Developing a broad perspective of future work and career in medical students through field trips to a disaster area: a qualitative study.

OBJECTIVE: Field trips to disaster-affected areas (FTDAs) without a specific purpose, such as medical cooperation, are widely used in medical education. However, what medical students gain from FTDAs remains unclear. The present study aimed to clarify what medical students gain from FTDAs. Five medical students who had visited the Fukushima nuclear power plant in Japan participated in a semi-structured group interview to ask what they gained from such a visit. The narratives were analysed using open coding. RESULTS: The following four themes emerged: "Spirit of scientific inquiry", "Foundation for lifelong education and personal growth", "Broadened understanding of the medical profession", and "Importance of practicing medicine in the community setting". The ambiguity of medical students' specific roles in the field trip compared to the fieldwork may have encouraged them to make sense of the experience from their perspective. As a result, students may have gained a broader perspective of their future work and career through the FTDA. If medical educators can gain consensus from the residents of a disaster site, different disaster-affected areas can be potential sites for medical education using FTDAs.

Post-Disaster Community Transition of Psychiatric Inpatients: Lessons from the Fukushima Nuclear Accident.

This study sought to explore factors related to community transition after the mandatory evacuation of psychiatric inpatients to other hospitals owing to the Fukushima Daiichi Nuclear Power Plant accident. A retrospective cohort design was adopted and 391 psychiatric patients were examined. Univariate and multivariate analyses were conducted to confirm the association between the achievement or non-achievement of discharge to community living and their backgrounds (age, gender, evacuation destination, psychiatric diagnoses, and physical complications). Multivariate analysis indicated that patients with psychiatric diagnoses of schizophrenia, schizotypal, and delusional disorders (International Statistical Classification of Diseases and Related Health Problems 10th revision, F20-29), and those with physical diagnoses of the circulatory (I00-95) and digestive (K00-93) systems showed a significant association with the non-attainment of community transition. From these results, we hypothesized that difficulties in the management of medication during and immediately after the extremely chaotic settings of evacuation could have negative effects on the community transitions. Furthermore, another possible concern was that individuals' persistent psychotic status before the accident had been carried over to the destination hospitals. Therefore, pre-disaster daily cooperation across hospitals and challenges for vulnerable psychiatric patients' future community lives are also essential.

Association between home meal preparers and salt intake in haemodialysis patients: a cross-sectional study.

OBJECTIVES: This study aimed to examine the association between home meal preparer and salt intake among haemodialysis patients, including daily dietary status. We hypothesised that salt intake is higher among individuals who rely on meal preparation from others than those who prepare meals by themselves. DESIGN: Cross-sectional study. SETTING: Two medical facilities in Fukushima Prefecture, Japan. PARTICIPANTS: 237 haemodialysis outpatients who visited one of the medical facilities between February 2020 and August 2021 and were diagnosed with anuria, defined as urination of <100 mL/day, were the potential participants of the present study. Finally, 181 participants (131 male and 50 female) were included in the analysis. OUTCOME MEASURE: Salt intake amount was calculated from the results of predialysis and postdialysis blood draws, using Watson's formula based on predialysis weight, predialysis serum sodium level, postdialysis weight and serum sodium level at the end of dialysis. RESULTS: Salt intake was significantly higher in participants who relied on meal preparation from others ('relying on others') than those who prepared meals by themselves ('self-prepared') (B=1.359; 95% CI: 0.495 to 2.222). No statistical difference was found between individuals who ate out or ate takeout ('outsourcing') and those who prepared their own meals ('self-prepared'). These results were robust after adjustment for confounding factors. CONCLUSIONS: The present study revealed an association between self-preparation of meals at home and reduced salt intake among dialysis patients. Our findings suggest that whoever is the home meal preparer is possibly a social determinant of salt intake. To improve the prognosis of haemodialysis patients, actively reaching out to the family and assessing their social environment, such as identifying the home meal preparer and, if the patient relies on others for meal preparation, conducting nutritional/dietary guidance for that person, are effective in enhancing salt reduction.

Inappropriate timing of salt intake increases the risk of heat-related illness: An observational study.

