reduction may decrease stress, disease activity, and inflammatory cytokine levels in patients with autoimmune hepatitis.

Background & Aims: Psychological and life stressors may impact autoimmune hepatitis (AIH) disease activity and increase relapse risk. Mindfulness-based stress reduction (MBSR) is a validated course that reduces stress reactivity, and improves stress and emotion regulation. This single-arm exploratory pilot study of adult patients with AIH aimed to define the impact of an 8-week MBSR program on quality of life, disease activity, and cytokine mediators. Methods: The perceived stress survey-10 (PSS) and the brief self-control scale (BSCS) measured subjective distress and self-control. Serum alanine aminotransferase (ALT) and cytokine levels were measured, and immunosuppressant doses recorded. Results: Seventeen patients completed the MBSR program. Post-MBSR, 71% (n = 12) showed PSS score improvement at 8 weeks vs. baseline (median 15 vs. 21, p = 0.02). At 12 months, PSS improvement persisted vs. baseline (median 15 vs. 21, p = 0.02). Post-MBSR, 71% (n = 12) showed BSCS score improvement at 8 weeks vs. baseline (median 4.1 vs. 3.8, p = 0.03). At 12 months, the median BSCS score remained significant (3.9 vs. 3.8, p = 0.03). After the 8-week MBSR, the 35% of patients with ALT >34 U/L had a median ALT reduction (44.5 vs. 71.5 U/L, p = 0.06), whereas the 71% of patients on prednisone had significant dose reductions (5.75 vs. 10 mg, p = 0.02) which persisted at 12 months vs. baseline (3.75 vs. 10 mg, p = 0.02) without a compensatory increase in steroid-sparing dosing. Significant improvement was noted in peripheral blood cytokine levels (IL-6, IL-8, IL-10, IL-17, IL-23, and sCD74/MIF ratio) from baseline to 8 weeks. Conclusions: MBSR significantly improved perceived stress and self-control scores while decreasing ALT levels, steroid requirements, and inflammatory cytokine levels in this pilot study in adult AIH. Stress modification may impact quality of life and disease activity, and should be further evaluated as an intervention in AIH. Clinical Trials registration: This study is registered at ClinicalTrials.gov (NCT02950077). Lay summary: Autoimmune hepatitis can reduce quality of life and mental health, while stress may impact autoimmune hepatitis itself. We piloted mindfulness-based stress reduction as a strategy to reduce stress in adult patients with autoimmune hepatitis and found that the intervention reduced perceived stress and may have also impacted the disease by improving inflammation and medication needs. Stress reduction should be further studied to improve quality of life and possibly to impact disease activity in autoimmune hepatitis.

Trajectories of suicidal ideation following separation from military service: Overall trends and group differences.

BACKGROUND: Although the transition out of military service is a high-risk time for suicidal ideation (SI), a paucity of research examines the development of SI during this transition process and veteran subgroups at risk for SI as they readjust to civilian life. METHODS: A population-based, longitudinal post-9/11 veteran cohort reported SI frequency at 3, 9, 15, 21, and 27 months post-separation using the Patient Health Questionnaire-9. We identified distinct trajectories of SI over time (i.e., classes) using latent class growth analysis and examined demographic and military service predictors of class membership overall and by gender using multinomial logistic regression. RESULTS: Four SI trajectories that were similar across genders were identified: resilient (90.1%), delayed onset (5.0%), remitting (2.7%), and chronic (2.2%). Younger age, minority race/ethnicity, medical and other (vs. honorable) separation types, and Veterans Health Administration service utilization were associated with increased odds of assignment to a higher-risk trajectory (delayed onset, remitting, and/or chronic vs. resilient), whereas continued service in the National Guard/Reserves and officer rank was associated with lower odds of assignment to a higher-risk trajectory. CONCLUSIONS: Findings regarding veterans at greatest risk for SI following military separation can inform targeted assessment and early intervention efforts.

Changes in the health and broader well-being of U.S. veterans in the first three years after leaving military service: Overall trends and group differences.

