Objectives
  This study aimed to compare accessibility to the health services in Brazilian CSHCN (children with special health care needs) with non-CSHCN living in Japan and the parenting stresses of the parents of both groups of children, as well as to examine if the children’s being CSHCN is a factor of increasing the parenting stresses of their mothers.
Methods
  A questionnaire was administered to 130 Brazilian mothers in Japan of children between 3-6 years of age living in Aichi Prefecture, and analyzed the valid answers of 73.The questionnaire was constructed with background information, CSHCN Screener^©, children’s health care service needs, and PSI/SF (Parenting Stress Index Short Form). We evaluated the differences between CSHCN and non-CSHCN, and conducted a multiple linear regression analysis on the parenting stress scores.
Results
  Nine out of 73 children were identified as CSHCN including four with asthma, three with autism, one with chronic bronchitis, and one with cardiac hypertrophy. Although all CSHCN had family doctors, their mothers had unmet needs for specific health care services, especially dental care, rehabilitation and consultation of specialists. There were three mothers of non-CSHCN who had delayed or forgone care.
  The average score of PSI in all mothers was: TS (Total Stress)＝60.2, PD(Parental Distress)＝22.0, P-CDI(Parent-Child Dysfunctional Interaction)＝16.9, DC(Difficult Child)＝21.7. DC score was significantly higher in CSHCN than in non-CSHCN. Three determinants of elevated TS score were having CSHCN or children with chronic diseases, experiencing severe economic difficulties, and having a husband who did not speak Japanese.
Conclusions
  The study revealed that Brazilian mothers with CSHCN in Japan were not disadvantaged in terms of access to health services, but had unmet needs in some specific areas. Although the mothers of CSHCN showed relatively low levels of total parenting stress, they had significantly higher levels of stress on the difficult child characteristics. Attention for the stress of the mothers of CSHCN is required.

Objectives: We examined the effects of Toki-shigyaku-ka-goshuyu-shokyo-to on chronic constriction injury of the sciatic nerve as a neuropathic pain model in rats.
Methods: Sprague-Dawley rats were randomly divided into 3 groups: group 1, no constriction and no medication (n=8); group 2, constriction without medication (n=8); group 3, constriction with medication (n=8). On each group we performed thermal stimulation tests for pain measurement before the operation and 7 and 14 days after the operation. We also measured body temperature at the tympanum and the planta.
Results and conclusions: A significant increase of pain was observed at 7 and 14 days after constriction in group 2. Toki-shigyaku-ka-goshuyu-shokyo-to relieved their pain 14 days after constriction. Furthermore,
Toki-shigyaku-ka-goshuyu-shokyo-to warmed their feet significantly, while chronic constriction injury induced coldness in the constricted feet. We conclude that Toki-shigyaku-ka-goshuyu-shokyo-to relieves both pain and coldness in a neuropathic pain model.

　　This study was conducted with a view to improving medication management service by reviewing renal excretory drug prescription practices in our hospital for patients with decreased kidney function without intervention of pharmacists. The subjects were the outpatients to whom the doctors had prescribed drugs containing digoxin, cibenzoline, bezafibrate, levofloxacin, valaciclovir or dabigatran. We retrospectively reviewed their serum creatinine levels, sex, age, height, weight and the amount of the drugs prescribed. It was found that there are cases in which medication had been prescribed without serum creatinine testing or prescribed in excess of the amount needed. Furthermore, there were cases in which the renal function had been judged in all probability by age and serum creatinine levels alone. Based on these findings, we concluded that pharmacists should intervene in pharmacotherapy using renal excretory drugs. For the realization of this, it would be necessary to build a system within the Department of Pharmacy to support the pharmacotherapy.

We examined the effects of several problem-based learning (PBL) tutorials on the development of clinical abilities among medical students. In 1988, 2 years before our university implemented the PBL tutorial curriculum, one to three trial tutorials were used for a portion of the students in the 1st through 3rd years to identify a suitable tutorial education system for Japanese students. To examine the effects of these trial tutorials, we sent questionnaires to graduates who had participated in the trial tutorials and to those who had not. We found that graduates who had participated in the trial tutorials were more likely than graduates who had not to report logical thinking capabilities during their undergraduate years and clinical problem-solving abilities at the end of their internship. The results suggest that the use of one or more tutorials is effective in helping students develop logical thinking and problem-solving ability.

Positive self-esteem helps students build and maintain self-efficacies to affect later clinical practice. We examined the outcome of problem-based-learning (PBL) curriculum by evaluating self-efficacy in terms of sustained learning and clinical competencies among medical school graduates.
1) We compared practicing doctors who either had PBL tutorial experience or who had not by a questionnaire survey.
2) The subjects self-evaluated whether they had achieved expected abilities (1) at the end of undergraduate years, (2) during 2-year internship, and (3) at present.
3) Among 1, 502 doctors surveyed (response rate=36.0%), doctors with PBL tutorial experience had higher selfefficacy (odds ratio>2.1) in their clinical abilities than doctors without it, especially during the school years.
4) In the later 2 periods, doctors with PBL experience had higher self-efficacy in communication skills.
5) PBL tutorial foster self-efficacy in clinical abilities, especially in communication skills, during earlier clinical career.