The importance of salt intake in preventing heat-related illness (HRI) is well established, however, the specific method of ingestion has not been sufficiently studied. This study, therefore, aimed to investigate the optimal timing of salt intake to prevent HRI during hot outdoor work. We recruited 28 healthy male firefighters working at a fire department in Japan. They were provided a questionnaire to complete before and after receiving training in the summer season. We assessed their salt intake as before, during, and after training or none. In addition, they completed a brief self-administered diet history questionnaire to evaluate their daily salt and alcohol intake. HRI was determined through subjective and objective symptoms listed in the questionnaire, and environmental data were obtained from a national database. Subsequently, factors related to HRI were determined using a logistic regression model. The mean age of the participants was 31.0 ± 7.7 years. The study was performed within 250 working days, and we detected 28 HRI symptoms (11.2%). The median alcohol intake was 25.6 g/day when calculated according to the actual work system. Logistic mixed effect model analysis revealed that salt intake before training (OR: 5.893, 95% CI: 1.407-24.675), and salt intake before and during training (OR: 22.889, 95% CI: 4.276-122.516) were positively associated with HRI symptoms. The results indicate that inappropriate timing of salt intake increases the risks of HRI. Thus, a timely intake of salt in adequate amounts may be important in preventing these risks.

Associations of endurance, muscle strength, and balanced exercise with subjective sleep quality in sedentary workers: A cross-sectional study.

BACKGROUND: The optimal exercise combination for improving sleep quality among sedentary workers is unclear. OBJECTIVE: To reveal what combination of exercises contributes to good sleep quality. METHODS: In this cross-sectional study, we enrolled 5,201 sedentary workers who underwent health examinations in 2019. Data on sleep quality, basic attributes, energy expenditure, and lifestyle aspects such as exercise and physical activity, supper time close to bedtime, and alcohol intake were obtained. The subjects reported their exercise habits by selecting up to three forms of exercise from a list of 182 options, which were classified into three types: endurance (e.g., jogging), muscle strength (e.g., bench pressing), and balanced types which combined both endurance and muscle strength characteristics. (e.g., walking). These forms were then categorized into eight combination patterns: endurance only; muscle strength only; balanced only; endurance and muscle strength; endurance and balanced; muscle strength and balanced; all types; and absence of any exercise habits. Binary logistic regression analysis was used to examine the associations between the exercise combination patterns and sleep quality. RESULTS: Good sleep quality was significantly associated with "endurance" (OR = 1.419; 95% CI 1.110-1.814), "balanced only" (OR = 1.474; 95% CI 1.248-1.741), and "endurance and balance" (OR = 1.782; 95% CI 1.085-2.926) exercise patterns. No significant associations were found between the combinations that included muscle strength exercises and sleep quality. CONCLUSION: The endurance or balanced-type exercises, or a combination of both, may help to improve the sleep quality of sedentary workers as part of occupational health management.

Perceived Future Outcomes of Unsuccessful Treatment and Their Association with Treatment Persistence Among Type-2 Diabetes Patients: A Cross-Sectional Content Analysis.

INTRODUCTION: Despite the known strong association between patients' knowledge of outcomes of type 2 diabetes mellitus (T2DM) and treatment persistence, this knowledge in this patient population requires further clarification. The aim of our study was to reveal the perception of unsuccessful treatment outcomes among patients with T2DM and its association with treatment persistence by analysing answers to open-ended questions. METHODS: In this cross-sectional study, 106 patients with T2DM who lived in Fukushima Prefecture, Japan, had a medical record in the Fukushima National Health Insurance Organisation database and had no cognitive problems were enrolled by purposive sampling. Treatment status was defined as "non-persistent" when a participant's treatment medical record was absent for a continuous period of ≥ 6 months; otherwise, it was referred to as "persistent". We asked about the possible future problems of untreated T2DM, inductively classified the open answers into 15 codes and then statistically examined the association between these codes and treatment persistence using logistic regression analysis adjusted for age and sex. RESULTS: Persistent treatment was prevalent among participants who mentioned the code "treatment", which encompasses the terms that indicated invasiveness, such as dialysis, insulin injection, and shots (odds ratio 4.339; 95% confidence interval 1.104-17.055). CONCLUSION: Persistent treatment was prevalent among patients with T2DM who mentioned the code "treatment", suggesting that these patients may anticipate a threat due to the invasiveness of diabetes and thus participate in persistent treatment to avoid this threat. Healthcare professionals should provide appropriate information and supportive conditions to achieve both a reduced feeling of threat and persistent treatment engagement.