OBJECTIVES: Scholars have theorized that the initial period after military discharge may be a particularly vulnerable time for veterans. Yet, several recent studies raise the prospect that risk for poor adjustment may actually increase rather than decrease over time. The current study examined whether the U.S. military veteran population experiences improvements or declines in their health and broader well-being during the first three years after leaving military service and documented differences based on gender, military rank, and warzone deployment history. METHODS: A population-based sample of 3733 newly separated veterans completed a survey within three months of separation (Fall 2016), followed by five additional surveys at six-month intervals. Weighted multilevel logistic regressions were conducted to examine changes in the proportion of veterans reporting good health and broader well-being over time. RESULTS: Most aspects of veterans' health and broader well-being worsened over time, with a noteworthy increase in reporting of mental health conditions and a decline in veterans' community involvement. Declines in the proportion of veterans reporting good health and well-being were most notable for women, with smaller differences observed for other subgroups. CONCLUSIONS: The finding that veterans experienced worsening health and broader well-being over time highlights the need for enhanced prevention and early intervention efforts to mitigate these declines. Findings also point to the importance of attending to the unique readjustment concerns of female veterans and other at-risk subgroups.

An examination of the mental health and academic performance of student veterans.

Objective: The purpose of this study was to provide a more comprehensive look into the demographics of the veteran student subpopulation while exploring the relationship between the mental health of student veterans and their academic performance. Methods: A nationwide anonymous survey was distributed to student veterans who were enrolled in postsecondary institutions. Results: A large number of participants reported distress with symptoms of PTSD, depression, sleep disturbances, and/or suicidal ideation and attempts, and screened likely for mental health problems in these areas. Participants also endorsed academic problems ranging from the ability to stay focused to failing tests and quizzes. Additional findings demonstrated a positive association between GPA and both PTSD and depression. Conclusion: These findings can be used as a platform upon which to begin the discussion on the implications for mental health professionals, administrators, and educators.

Identifying factors that contribute to military veterans' post-military well-being.

Prior research has examined the independent effects of demographic and military characteristics, trauma history, and coping resources on military veterans' health. However, there is limited knowledge of how these factors intersect with one another and with veterans' health to impact their broader well-being as they readjust to civilian life. Data for this study were drawn from a longitudinal investigation of the health and broader well-being of U.S. veterans (N = 7150) who had recently left military service. Machine learning analyses (random forests of regression trees) were used to examine how factors assessed shortly after military separation were associated with veterans' well-being approximately a year later. Veterans who endorsed the combination of low depression, high social support, and high psychological resilience were most likely to report high well-being a year later. Neither demographic and military characteristics nor trauma history emerged as strong predictors of veterans' well-being when considered in the context of other factors. Although most predictors were similar for women and men, depression was a stronger predictor of women's well-being. Results highlight the importance of screening for and intervening with veterans who report high depression, low social support, and low psychological resilience when leaving military service. These findings can inform efforts to promote veterans' post-military well-being.

Systematic review and meta-analysis comparing Adjustable Transobturator Male System (ATOMS) and male Readjustment Mechanical External (REMEEX) system for post-prostatectomy incontinence.

OBJECTIVE: To assess the efficacy and safety of Adjustable Transobturator Male System (ATOMS) compared to male Readjustment Mechanical External (REMEEX) system for post-prostatectomy incontinence (PPI). MATERIAL AND METHODS: A systematic review and meta-analysis on adjustable device ATOMS compared to male REMEEX is presented. Studies on female or neurogenic incontinence were excluded. Primary objectives were evaluation of dryness (the proportion of patients with no-pad or one safety pad/day after device adjustment) and improvement between devices. Secondary objectives were complications and explant rate. They were estimated using a random-effect model. Statistical heterogeneity among studies was assessed using Cochran's Q test, Higgins's I2 statistics and tau2. RESULTS: Combined data of 29 observational studies with 1919 patients showed an equivalent proportion of patients treated with radical prostatectomy (p = .125) and previous radiation (p = .126). Dryness rate was 69.3% for ATOMS and 53.4% for male REEMEX (p = .008). Improvement rate was 90.8% for ATOMS and 80.2% for REMEEX (p = .007). Complication rate was 18.9% for ATOMS and 35.8% for REMEEX (p = .096) and explant rate was 5.5% for ATOMS and 13.9% for REMEEX (p = .027). Significant heterogeneity was evidenced, due to absence of randomized studies, variable incontinence severity baseline, difficulties for a common reporting of complications and difference in the follow-up. Differences observed between devices remained statistically significant when only studies with silicone-covered scrotal port (SSP) ATOMS and male REMEEX system II were considered. CONCLUSIONS: Despite the absence of direct comparison and the limitations observed ATOMS appears more effective than male REMEEX to treat PPI, and with less explant rate as reported in the literature.

