What do Iranian physicians value most when choosing a specialty? Evidence from a discrete choice experiment.

BACKGROUND: Choosing a specialty by physicians is fundamentally linked to the performance of health systems and public health outcomes. Identifying the determinants of specialty selection is important to health policy for targeting resources and planning the development of services. This study examined preferences of Iranian physicians for medical specialty using a discrete choice experiment (DCE) method. METHODS: In this study, the attributes of the DCE were determined using rigorous qualitative approach. Then we applied D-efficiency criteria to design the DCE and validated it at a pilot study. In the final survey, we recruited participants from six Iranian provinces and analyzed data using conditional logit model. We estimated willingness to pay (WTP) for non-monetary attributes. RESULTS: The WTP analysis revealed that the most important non-monetary attributes in the selection of a specialty were job burnout, opportunity for procedural activities, and job prestige. The results imply that the attributes that were related to the quality of personal life was more important only for physicians who preferred to choose non-surgical specialties. CONCLUSIONS: The findings demonstrate that traditional gender patterns of specialty selection are changing and quality of personal life characteristics might be the most important factor when developing policies to recruit physicians into non-surgical specialties.

Do failures in non-technical skills contribute to fatal medical accidents in Japan? A review of the 2010-2013 national accident reports.

OBJECTIVES: We sought to clarify how large a proportion of fatal medical accidents can be considered to be caused by poor non-technical skills, and to support development of a policy to reduce number of such accidents by making recommendations about possible training requirements. DESIGN: Summaries of reports of fatal medical accidents, published by the Japan Medical Safety Research Organization, were reviewed individually. Three experienced clinicians and one patient safety expert conducted the reviews to determine the cause of death. Views of the patient safety expert were given additional weight in the overall determination. SETTING: A total of 73 summary reports of fatal medical accidents were reviewed. These reports had been submitted by healthcare organisations across Japan to the Japan Medical Safety Research Organization between April 2010 and March 2013. PRIMARY AND SECONDARY OUTCOME MEASURES: The cause of death in fatal medical accidents, categorised into technical skills, non-technical skills and inevitable progress of disease were evaluated. Non-technical skills were further subdivided into situation awareness, decision making, communication, team working, leadership, managing stress and coping with fatigue. RESULTS: Overall, the cause of death was identified as non-technical skills in 34 cases (46.6%), disease progression in 33 cases (45.2%) and technical skills in two cases (5.5%). In two cases, no consensual determination could be achieved. Further categorisation of cases of non-technical skills were identified as 14 cases (41.2%) of problems with situation awareness, eight (23.5%) with team working and three (8.8%) with decision making. These three subcategories, or combinations of them, were identified as the cause of death in 33 cases (97.1%). CONCLUSIONS: Poor non-technical skills were considered to be a significant cause of adverse events in nearly half of the fatal medical accidents examined. Improving non-technical skills may be effective for reducing accidents, and training in particular subcategories of non-technical skills may be especially relevant.

Introduction of the non-technical skills for surgeons (NOTSS) system in a Japanese cancer center.

PURPOSE: Non-technical skills rating systems, which are designed to support surgical performance, have been introduced worldwide, but not officially in Japan. We performed a pilot study to evaluate the "non-technical skills for surgeons" (NOTSS) rating system in a major Japanese cancer center. METHODS: Upper gastrointestinal surgeons were selected as trainers or trainees. The trainers attended a master-class on NOTSS, which included simulated demo-videos, to promote consistency across the assessments. The trainers thereafter commenced observing the trainees and whole teams, utilizing the NOTSS and "observational teamwork assessment for surgery" (OTAS) rating systems, before and after their education. RESULTS: Four trainers and six trainees were involved in this study. Test scores for understanding human factors and the NOTSS system were 5.89 ± 1.69 and 8.00 ± 1.32 before and after the e-learning, respectively (mean ± SD, p = 0.010). The OTAS scores for the whole team improved significantly after the trainees' education in five out of nine stages (p < 0.05). There were no differences in the NOTSS scores before and after education, with a small improvement in the total scores for the "teamwork and communication" and "leadership" categories. CONCLUSION: These findings demonstrate that implementing the NOTSS system is feasible in Japan. Education of both surgical trainers and trainees would contribute to better team performance.