Prediction of the prognosis of somatoform disorders using the Minnesota Multiphasic Personality Inventory.

BACKGROUND: Somatoform disorders are frequently resistant to treatment. This study aimed to determine the utility of the Minnesota Multifaceted Personality Inventory (MMPI) in predicting the prognosis of somatoform disorders. METHODS: Overall, 125 patients diagnosed with somatoform disorders between January 1, 2013 and December 31, 2017 in the psychiatric department of Fukushima Medical University Hospital were included. Patients with positive outcomes were identified based on a subjective estimation regarding (1) pain and (2) social functions, including activities of daily living. They were divided into the improved group (IG) and the non-improved group (NIG). Each factor was then descriptively compared between the two groups, and the sensitivity and specificity were determined. RESULTS: The NIG had significantly higher scores but only on the Hy scale. Thus, the optimal Hy scale cutoff score was calculated. The cutoff point was 73.5, with a sensitivity of 55.7% and a specificity of 71.7%. CONCLUSION: An MMPI Hy scale score higher than a cutoff value of 73.5 predicts a poor response to conventional supportive psychotherapy or drug therapy in patients with somatoform disorders. This cutoff point may be used as an important index for selecting treatment for somatoform disorders.

Post-evacuation return of psychiatric hospital inpatients evacuated to hospitals outside the Fukushima prefecture after the nuclear accident: A Retrospective Cohort Study.

BACKGROUND: Post-evacuation return after mandatory hospital evacuation due to complicated disasters is often overlooked and not well-discussed. AIMS: In this study, we explored the factors which are related to the ease or difficulty of the post-evacuation return to Fukushima prefecture of psychiatric inpatients who had been evacuated to hospitals outside the prefecture because of the Great East Japan Earthquake (GEJE) and subsequent Fukushima Daiichi Nuclear Power Plant (FDNPP) accident. METHOD: This retrospective cohort study included evacuated psychiatric hospital inpatients who were registered in the Matching Project for Community Transition (MPCT) and had been traced until July 31, 2019. A total of 531 patients were included for the analyses. Univariable and multivariable analysis were conducted to detect the patients' traits including their psychiatric/physical backgrounds which were associated with their outcome - the time from GEJE to the date of return to Fukushima. RESULTS: Over half of the patients returned to Fukushima. In the multivariable analysis, the patients' gender (male), age (older), and psychiatric diagnoses of schizophrenia, schizotypal and delusional disorders (ICD-10, F20-29) showed lower hazard ratio (HR) and statistically significant association with the difficulties of post-evacuation return. Meanwhile, disorders of psychological development (F80-89), diseases of the nervous (G00-99, except G40-41) and genitourinary (N00-99) systems showed higher HR and statistically significant association with the ease of return. CONCLUSIONS: The specific characteristics of the psychiatric inpatients including their psychiatric and physical status are associated with their post-evacuation return to their hometown. These results indicated that the evacuated hospitals' practitioners and staffs from the MPCT understood the necessity of the earlier return of inpatients to their hometown. Moreover, clinicians should pay more attention to some symptoms unique to psychiatric patients which contributed to their difficulties in returning safely or expressing their hope to return.

Reliability and validity of the Japanese version of the weight bias internalization scale.