It is more than Interference: Examining the neurohemodynamic correlates of the flanker task with functional near-infrared spectroscopy.

Previous functional near-infrared spectroscopy studies using the Eriksen flanker task, in contrast to functional magnetic resonance imaging studies, revealed the quite puzzling finding of an inverted conflict effect, that is, greater middle and superior frontal activation in response compatible than in response incompatible trials. However, since neither prior functional near-infrared spectroscopy studies nor most previous functional magnetic resonance imaging studies separated between an identical and a compatible condition, it is hard to pinpoint whether this discrepancy occurs on the level of stimulus processing or response generation. By assigning two letters to both left (D, F) and right (J, K) hand reactions, we were able to separate identical (e.g., JJJ) and compatible (e.g., JKJ) conditions that solely differ in their stimulus congruency. Replicating prior functional magnetic resonance imaging findings, we found the standard conflict effect at the transition of superior and middle frontal gyrus, when comparing the activation in compatible trials to that in incompatible trials. Both changes in oxygenated and deoxygenated hemoglobin thus pointed to more effortful processing in incompatible trials. Interestingly, however, identical trials showed the highest activation in this region, according to both changes in oxygenated and deoxygenated blood. A finding that mirrors and extends prior functional near-infrared spectroscopy findings, which only regarded oxygenated blood. We argue that this pattern of results does not reflect the standard conflict effect. We rather assume that other processes like perceptual familiarity or strategic readjustment might be at play.

Training for a new environment: Using military operational concepts in counseling veterans.

Since September 11, 2001, the United States has engaged in an extended period of military conflict, resulting in 4.1 million men and women serving in support of Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn. Whereas not all servicemembers experience mental health issues, many have experienced difficulties with readjusting to the civilian world, often requiring mental health services both inside and outside of the Department of Veterans Affairs. Issues related to stigma and military culture contribute to barriers not only for veterans seeking treatment but for clinicians providing services who may lack experience with military culture. This article provides a framework to use military concepts in clinical sessions to further therapeutic engagement with the military/veteran client.

A lifeline in the dark: Breaking through the stigma of veteran mental health and treating America's combat veterans.

For generations, veterans have answered the call to service and served their country honorably and with distinction. Unfortunately, the consequences of combat cause many veterans to struggle with life after the military and with readjustment/reintegration into civilian life. Today more than ever, there are a multitude of resources, education, and treatment options for combat veterans. For mental and physical health providers, business leaders, and other professionals who work with veterans, it is of the upmost importance that they learn about programs around them that are successful in treating veterans. The current article reviews two U.S. Department of Veterans Affairs nationwide programs-the Readjustment Counseling Service/Vet Center and Veteran Cultural Competence Training-designed to decrease mental health stigma for veterans and to increase veteran engagement with mental health services. These programs highlight the importance of being aware of the culture within military systems, being aware of personal biases, and fostering an environment of genuineness, safety, and nonjudgmental empathy. In doing so, these programs are successful in reducing the unspoken power of stigmatization; they effectively reach out to veterans in need, providing a lifeline in the dark.

Visión personal del rol de SOCHED en la tramitación parlamentaria de la Ley de Identidad de Género (2013 - 2018) / Personal vision of the role of SOCHED in the parliamentary procedure of the Gender Identity Law (2013 - 2018)

SOCHED debe preocuparse del desarrollo profesional de sus miembros y de alzar su voz ante temas endocrinológicos relevantes para la sociedad chilena. La invisibilidad a todo nivel del tema trans nos encontró mal posicionados, pues la nula formación en este aspecto cerraba el ciclo de su desconocimiento en pre y post grado. Las solicitudes de muchos años para discutir el tema en nuestros congresos había sido sistematicamente rechazadas o ignoradas. El desconcierto y alarma produjeron las consultas de personas trans que nos solicitaban la fase endocrinológica de la readecuación corporal, revelando la falta de preparación para comprenderlos y tratarlos. El proyecto de ley de identidad de género puso en evidencia además la falta de estructura de SOCHED para actuar en el campo político y parlamentario. Reseñamos la actuación de SOCHED en este proceso y las medidas sugeridas sobre cambios a realizar y puntos débiles a corregir. Se debe evitar su repetición , por ejemplo si se propusiera el tratamiento hormonal de la pedofilia.