Contributions of social context to blood pressure: findings from a multilevel analysis of social capital and systolic blood pressure.

BACKGROUND: In recent years, few studies have quantified the effect of residential context on blood pressure. Although these studies have emphasized the importance of socioeconomic influences such as education or poverty levels, the association between the features of social structure such as social capital and blood pressure remain unclear. Therefore, we investigated whether social capital was associated with systolic blood pressure after controlling for individual potential confounders. METHODS: We analyzed data from the Shimane Study conducted from 2006 to 2008 in rural mountainous regions of Japan. After excluding the missing data and data of participants taking hypertension medication, we conducted a multilevel analysis of the data for 335 individuals nested within 30 postcode sectors. RESULTS: Systolic blood pressure increased with increasing age and body mass index. We also found that a higher systolic blood pressure was observed among smokers and those taking medication for diabetes. Regarding the contextual effects of social capital, systolic blood pressure increased with an increasing proportion of lack of fairness, after adjustment for individual confounders. CONCLUSIONS: To the best of our knowledge, this study is the first to investigate the association between social capital and systolic blood pressure by using a multilevel methodological framework. Surprisingly, we found that lack of fairness had a strong effect on systolic blood pressure. However, we could not find any significant associations between other items of social capital and systolic blood pressure. Further studies are needed to clarify the mechanism by which lack of fairness may have an effect on systolic blood pressure.

Social capital and psychological distress of elderly in Japanese rural communities.

The growing recognition of the social determinants of health has stimulated research on social capital and mental health. We explored new empirical evidence regarding whether social capital was a determinant of psychological distress. Baseline surveys examining psychological distress were conducted in two towns in 2006­2007 (participation rates for those aged 20 or over were 27.6 per cent, 6.1 per cent). We also conducted follow-up surveys in 2008 to capture the social capital measured by trust. By linking these data and excluding the missing data, 141 males and 234 females remained as the subjects of our study. Results showed that the odds ratios of psychological distress was higher in groups with low social capital measured by trust (odds ratio 2.17; 95 per cent CI, 1.40-3.36), than those in groups with high social capital. Further, we examined the interaction effect of social capital and social support. The odds ratios of psychological distress was higher in groups with some social support/lower trust (odds ratio 2.21; 95 per cent CI, 1.36-3.58) or no social support/lower trust (odds ratio 2.07; 95 per cent CI, 1.06­4.05), than those in groups with some social support/higher trust. These findings reinforce the hypothesized discussion regarding pathways from social capital to psychological distress via supportive relationships.

Social capital and mental health in Japan: a multilevel analysis.

BACKGROUND: A national cross-sectional survey was conducted in Japan. This is because the growing recognition of the social determinants of health has stimulated research on social capital and mental health. In recent years, systematic reviews have found that social capital may be a useful factor in the prevention of mental illness. Despite these studies, evidence on the association between social capital and mental health is limited as there have been few empirical discussions that adopt a multilevel framework to assess whether social capital at the ecological level is associated with individual mental health. The aim of this study was to use the multilevel approach to investigate the association between neighborhood social capital and mental health after taking into account potential individual confounders. METHODOLOGY/PRINCIPAL FINDINGS: We conducted a multilevel analysis on 5,956 individuals nested within 199 neighborhoods. The outcome variable of self-reported mental health was measured by the one dimension of SF-36 and was summed to calculate a score ranging from 0 to 100. This study showed that high levels of cognitive social capital, measured by trust (regression coefficient = 9.56), and high levels of structural social capital, measured by membership in sports, recreation, hobby, or cultural groups (regression coefficient = 8.72), were associated with better mental health after adjusting for age, sex, household income, and educational attainment. Furthermore, after adjusting for social capital perceptions at the individual level, we found that the association between social capital and mental health also remained. CONCLUSIONS/SIGNIFICANCE: Our findings suggest that both cognitive and structural social capital at the ecological level may influence mental health, even after adjusting for individual potential confounders including social capital perceptions. Promoting social capital may contribute to enhancing the mental health of the Japanese.

Political ideology and health in Japan: a disaggregated analysis.

