Lifestyle changes of Japanese people on overseas assignment in Michigan, USA

<p>Abstract</p> <p>Background</p> <p>Temporary work assignments in the United States (US) are widely considered to have negative health outcomes on Asians mostly due to adverse changes in diet and exercise, though there is little research on this phenomenon. This study investigated the impact of lifestyle changes on the biological and psychological health and health behaviours of Japanese people on temporary assignments in the US.</p> <p>Methods</p> <p>In this cross sectional survey, we distributed a 38 item self-administered questionnaire addressing health habits, mental health function, lifestyle changes and dietary habits to adult Japanese patients presenting for general physicals at a family medicine clinic serving Japanese patients. We conducted simple statistics and regression analysis between length of stay and other health outcomes to determine whether length of residence in the US was predictive of negative lifestyle changes.</p> <p>Results</p> <p>Most participants reported increased caloric intake, weight gain, and less exercise. They also reported increased time with family. More women than men reported physical symptoms and anxiety related to stress. Smoking and alcohol intake were essentially unchanged. No associations were identified between length of residence in the US and health lifestyle habits or other health outcomes.</p> <p>Conclusion</p> <p>Negative lifestyle changes occur in diet and exercise for overseas Japanese people, but a positive change in increased family time was found. Women appear to be at a greater risk for somatic disorders than men. As duration of stay does not appear predictive of adverse changes, clinicians should advise patients going abroad of these risks regardless of the term of the work assignment.</p

A two-item version of the Japanese Consultation and Relational Empathy measure:A pilot study using secondary analysis of a cross-sectional survey in primary care

BACKGROUND: The Consultation and Relational Empathy (CARE) measure is a patient-reported measure of physician empathy which is widely used internationally. The Japanese version of the CARE measure has very high internal reliability, suggesting that a shorter version may have adequate validity and reliability. OBJECTIVE: To investigate a valid shorter version of the Japanese CARE measure. METHODS: We conducted a pilot study using secondary analysis of previous data obtained from 9 general practitioners and 252 patients and used to develop the Japanese CARE measure. All 1,023 possible combinations of the Japanese CARE items (n = 1–10) were candidates for the short measure. The internal consistency (Cronbach’s alpha) and the correlations between candidate short questionnaires and the original questionnaire were calculated. After selecting the most valid short questionnaire, inter-rater reliability was determined using generalizability theory, and construct validity (Spearman’s rho) was determined using patient satisfaction. RESULTS: Two items were selected for a pilot shorter version: item 6 “Showing care and compassion” and item 9 “Helping you to take control.” These showed high internal consistency and correlations with the 10-item measure (Cronbach’s alpha = 0.920, correlation = 0.979). Forty-five questionnaires per doctor allowed us to reliably differentiate between practitioners. The construct validity for the pilot short measure was high (Spearman’s rho 0.706, P < 0.001). CONCLUSION: We generated a pilot 2-item version of the Japanese CARE measure. This pilot 2-item version provides a basis for future validation studies of short CARE measures in other languages

Evaluation of a communication skills seminar for students in a Japanese medical school: a non-randomized controlled study

BACKGROUND: Little data exist for the effectiveness of communication skills teaching for medical students in non-English speaking countries. We conducted a non-randomized controlled study to examine if a short intensive seminar for Japanese medical students had any impact on communication skills with patients. METHODS: Throughout the academic year 2001–2002, a total of 105 fifth-year students (18 groups of 5 to 7 students) participated, one group at a time, in a two-day, small group seminar on medical interviewing. Half way through the year, a five-station objective structured clinical examination (OSCE) was conducted for all fifth-year students. We videotaped all the students' interaction with a standardized patient in one OSCE station that was focused on communication skills. Two independent observers rated the videotapes of 50 students who had attended the seminar and 47 who had not. Sixteen core communication skills were measured. Disagreements between raters were resolved by a third observer's rating. RESULTS: There was a statistically significant difference in proportions of students who were judged as 'acceptable' in one particular skill related to understanding patient's perspectives: asking how the illness or problems affected the patient's life, (53% in the experimental group and 30% in the control group, p = .02). No differences were observed in the other 15 core communication skills, although there was a trend for improvement in the skill for asking the patient's ideas about the illness or problems (60% vs. 40%, p = .054) and one of the relationship building skills; being attentive and empathic nonverbally (87% vs. 72%, p = .064). CONCLUSION: The results of this study suggest that a short, intensive small group seminar for Japanese medical students may have had a short-term impact on specific communication skills, pertaining to understanding patient's perspectives

Preconception care by family physicians and general practitioners in Japan

BACKGROUND: Preconception care provided by family physicians/general practitioners (FP/GPs) can provide predictable benefits to mothers and infants. The objective of this study was to elucidate knowledge of, attitudes about, and practices of preconception care by FP/GPs in Japan. METHODS: A survey was distributed to physician members of the Japanese Academy of Family Medicine. The questionnaire addressed experiences of preconception education in medical school and residency, frequency of preconception care in clinical practice, attitudes about providing preconception care, and perceived need for preconception education to medical students and residents. RESULTS: Two hundred and sixty-eight of 347 (77%) eligible physicians responded. The most common education they reported receiving was about smoking cessation (71%), and the least was about folic acid supplementation (12%). Many participants reported providing smoking cessation in their practice (60%), though only about one third of respondents advise restricting alcohol intake. Few reported advising calcium supplementation (10%) or folic acid supplementation (4%). About 70% reported their willingness to provide preconception care. Almost all participants believe medical students and residents should have education about preconception care. CONCLUSION: FP/GPs in Japan report little training in preconception care and few currently provide it. With training, most participants are willing to provide preconception care themselves and think medical students and residents should receive this education

一般市民が模擬患者として熟達する過程

報告Reports　本研究の目的は、模擬患者（Simulated or Standardized Patient: 以下SP）養成において、SP が熟達する過程ごとの特徴を明らかにすることである。　対象は、2002 年から2012 年までSP 養成者が作成したSP トレーニング時、SP 参加型授業時のSP の発言・行動記録、SP 養成者の感想および介入の記録である。SP 養成過程は、ドレイファス・モデルを参考に、初心者、新人、一人前、中堅、達人のレベルとし、得られたデータを各レベルに分類し、特徴をカテゴリー化した。　その結果、一般市民であったSP が熟達する過程の特徴として、以下のカテゴリーが抽出された。初心者レベルでは＜SP として不確実な自分＞を感じ、新人レベルでは＜SP として不安な自分＞を感じる。さらに一人前レベルでは＜SP として自覚が芽生える自分＞を認識し、中堅レベルでは＜SP として成長を感じる自分＞を実感する。そして、達人レベルに到達すると＜SPを極める自分＞の存在を認識する

74 Continuing care of chronic illness: Evidence- based medicine and narrative-based medicine as competencies for patient-centered care

Abstract: The longitudinal care of patients with chronic illnesses is one of the most central responsibilities of a family physician&apos;s practice. To the patient-physician relationship, the patient brings his needs -arising from his prior life experiences, current life situation, resources, and explanatory models of illness. The physician brings expertise and evidence about the best care for the disease. The bridge connecting these two worlds is narrative-based medicine (NBM). An essential competency for the best care of patients with chronic illness is an amalgamation of evidence-based medicine (EBM) and NBM, based upon an underlying infrastructure of behavioral science. Although such knowledge, skills, and attitudes are essential, the very best longitudinal care develops over time and requires careful observation by physicians