SOCHED must worry about the professional development of its members and to raise its voice before the endocrinological issues for the Chilean society. The invisibility at all levels of the trans aspect found us bad positioned, as the null formation in this aspect closed the cycle of its disconnection in pre-and post-grade. The request of many years to discuss this topic in our congresses had been systematically rejected or ignored. The alarm and disconcerate caused by the questions of trans persons who requested us the endocrinological phase of body readjustment, revealing the failure of preparation to understand and treat them. The gender identity law project put evidence also the lack of SOCHED structure to act in the political and parliamentary field. We review the action of SOCHED in this process and the measures suggested about changes to be implemented and the weaknesses points to correct. their repetition must be avoided, for example if the hormone treatment of the pedophilia is proposed.

Use of best-worst scaling to estimate the magnitude of stressful life events in older adults.

AIM: The magnitude of stressful life events can be measured by using rating scales such as the Social Readjustment Rating Scale. This study aimed to estimate the magnitude of stressful life events by using a best-worst scaling approach in a sample of community-dwelling older persons in Taiwan. METHODS: Participants aged 55 years or older were asked to rate the stressfulness of 11 life events on a scale from 0 to 10 and the best-worst scaling. We used the case one (object case) best-worst scaling design: each task on a list of events was presented to participants, and they were asked to indicate the events that they considered most and least stressful. RESULTS: A total of 61 persons (66% women) provided valid responses for analysis; the mean age was 64.8 ± 8.6 years. For best-worst scaling, 'major illness of family member' (mean best-minus-worst score = 128) was rated the most stressful, and 'sexual difficulties' was rated the least stressful (mean best-minus-worst score = -153). For the rating scale, 'major personal illness' was rated the most stressful (mean rating = 6.95), and 'sexual difficulties' was again the least stressful (mean rating = 2.05). Rankings of events based on both methods were similar but were different from ratings based on the Social Readjustment Rating Scale. CONCLUSION: The current study explored using BWS to estimate the magnitude of stressful life events. The magnitude of events estimated in our study was found to differ from the magnitude estimated previously by some common scales for assessing stressful life events.

Las políticas públicas en la educación médica y su influencia en el reajuste curricular / Public politics in medical education and their influence on the curricular readjustment

Los desafíos del mundo actual exigen otorgar a la salud una prioridad dentro de las políticas sociales y en este proceso la universidad asume una posición de principios. En los últimos años, diversos países de la región latinoamericana y del mundo han mostrado el resultado del trabajo de reajuste de los currículos de formación. Se advierte el interés de acercar más al profesional a la atención primaria de salud y se implementan nuevas disciplinas, para lograr cumplir con las metas de Salud para Todos de la Organización Mundial de la Salud. Cuba por su parte, se ha caracterizado por mantener desde 1959 una línea coherente de trabajo para lograr la calidad de los servicios de salud. La formación de médicos ha sido desde entonces una tarea estratégica y una serie de planes de estudio han permitido en cada momento histórico enfrentar estos retos. Disímiles son los criterios publicados en estos últimos años con respecto a la manera en que hoy se conduce la formación básica del futuro galeno, lo que ha generado debates entre los interesados y al fin motivado reformas, aunque estas aún insuficientes. Actualmente se implementa un nuevo plan de estudios en la carrera de medicina, verdadera tarea para los docentes que llevan a cabo esta labor. El propósito es promover una reflexión acerca del tratamiento de las políticas públicas en salud de la región y en particular el de Cuba, haciendo hincapié en la educación médica como eje formador y sostenedor de la misma (AU).

The challenges of the current world require conferring to health care a priority among the social politics, and in this process the medical university assumes a position of principles. During the last years, several countries of the Latin American area and around the world have showed the results of the readjustment of the training curriculums. It is noticed the interest of approaching professionals to the primary health care, and new subjects are implemented, to reach the aims of "Health for everyone", the program of the World Health Organization (WHO). Cuba, for its part, has been characterized for keeping up a coherent line of work to achieve the quality of health services since 1959. Since them the training of physicians has been a strategic task, and a series of study plans have allowed to affront these challenges in each historical moment. Several criteria have been published in the last years with respect to the way the basic training of the futures physicians is led; it has generated disputes among the interested factors, motivating reforms at the end that are still insufficient. Currently, a new study plan is implemented in the medicine studies, a true task for the teaching staff carrying this task out. The aim is promoting reflections on the treatment of public health politics in the region and particularly in Cuba, making emphasis in medical education as its training and sustaining axis (AU).