BACKGROUND: Recent studies from the USA and Europe suggest an association between an individual's political ideology and their health status, with those claiming to be conservatives reporting better health. The presence of this association is examined in Japan. METHODS: Individual-level data from the 2000-3, 2005 and 2006 Japan General Social Survey were analysed. The outcomes of interest were self-rated poor health and smoking status. The independent variable of interest was reported political beliefs on a 5-point 'left'-to-'right' scale. Covariates included age, sex, education, income, occupational status and fixed effects for survey periods. Logistic regression models were estimated. RESULTS: There was an inverse association between political ideology (left to right) and self-rated poor health as well as between ideology and smoking status even after adjusting for age, sex, socioeconomic status and fixed effects for survey periods. Compared with those who identified as 'left', the OR for reporting poor health and smoking among those who identified as 'right' was 0.86 (95% CI 0.74 to 0.99) and 0.80 (95% CI 0.70 to 0.91), respectively. CONCLUSIONS: Health differences by political ideology have typically been interpreted as reflecting socioeconomic differences. The results from Japan corroborate the previous findings from the USA and Europe that socioeconomic differences do not account for health differences by political ideologies. Political ideology is likely to be a marker of several latent values and attitudes (eg, religiosity, individual responsibility and/or community participation) that might be beneficial for health at the individual level.

Social capital and perceived health in Japan: an ecological and multilevel analysis.

Numerous empirical studies, largely conducted in Western societies, have linked social capital to health outcomes. However, few studies thus far have been conducted in northeastern Asian countries, particularly Japan. Therefore, whether social capital is a determinant of health in Japanese society remains unclear. This study attempted to provide new evidence for the impact of social capital on health in Japan by analyzing original survey data with two different statistical models. In total, 1910 subjects were randomly selected from 210 enumeration districts (EDs) considered in the 2000 population census. In the present study, after excluding missing data on the outcome and predictor variables, we conducted an analysis of 1157 individuals nested within 206 EDs. Ecological and multilevel regression analyses were performed to examine the association between social capital and health, measured by the General Health (GH) perception item (a subcategory of Short Form 36 (SF-36)), and to estimate the impact of aggregated indicators of social capital on health. We developed an original Japanese version of three social capital items (perceived helpfulness, kindness, and greeting) based on previous studies and expert opinions and prepared a social cohesion index that integrated these three social capital items. The ecological model, after adjusting for sociodemographic factors, revealed that perceived helpfulness and greeting, along with the social cohesion index, were observed to have statistically significant associations with GH. The multilevel model, after adjusting for individual social capital perceptions, indicated that the two aggregated indicators of community social capital (kindness and greeting), along with the social cohesion index, showed a statistically significant association with GH. These results showed the existence of a contextual effect of social capital on health outcomes, although individual differences in social capital perceptions in Japan were considered.

Medical students' knowledge and perceptions of e-health: results of a study in Sri Lanka.

The present study investigates the knowledge, perceptions and attitudes of medical students in Sri Lanka in regard to e-health. We also examined the barriers which impede them to develop knowledge and skills in e-health within their medical curriculum. A questionnaire focusing on the knowledge, attitudes and expectations of medical students towards e-health was distributed to all final year students (n=136) at the Faculty of Medical Sciences, Sri Jayewardenepura University, Sri Lanka. Response rate was 74%. 43% of respondents stated that they were familiar with the term e-health. 51% rated their knowledge of e-health applications as minimal. 88% admitted that they had no e-health education or training of any kind. Over 80% of all respondents thought that e-health had an important role to play in the current and future health sector, particularly in developing countries. Our survey revealed that respondents had very poor access to computers and Internet use was rare. 77% of respondents admitted that they were not provided with systematic knowledge and skills in e-health through their medical curriculum and identified the absence of formal education in e-health as a serious shortcoming.

[New directions of patient safety policy in several foreign countries].

The importance of safety in healthcare has long been recognized, but actual policies and actions to prevent medical errors and improve patient safety have not been developed comprehensively. Retrospective studies based on medical records provide evidence of the extent of adverse events in healthcare services. The new trends in policies for patient safety differ radically from the previous ones in that they emphasize the necessity of reforming the entire healthcare system to make patient safety the first priority. To achieve this it is necessary to establish an adequate information system to collect and analyze data in a timely fashion and distribute the results to stakeholders to encourage "Safety Culture" in healthcare industries.