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

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

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

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

A qualitative study of factors promoting EBM learning among medical students in Japan.

Objectives: To identify the elements needed to facilitate undergraduate EBM learning among Japanese medical students. Methods: We conducted a qualitative study based on individual semi-structured interviews. Participants were physicians working at universities, teaching hospitals, or clinics who teach EBM to medical students. Purposive sampling was used to recruit participants via email through the researchers' acquaintances. Six physicians agreed to participate in the study and were interviewed individually from October 2019 to January 2020. The interviewees were asked about their own EBM learning and teaching experiences, what they kept in mind when teaching EBM to medical students, and what they felt was needed to improve current undergraduate EBM education. Interviews were recorded. Transcripts were analysed using thematic analysis. Results: Thematic analysis extracted five themes: finding foreground questions, observing role models, active learning, understanding patient backgrounds, and understanding the reason for learning EBM. To promote EBM education for medical students, it is first necessary for students to actively participate in clinical practice and identify foreground questions by observing their supervisors practicing EBM. In addition to acquiring skills in information retrieval and critical appraisal, understanding a patient's background leads to understanding the significance of learning EBM, which improves students' motivation to learn EBM. Conclusions: This study identified five themes that promote undergraduate EBM education. Curriculum development incorporating these elements would improve EBM education in Japan and other countries.

Effectiveness of a case-based digital learning interprofessional workshop involving undergraduates in medical technology, radiological science, and physical therapy: A pre-post intervention study.

All healthcare professionals must understand information on a patient's biophysical functions, and it is important to educate professionals on how to use this information in an interprofessional team for diagnosis. However, there is little interprofessional education for students of medical technology and radiological science involved in biophysical function diagnosis. In the present study, we developed a case-based interprofessional learning tool for using biophysical information for diagnosis. The study examined the effects of a collaborative exercise workshop for healthcare professional students using the tool. Participants were 234 students from three healthcare professions (medical technology, radiological science, and physical therapy). They completed the Japanese version of the Readiness for Interprofessional Learning Scale before and after the workshops. The workshops incorporated digital materials that allowed students to examine the test results of a virtual patient, answer questions, and discuss their diagnoses and prognoses. For analysis, a two-way analysis of variance was performed on the total score on the Readiness for Interprofessional Learning Scale of the three departments, and the effectiveness of the workshop for the three departments was compared. Statistical analyses showed no interaction between time and department (p = 0.283). After the workshop, students from all three departments showed significant improvements in total scores on the Readiness for Interprofessional Learning Scale (p < 0.01) with medium to large effect sizes (r = 0.33-0.52). In the comparison between departments, there was a significant difference in the awareness levels of only medical technology and radiological science students before the workshop (p = 0.015). This study conducted case-based learning workshops with students from three departments, in which a patient's biophysical information was conveyed between occupational practices. The workshops improved the awareness of interprofessional education in students from all departments and revealed that interprofessional education is important for healthcare professions involved in biophysical function diagnosis.

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

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

Crisis-management, Anti-stigma, and Mental Health Literacy Program for University Students (CAMPUS): A preliminary evaluation of suicide prevention.

Background: University students have specific risk factors for suicide, necessitating targeted prevention programs. This preliminary study evaluated the efficacy of the Crisis-management, Anti-stigma, Mental health literacy Program for University Students (CAMPUS) for reduction of risk factors and promotion of preventative behaviors. Methods: A total of 136 medical students attended the CAMPUS as a required course at the national university in Japan. The CAMPUS consisted of a lecture and two group sessions covering mental health literacy, self-stigma, and gatekeeper efficacy (e.g., identifying and helping at-risk individuals). The students were asked to role-play based on a movie about gatekeepers and scripts about self-stigma and suicide-related issues. Participants completed questionnaires on suicidal thoughts, depression, help-seeking intentions, self-efficacy as gatekeepers, self-concealment, and self-acceptance. A total of 121 students completed the questionnaires pre- and post-program, and 107 students also responded six months later. Results: Students demonstrated significantly reduced overall suicide thoughts six months post-program compared to before the program. In addition, gatekeeper self-efficacy, help-seeking intentions for formal resources, and self-acceptance were improved in the students six month after the program. Conclusions: The CAMPUS suggested effective at reducing suicidal people and promoting preventative psychological tendencies among medial students. This study was a one-group pre post design study without control group. The CAMPUS program was delivered as a mandatory requirement to a group with relatively low suicide risk. Further studies are required to assess its suitability for the general university student population.

Validation of the professional self-identity questionnaire for medical students during clinical practice in Japan.