OBJECTIVE: The weight bias internalization scale (WBIS) is widely used in several languages. However, there is no Japanese version of the WBIS. The purpose of this study is to develop a Japanese version of the WBIS and to verify its reliability and validity. We translated the original version of the WBIS and had approval from the scale developer. Adults who perceived themselves to be obese completed online baseline survey (N = 285) and two-week follow-up survey (N = 100). We used the Japanese WBIS and scales for obesity-related quality of life, self-esteem, self-efficacy, and depression. We calculated Cronbach's alpha and intra-class correlation coefficient (ICC) to assess reliability of the WBIS and conducted confirmatory factor analysis (CFA) and correlation analysis to assess its validity. RESULTS: Cronbach's alpha was 0.91 at baseline and 0.92 at follow-up, and the ICC was 0.87. CFA showed that a one-factor model demonstrated an acceptable fit (χ2 (44) = 158.6, CFI = 0.93, RMSEA = 0.096, SRMR = 0.051), similar to the original version. As we had hypothesized, overall, the Japanese version of the WBIS was significantly correlated with obesity-related quality of life, self-esteem, self-efficacy, and depression. These results confirmed its adequate reliability and validity.

Concerns related to returning home to a "difficult-to-return zone" after a long-term evacuation due to Fukushima Nuclear Power Plant Accident: A qualitative study.

This study aimed to identify concerns related to returning to the Nagadoro district of Iitate Village, Fukushima Prefecture, Japan, in 2023 among its residents as it is designated as a difficult-to-return zone after the Fukushima Daiichi nuclear power plant accident. The following four concerns were extracted from the interviews and qualitative analysis: "Difficulties in restarting/continuing farming," which represent the difficulties in making a living from agriculture due to the absence of family members and neighbors, and the insufficient radiation decontamination; "Discriminatory treatment of products and residents from villagers," which suggests the presence of discriminations that residents of Nagadoro district are eccentrics and its agricultural products should not be treated together with those of other districts in the Village due to the recognition that the district is severely polluted by radiation; "Shift of the responsibility of returning home from the country to residents by scapegoating," which is characterized by the shift of responsibility from the government to the residents, including harsh social criticism of the residents of Nagadoro district for not returning even though the evacuation order has been lifted, when it should have been the government's responsibility to recover the district to a habitable state; "Loss of options for continued evacuation," which is the loss or weakening of the position of residents of the Nagadoro district who continue to evacuate, and of administrative compensation, resulting from the legal change that they are no longer "evacuees" after the evacuation order is lifted. The findings of this study will provide a foundation for the support of residents of the Nagadoro district after lifting the evacuation order scheduled for the spring of 2023. The findings may be transferable to the residents of other difficult-to-return zones expected to be lifted after the Nagadoro district and to also a radiation disaster-affected place in the future.

The Systematic Workplace-Improvement Needs Generation (SWING): Verifying a Worker-Centred Tool for Identifying Necessary Workplace Improvements in a Nursing Home in Japan.

This study developed and tested a new measurement instrument, the Systematic Workplace-Improvement Needs Generation (SWING), to identify workplace-improvement needs. The participants were 53 workers in a Japanese nursing home for the elderly. The respondents used the SWING questionnaire to self-generate five 'cues' they considered important to improve the workplace. The workers determined each cue's sufficiency level and weight balance (importance), and then we summarised the 265 cues into 21 categories for workplace improvements. The respondents identified the following items as the most important and the least sufficiently provided areas for workplace improvement: 'interaction with customers', 'physical and psychological harassment', 'rewarding and challenging work', and 'sharing goals and objectives'. Although the workplace-improvement recommendations differed greatly from person to person, SWING prioritised the items by weight (importance) and sufficiency (current status), allowing organisations to address the needed improvements systematically. The SWING tool effectively elicited and prioritised respondents' recommendations for improving the workplace. Because its items are self-generated by the respondents, SWING can be used for any occupation or workplace. Visualisation with bubble plots to clarify the improvement needs is incorporated into SWING.

Visualizing the decline of public interest in the Great East Japan Earthquake and Fukushima Daiichi nuclear power plant accident by analyzing letters to the editor in Japanese newspapers.

This study aimed to delineate the decline in public interest toward the March 2011 Great East Japan Earthquake (GEJE) and the Fukushima Daiichi nuclear power plant (FNPP) accident in Japan over a ten-year period. In this longitudinal descriptive study, we searched for publications within a ten-year period in Letters to the Editor that mentioned the GEJE, the FNPP accident, or the January 1995 Great Hanshin-Awaji Earthquake (GHAE) that occurred in Japan, using the official databases of the three largest Japanese newspapers. The GEJE- and GHAE-related publications (4,809 and 2,092, respectively) are depicted as scatter plots. The results show a gradual decrease in the publications mentioning GEJE or GHAE. The impact of GEJE and FNPP on Japanese society was enormous, but the public interest waned over time. Communication strategies that maintain a high public interest in previous disasters may be necessary.