INTRODUCTIONIn this study, we compared the choice of medical specialty and subspecialty interest among problem-based-learning (PBL) graduates and non-PBL graduates.

MATERIALS AND METHODSQuestionnaires were mailed to a total of 1398 female doctors who graduated from Tokyo Women's Medical University (TWMU) between 1989 and 2003. The response rate was over 30%, giving 248 respondents who had undergone a PBL curriculum (PBL+) and 220 subjects who had not (PBL-). Current specialty of the graduates were compared between the PBL+ and PBL-, and also compared with the general Japanese female doctors (Control 1 and 2) of similar age groups. Respondents were analysed in terms of their interests in subspecialty medical care or general medical practise, which includes comprehensive medical care, primary care and basic medicine. Internal medicine doctors working in the university hospitals were compared with those working outside the university hospitals. Internal medicine doctors were also compared with specialists in ophthalmology, otolaryngology, dermatology and psychiatry. Subjects were compared by odds ratio (OR) to examine group difference in the field of interest. OR >2.0 was considered statistically significant.

RESULTSMost doctors in all groups chose internal medicine. More PBL+ internal medicine doctors showed interests in comprehensive medical care and primary care; more PBL+ internal medicine doctors working outside university hospitals showed interest in comprehensive medical care and primary care when compared with those who were working in the university hospitals. The PBL- graduates did not show such a characteristic.

CONCLUSIONSMore PBL+ graduates who chose internal medicine showed interest in holistic medical practices such as primary care and community medicine and more PBL+ specialists showed sustained interest in their respective fields.

Adult ; Career Choice ; Education, Medical, Undergraduate ; Female ; Humans ; Internal Medicine ; statistics & numerical data ; Japan ; Problem-Based Learning ; statistics & numerical data

  In Japan, few health care professionals have a basic understanding（core competency）of the design of clinical research and statistical analysis. We developed a blended distance–learning program comprising face–to–face lectures with e–learning for busy health care professionals who work in the clinical settings to achieve core competency in clinical research. The purpose of this study was to examine the educational effects of this program.
1）Four months after the end of the program, 64％ of the participants had started to conduct clinical research.
2）This program may increase the number of research colleagues that can discuss clinical research.
3）This program could enhance the confidence（self–efficacy）of health care professionals in clinical research.

Tenmin NAMIKAWA (並河天民) thought the Shanghanlun (傷寒論) was an important text. He also taught his pupils the importance of prescribing Zhongjing ZHANG's (張仲景) medicines. Ryokyu ARIMA (有馬凉及) was a physician-teacher, who prescribed Chengqitang (承気湯) for the emperor without conferring with other doctors. His chengqitang formulary was derived from medical texts by Zhongjing ZHANG. Kyugo GODA (合田求吾) on the other hand, was a pupil of Ikkannsai MATSUBARA (松原一閑斎), who wrote in the Idokikigaki (医道聞書) : theKoho (古方) school started by Ryokyu ARIMA. He was a hero who was punished by the Goseiin (後西院) emperor. He taught Koho to Tenmin. This therefore reveals that Ryokyu ARIMA was a teacher who taught the importance of the Shanghanlun.

At the 71st Annual Meeting of the Japan Society for Oriental Medicine held in August 2021, we performed a special program focusing on education in Kampo medicine, “Pre-graduation and post-graduation education in Kampo medicine for the next generation.” As a part of this project, we constructed the “Common Kampo test” based on the “Standard lectures on Kampo” as a web-based test using Moodle, and then the test was conducted in the form of a web test with 163 participants. The commentary of the “Common Kampo test” was live-streamed and was viewed by many participants, including students, educators and academics from all over Japan. In this paper, we report on the series covering the construction of the web system, creation of questions, answer results, and commentary on answers. With the recent popularization of tablet devices and smartphones, this web-based test system has the potential to become a scientifically based and optimal learning system not only for students but also for medical professionals such as doctors, pharmacists, and nurses.

BACKGROUND: Estimates of daily sodium (Na) and potassium (K) excretion were explicitly biased when using equations for adults. We aimed to develop equations to estimate them using overnight urine from Japanese children and adolescents. METHODS: The subjects comprised 70 students aged 10.49-15.76 years: validation group, n = 34; and verification group, n = 36. Each subject performed two operations of overnight spot urine (U RESULTS: In validation, we formulated Na excretion (mg d CONCLUSION We obtained validated equations to estimate daily Na and K excretion with accessible variables such as Na, K, and Cr concentrations of overnight urine, body height and weight, and age for children and adolescents. When using the obtained equations, caution should be paid to small but definite biases and measurement errors.
Adolescent ; Child ; Creatinine/urine* ; Female ; Humans ; Japan ; Male ; Potassium/urine* ; Sodium/urine*