OBJECTIVES: To validate the Professional Self Identity Questionnaire (PSIQ) for medical students during clinical practice. METHODS: We conducted a single-year longitudinal questionnaire study using the PSIQ. The PSIQ rates the nine items of "teamwork", "communication", "conducting assessment", "cultural awareness", "ethical awareness", "using records", "dealing with emergencies", "reflection", and "teaching" on a scale of 1-7 points. The study participants consisted of 118 fifth- and sixth-grade medical students who completed a mandatory 4-week clinical practice in a community-based medical education (CBME) curriculum. The data were collected before and after the CBME curriculum and after clinical practice at the time of graduation. To validate the internal structure of the PSIQ, we calculated Cronbach's alpha in the three phases. Additionally, to assess construct validity, we analyzed the trends and differences in each of the nine items of the PSIQ using repeated measures analysis of variance (ANOVA). We also showed the differences in effect size before and after the CBME curriculum. RESULTS: The data of 105 medical students were analyzed. Cronbach's alpha in the three phases was 0.932, 0.936, and 0.939, respectively. PSIQ scores increased progressively for all items, and the F-test for repeated measures ANOVA of nine items' average score across the three phases showed a significant difference F(2,208) = 63.59, p<0.001. The effect size for professional identity of cultural awareness before and after the CBME curriculum was 0.67, or medium. CONCLUSIONS: We validated the PSIQ for medical students during clinical practice. Reflecting on professional identity may provide an opportunity for meaningful feedback on readiness to become a doctor.

Clinical Application of the Vestibular Stimulation Effect on Balance Disorders with Dementia.

BACKGROUND: In a previous study on Alzheimer's disease (AD), we showed that vestibular dysfunction derived from cerebral disorders contributes to balance disorders. No previous clinical study has attempted to prevent the progression of balance disorders in dementia patients through vestibular stimulation using an air caloric device. OBJECTIVE: The purpose of this pilot study was to delay the progression of balance disorders by inducing vestibular compensation, specifically by utilizing the effect of vestibular stimulation to activate the cerebrum. METHODS: Fifteen individuals were randomized and classified into a stimulation group or a nonstimulation group. Eight AD patients underwent vestibular stimulation every 2 weeks for 6 months in the stimulation group. Seven AD patients participated in the nonstimulation group (the control group). Both groups were subsequently evaluated using a Mini-Mental State Examination (MMSE), stepping test, caloric test, and smooth pursuit eye movement test just before starting the study and 6 months later. RESULTS: For balance parameters, the various tests did not show any significant differences between the two groups. However, in the stepping test, the decline rate tended to be higher in the nonstimulation group than in the stimulation group. The stimulation group's rate of decline in MMSE scores was lower than that of the nonstimulation group (p=0.015). No adverse events were tracked during the present study. CONCLUSION: Repeated vestibular stimulation might help patients retain greater balance and higher function. To prove these effects, the future clinical application will require an increased number of cases and longer periods of vestibular stimulation. This study showed that vestibular stimulation by air caloric device is safe and tolerable in patients with AD.

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

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

Effectiveness of an interprofessional education program using team-based learning for medical students: A randomized controlled trial.

BACKGROUND: To respond to increasingly complicated healthcare needs in primary care settings, all health and medical welfare professionals are required to collaborate with multiprofessionals, namely via "interprofessional work" (IPW). Interprofessional education (IPE) is essential for effective IPW, especially for medical students. This study aimed to determine whether participation in IPE can increase medical students' readiness for interprofessional learning. METHOD: We examined the difference in readiness of medical students for interprofessional learning before and after an IPE program that used team-based learning (TBL). Each student was assigned to either a uniprofessional or multiprofessional group. They were evaluated using the Japanese version of the Readiness for Interprofessional Learning Scale (RIPLS). Program participants were 126 second-year medical students and 18 students of healthcare professions other than medical doctor who participated in a combined IPE program conducted by two universities. Medical students were allocated to 12 uniprofessional and nine multiprofessional groups at random. RESULTS: One hundred and twelve medical students who replied to the questionnaire both before and after the program (valid response rate, 88.9%) were eligible for analysis. Of these, 42 were assigned to uniprofessional groups and 70 to multiprofessional groups. After the program, the RIPLS total score increased to a greater extent in the multiprofessional groups than in the uniprofessional groups (difference 3.17, 95% confidence interval 0.47-5.88, P = .022). Multiple regression analysis showed the same result. CONCLUSIONS: Learning in multiprofessional groups increased medical students' readiness for interprofessional learning in an IPE program using TBL.

Factors associated with influenza vaccination in Japanese elderly outpatients.

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.

Inappropriate use of the emergency department for nonurgent conditions: Patient characteristics and associated factors at a Japanese hospital.