Association between subjective economic status and refusal of life-prolonging treatment: a cross-sectional study using content analysis with stratified random sampling.

INTRODUCTION: Older adults tend to refuse life-prolonging treatment for various reasons, and it is important to respect their choice of treatment at the end-of-life stage. The present study examines the associations of subjective economic status and gender with reasons for refusal of life-prolonging treatment in older adults in general population. METHODS: In this cross-sectional study, using stratified random sampling, 1,595 older adults living in Koriyama City, Japan, as of 2016, completed self-administered questionnaires on subjective economic status and preference for life-prolonging treatment, with free-description regarding reasons for refusal. We analyzed the associations between the combination of subjective economic status and gender with frequently mentioned terms and their clusters regarding such reasons, using χ2 test, content analysis, text mining and hierarchical cluster analysis. RESULTS: The combinations of subjective economic status and gender were significantly associated with clustered reasons for refusal of life-prolonging treatment (p < 0.01). The reasons frequently mentioned were: 'avoidance of unnecessary medical care' and 'dignity' in well-off females; and 'financial burden on family' in poor males. CONCLUSIONS: Our findings suggest that older adults who at first glance appear to be freely refusing life-prolonging treatment, may have their decision making restricted through economic constraints.

Heterogeneous trends of premature mortalities in Japan: joinpoint regression analysis of years of life lost from 2011 to 2019.

Purpose: To assess long-term premature mortalities in Japan for providing evidence of strategies for sustainable development in population health. Methods: Descriptive study for observing the trends of premature mortalities due to 10 major causes and all-cause in Japan was conducted using governmental statistics taken between 2011 and 2019. Years of life lost (YLL) was calculated for each cause, and the trends of these were examined by joinpoint regression analysis. Results: The means of YLL for all-cause through 2011 to 2019 were 8,121,565.1 in males and 6,743,198.4 in females. For each cause, the trends of age-standardized YLL were downward except for malignant neoplasm of pancreas and heart failure in males, and malignant neoplasm of pancreas, malignant neoplasm of breast, and age-related physical debility in females. One significant joinpoint for heart failure was found in males, and one significant joinpoint for each of malignant neoplasm of pancreas and age-related physical debility were found in females. Conclusions: Premature mortalities due to malignant neoplasm of pancreas in both sexes, heart failure in males and malignant neoplasm of breast in females were issues to be prioritized for promoting population health in Japan.

Effect of occupation on sleep duration among daytime Japanese workers: A cross-sectional study.

ABSTRACT: Occupation is one of the factors contributing to the loss of sleep. Although many studies have investigated sleep loss due to irregular and nighttime shifts, the causes of sleep loss in daytime workers remain unknown. The aims of the present study were to determine whether occupation is a dependent factor for sleep duration and whether working status and lifestyle are related to sleep duration.We examined the health check results of 17,519 (9028 men and 8491 women) workers who had at least 1 health check between the fiscal years 2013 and 2019. We asked about the workers' occupation, bedtime, dinner time, overtime work, and commuting time, using a self-administered questionnaire at their health check. The occupations were classified into 4 categories: high white-collar, low white-collar, pink-collar, and blue-collar. We conducted a linear regression model and analysis of covariance to investigate the effect of occupation on sleep duration.As a result of linear regression analysis, bedtime, overtime work and occupation were significantly associated with decreased sleep duration in males, and bedtime, age, and occupation were significantly associated with decreased sleep duration in females. Analysis of covariance revealed that both male and female blue-collar tended to sleep for significantly shorter durations than those in the other occupations.The results of the current study indicate that sleep duration is affected by occupation. When determining the cause of loss of sleep, medical personnel should consider their patient's lifestyles and how they have been affected by their occupation.

Association between participation in sports club activities and decision-making preferences in end-of-life treatment among Japanese elderly people:a cross-sectional study.