Las políticas públicas en la educación médica y su influencia en el reajuste curricular / Public politics in medical education and their influence on the curricular readjustment

Los desafíos del mundo actual exigen otorgar a la salud una prioridad dentro de las políticas sociales y en este proceso la universidad asume una posición de principios. En los últimos años, diversos países de la región latinoamericana y del mundo han mostrado el resultado del trabajo de reajuste de los currículos de formación. Se advierte el interés de acercar más al profesional a la atención primaria de salud y se implementan nuevas disciplinas, para lograr cumplir con las metas de Salud para Todos de la Organización Mundial de la Salud. Cuba por su parte, se ha caracterizado por mantener desde 1959 una línea coherente de trabajo para lograr la calidad de los servicios de salud. La formación de médicos ha sido desde entonces una tarea estratégica y una serie de planes de estudio han permitido en cada momento histórico enfrentar estos retos. Disímiles son los criterios publicados en estos últimos años con respecto a la manera en que hoy se conduce la formación básica del futuro galeno, lo que ha generado debates entre los interesados y al fin motivado reformas, aunque estas aún insuficientes. Actualmente se implementa un nuevo plan de estudios en la carrera de medicina, verdadera tarea para los docentes que llevan a cabo esta labor. El propósito es promover una reflexión acerca del tratamiento de las políticas públicas en salud de la región y en particular el de Cuba, haciendo hincapié en la educación médica como eje formador y sostenedor de la misma (AU).

The challenges of the current world require conferring to health care a priority among the social politics, and in this process the medical university assumes a position of principles. During the last years, several countries of the Latin American area and around the world have showed the results of the readjustment of the training curriculums. It is noticed the interest of approaching professionals to the primary health care, and new subjects are implemented, to reach the aims of "Health for everyone", the program of the World Health Organization (WHO). Cuba, for its part, has been characterized for keeping up a coherent line of work to achieve the quality of health services since 1959. Since them the training of physicians has been a strategic task, and a series of study plans have allowed to affront these challenges in each historical moment. Several criteria have been published in the last years with respect to the way the basic training of the futures physicians is led; it has generated disputes among the interested factors, motivating reforms at the end that are still insufficient. Currently, a new study plan is implemented in the medicine studies, a true task for the teaching staff carrying this task out. The aim is promoting reflections on the treatment of public health politics in the region and particularly in Cuba, making emphasis in medical education as its training and sustaining axis (AU).

Improved treatment satisfaction and medication adherence after readjusting oral medication regimens with the cooperation of health insurance pharmacy in type 2 diabetic patients in Japan.

BACKGROUND: Treatment satisfaction and medication adherence can be improved if physicians carefully monitor the situations, check the level of difficulties patients experience when taking medications at specific times, and readjust medication regimens based on this information. However, physicians in Japan encounter difficulties in taking enough time to collect this information in clinical practice. The aim of the current study was to investigate improvements in satisfaction and adherence with the cooperation of a health insurance pharmacy in clinical practice. METHODS: We retrospectively analyzed 29 type 2 diabetic outpatients who were receiving their prescriptions at a medical clinic and filling prescriptions at a nearby pharmacy. The pharmacy collected information regarding satisfaction, adherence, and preferred time of taking medications, and provided these data to the clinic. The oral medication regimens for these 29 patients were readjusted based on the information obtained. RESULTS: After readjustments, the dosing frequency was decreased from 3.4 ± 1.2 to 1.8 ± 0.5 times/day, and the number of pills was reduced from 5.7 ± 2.0 to 4.5 ± 1.7 (both p < 0.001). Increases in treatment satisfaction from 33 ± 12 to 44 ± 10 points (n = 29, p < 0.001) were observed when assessed using a questionnaire (60-point maximum). Medication adherence based on pill counts increased from 75% ± 22% to 91% ± 14% (n = 24, p < 0.001) (5 patients were excluded due to missing data). CONCLUSIONS: Treatment satisfaction and medication adherence were improved after readjustments of oral medication regimens with the cooperation of a health insurance pharmacy in clinical practice in Japan.