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目的:獨協医科大学では2010年度より地域枠入学制度が導入された.そこで2013年に,地域枠入学者の意識調査を施行し,「将来地域医療を行うという自覚」と「自分の将来についての不安」に着目してその調査結果を検討した.方法:対象は,地域枠入学者全員を含む地域包括医療実習生70名である.内訳は,第1学年20名,第2学年20名,第3学年18名,第4学年12名である.68名は学習支援システムを利用して記名式のWebアンケート調査に回答し,2名は自記式で同一調査に回答した.結果:「将来地域医療を行うことを大変自覚している・自覚している」ものは,第1学年85.0%,第2学年90.0%,第3学年77.8%,第4学年100%となった.また「将来地域医療を行うことを大変自覚している」ことは,「将来の自分のめざす医師像をもっている」ことと関与することが示唆された.自分の将来に不安があるものは,第1学年は60%,第2学年は55%,第3学年は50.0%,第4学年は50%であり,全体の半数以上が不安を持っていた.「不安がある」ものは有意に「地域包括医療実習以外にもっと地域医療について勉強の機会を与えてほしい」と考えていた.結論:地域医療教育はカリキュラムを越えてさらに発展する必要があることが示唆された.Objective:Four years have passed since Dokkyo Medical University first introduced an admission system for community medicine?oriented students. Therefore, a survey of community-mindedness among these students was held, and based on this survey, we examined the associated factors of willingness toward future engagement and present anxiety.Methods:Participants were 70 students(20 first-year students, 20 second-year students, 18 third-year students, and 12 fourth-year students)who took the comprehensive community medicine practice course. A total of 68 students answered the questionnaire using the learning medical system website and 2 students answered the questionnaire by hand.Results:Willingness to engage in community-oriented medicine was reported by 85.0% of first-years, 90.0% of second-years, 77.8% of third-years, and 100% of fourthyears, and willingness for future engagement was significantly associated with students\u27 possessing an ideal image of the doctor that they want to be. Present anxiety was reported by 60% of first-years, 55% of second-years, 50%of third-years, and 50% of fourth-years;over 50% of all students had some level of anxiety. Additionally, students who wanted to study more about community medicine beyond this practice course were significantly more likely to have present anxiety.Conclusion:Results suggested that education in community medicine was expected further developments

Oral Iron Absorption of Ferric Citrate Hydrate and Hepcidin-25 in Hemodialysis Patients: A Prospective, Multicenter, Observational Riona-Oral Iron Absorption Trial

Oral ferric citrate hydrate (FCH) is effective for iron deficiencies in hemodialysis patients; however, how iron balance in the body affects iron absorption in the intestinal tract remains unclear. This prospective observational study (Riona-Oral Iron Absorption Trial, R-OIAT, UMIN 000031406) was conducted at 42 hemodialysis centers in Japan, wherein 268 hemodialysis patients without inflammation were enrolled and treated with a fixed amount of FCH for 6 months. We assessed the predictive value of hepcidin-25 for iron absorption and iron shift between ferritin (FTN) and red blood cells (RBCs) following FCH therapy. Serum iron changes at 2 h (ΔFe2h) after FCH ingestion were evaluated as iron absorption. The primary outcome was the quantitative delineation of iron variables with respect to ΔFe2h, and the secondary outcome was the description of the predictors of the body’s iron balance. Generalized estimating equations (GEEs) were used to identify the determinants of iron absorption during each phase of FCH treatment. ΔFe2h increased when hepcidin-25 and TSAT decreased (−0.459, −0.643 to −0.276, p = 0.000; −0.648, −1.099 to −0.197, p = 0.005, respectively) in GEEs. FTN increased when RBCs decreased (−1.392, −1.749 to −1.035, p = 0.000) and hepcidin-25 increased (0.297, 0.239 to 0.355, p = 0.000). Limiting erythropoiesis to maintain hemoglobin levels induces RBC reduction in hemodialysis patients, resulting in increased hepcidin-25 and FTN levels. Hepcidin-25 production may prompt an iron shift from RBC iron to FTN iron, inhibiting iron absorption even with continued FCH intake