BACKGROUND: The purpose of this study was to investigate the primary factors associated with inappropriate out-of-hours emergency department (ED) use by patients with nonurgent conditions. METHODS: We compared patients with nonurgent conditions who made inappropriate, out-of-hours ED visits to patients who visited an acute care hospital during daytime consultation hours between May 30 and October 16, 2014, in terms of patient characteristics and reasons for consultation. Our goal was to identify factors associated with inappropriate ED use, defined as an out-of-hours, nonurgent, and unnecessary visits. RESULTS: We analyzed data from 84 patients who made inappropriate use of out-of-hours emergency care and 147 patients who sought care during regular consultation hours. In the inappropriate use group, "desire to be cured quickly" was the most common reason. Acute upper respiratory infection, acute gastroenteritis, and primary headache comprised 51.1% of diagnoses in the inappropriate use group. One factor associated with inappropriate use was two or more previous out-of-hours ED visits (odds ratio (OR) 3.19; 95% confidence interval (CI) 1.22-8.31) (reference: 0 visits). CONCLUSIONS: Patients with two or more previous out-of-hours ED visits were more than three times as likely to inappropriately use the ED compared to patients who had not visited the ED at all in the past 3 years.

Associated factors for discussing advance directives with family physicians by noncancer outpatients in Japan.

BACKGROUND: Advance directives (ADs) are seldom discussed between primary care physicians (PCPs) and their patients, especially those with noncancer diseases. The aim was to identify the factors associated with discussing AD by noncancer patients with their physicians. METHODS: This cross-sectional study was conducted in a hospital or clinic from October to December 2017. Physicians chose eligible noncancer patients aged 20 years or older to respond to an anonymous self-completed questionnaire inquiring about the objective variable "I want to discuss AD with my doctor," as well as basic characteristics, and facilitators and barriers to discussing AD identified in previous studies. The physicians responded to a survey comprising the Palliative Performance Scale (PPS) and inquiring about the disease category for each patient. Data were analyzed using binomial logistic regression analysis. RESULTS: A total of 270 patients (valid response rate, 79.6%) were included. Multivariate analysis identified a period of visit to the study site ≥ 3 years (odds ratio [OR], 2.07; 95% confidence interval [CI], 1.05-4.10), physicians who are very good at taking care of patients' disease (OR, 12.68; 95% CI, 1.12-143.22), and patients' worry about their quality of life (QOL) in the future (OR, 2.69; 95% CI, 1.30-5.57) as facilitators for discussing AD with physicians, and PPS ≤ 90 (OR, 0.51; 95% CI, 0.26-0.98) as a barrier. CONCLUSIONS: Our study indicates that patients' future QOL concerns, a long period of visit to a hospital, and the presence of physical symptoms were associated with the willingness of noncancer patients to discuss AD with PCPs.

Interprofessional education in medical schools in Japan.

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.

Validity Evidence for Interprofessional Performance Scale in Conference (IPSC) in Japan.

This article was migrated. The article was marked as recommended. Introduction: Assessment of interprofessional learning (IPL) in practice is a key educational strategy. Especially, interprofessional collaboration in a conference is reasonable to assess interprofessional competency because we have many conferences for sharing information and coping with complex issues interprofessionally in practice. This study aimed to validity evidence supporting the IPL assessment scores, namely the Interprofessional Performance Scale in Conference (IPSC), and to evaluate its reliability. Methods: As a content validity, to obtain a consensus concerning the IPSC, we held five workshops from June 2016 to January 2018. Covering a response process, healthcare professional participants (raters) assessed interprofessional performance using the developed IPSC by watching 3 different types of videos of case conferences, with 5 healthcare professionals participating in each. Rater agreement for the response process among six different raters was assessed using intraclass correlation coefficients (ICCs). Concerning internal structure, we examined the descriptive statistics and one-way analysis of variance as well as Generalizability (G) and Decision (D) studies. We explored the consequences of the IPSC through feedback sheet. Result:The finalized IPSC assessment consisted of 12 items with 4-point Likert scales. ICC was 0.45 for the overall score. The association between IPSC and videos was significant while that of IPSC and professionals was not. The G and phi coefficients were 0.86 and 0.84, respectively. In descending order, the portion of the variance was professionals (15.7%) and the interaction of professionals and raters (11.5%) of the total variance. As D study, to reach a phi coefficient of 0.80, seven items and five raters were required. Through assessing interprofessional performance in case conferences, we clarified participants could reflect their own interprofessional competency as a consequence of the IPSC. Conclusion:Findings from this study support using the IPSC as a tool to make consistent assessments of interprofessional performance in conferences.

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

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

Follow-up survey of Japanese medical students' interactions with the pharmaceutical industry.

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.

Relationship Between Depression and Stress Coping Ability Among Residents in Japan: A Two-Year Longitudinal Study.

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.

Potentially inappropriate medications with polypharmacy increase the risk of falls in older Japanese patients: 1-year prospective cohort study.

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.

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

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