INTRODUCTION: Decision-making regarding treatment at the end-of-life stage is an important issue for the elderly and their families. Such decision-making may be influenced by activities that promote communication and physical health. The purpose of this study was to examine the association between participation in sports club activities and decision-making regarding life-prolonging treatment among the general community-dwelling Japanese elderly. METHODS: In this cross-sectional study, which used stratified random sampling, 1,603 elderly people aged 65 years or older as of January 2016, living in Fukushima prefecture, Japan were enrolled. Data was collected by a self-completed questionnaire (effective response rate: 53.4%). The association of sports club activity participation with a preference for accepting or declining life-prolonging treatment was analyzed by multinomial logistic regression analysis. RESULTS: Of those participating in sports club activities, the results revealed an odds ratios of 1.812 for participants declining life-prolonging treatment (95% CI=1.325 to 2.477) and 1.948 for those who preferred life-prolonging treatment (95% CI=1.160 to 3.271). CONCLUSIONS: The present study suggests that participation in sports club activities is associated with articulating decisions about life-prolonging treatment in end-of-life care. Consideration of patient involvement in daily activities in non-medical settings may enhance decision-making for end-of-life care planning.

Risk of hospital insolvency and its relationship with income and borrowings from banks: a case-control study with large-scale financial data in Japan.

Considering the variety of stakeholders surrounding hospitals, hospital financial distress should be understood as a social issue, rather than just a matter involving the hospital owners. The present study aimed to assess Japanese hospital insolvency and related factors based on a nationwide financial dataset, and to identify indicators of the risk of insolvency. The legal financial reports used included a balance sheet and a profit-and-loss statement of hospitals owned by healthcare corporations, representing about 70% of all Japanese hospitals. This case-control study with descriptive analyses was conducted to clarify the financial status of healthcare corporations and to assess associations between specific factors and insolvency. Insolvency was found in 5.9% of healthcare corporations in 2016. Insolvency was significantly associated with operational income per sales (odds ratio, 0.16), and both short- and long-term borrowings per sales (odds ratios: 1.46 and 1.22 in this order). The present study found that 5.9% of Japanese healthcare corporations were insolvent, and hospital profitability and borrowing (both short- and long-term) could be key factors related to preventing hospital insolvency in Japan. To maintain sustainable healthcare services by hospitals, decision makers should consider the risk of insolvency, and balance the amount of borrowings against sales.

Qualitative and Quantitative Study on Components of Future Time Perspective and Their Association with Persistent Treatment for Type 2 Diabetes.

INTRODUCTION: Future time perspective (FTP) means the capacity to foresee, anticipate, and plan for future desired outcomes, and it contributes to persistent treatment for type 2 diabetes mellitus (T2DM). However, the components of FTP specific to T2DM patients have not been clarified. This study aimed to explore the components of FTP and to examine the associations between such components and persistent/impersistent diabetes treatment. METHODS: In this cross-sectional study, using qualitative and quantitative methods, 106 T2DM patients were enrolled by purposive sampling. The participants were interviewed in October and November 2018 by public health nurses in Koriyama City Public Health Center, Japan. In addition to the participants' status of treatment engagement (persistent/impersistent), their responses regarding reasons for persistent/impersistent treatment were collected and then summarized into nine subthemes, which were then merged into two main themes according to the presence or absence of FTP with a sense of T2DM ownership for analysis. RESULTS: The main theme, "presence of FTP with a sense of T2DM ownership," included subthemes such as "securing social independence," "planning on living a long and healthy life," "prioritizing avoiding being a burden on family and friends," "valuing improvement of diabetes," "avoiding tragic results," "optimistically viewing treatment as a form of self-development," and "improving mental health," whereas the main theme, "absence of FTP with a sense of T2DM ownership," included "lack of consciousness of disease" and "living a dissipated life." The association between the presence of FTP with a sense of T2DM ownership and persistent treatment for T2DM was found using Fisher's exact test (p < 0.001). CONCLUSION: Health care professionals should support T2DM patients in having an FTP with a sense of T2DM ownership and purpose in life instead of treatment goals when such patients mention their dissipated life or lack of insight into the disease.