Although the problem of improving the retention rate of female physicians in Japan has been vigorously discussed, a more comprehensive discussion on gender equality has been lacking. This paper provides an overview of gender inequality in Japanese medicine and discusses measures to promote gender equality. The main causes of gender inequality include gender stereotype, bias, discrimination, women’s double burden of paid and domestic work, and a working system of long and irregular hours based on the gender division of labor. Measures to promote gender equality are necessary to create a working environment that does not disadvantage female physicians.

We spent 18 days in Stockholm studying welfare facilities for the aged, a subject in which we have a strong interest. It was a short visit but turned out to be an extremely informative and wonderful experience thanks to Prof. Bredberg, Dr. Linde, and many other people who took care of us in Stockholm. We found Sweden to be a country which is organized in such a way that everybody can enjoy life. Next time it will be your turn ! I You should have the opportunity to share our experiences in Sweden.

1）To evaluate the division of labor by sex among Japanese physicians, we used anonymous, voluntary questionnaires to survey the alumni of a private medical school about the time spent weekly on clinical activities and unpaid domestic work.
2）Although the median time spent per week on clinical activities was less for women physicians （40 hours） than for men （50 hours）, the time spent on unpaid domestic work was significantly more for women （30 hours） than for men （3 hours）.
3）When the time spent on both clinical activities and domestic activities was totaled, women physicians worked more hours per week than did men physicians.
4）Our study showed a division of labor by sex among Japanese physicians.

Obesity is a major risk factor for lifestyle-related diseases and its prevention is essential in terms of public health. Body weight is influenced by a genetic predisposition as well as food intake, and exercise. In about 30% of the Japanese, a specific mutation [codon 64 TGG (Trp) →CGG (Arg)] of β3-adrenergic receptor gene is observed. The basal metabolic rate is about 200 kcal/day lower in the individuals with this type of mutation than in those without. We conducted a weight loss program which included analysis of β3-adrenergic receptor gene polymorphism, monitoring of eating behavior, and promotion for lifestyle modifications by public health nurses. The subjects for analyses were 39 Japanese men (mean age 37.8±8.6 years) and six Japanese women (46.8±6.4 years), with body mass index (BMI) over 24. They had not been receiving medical treatment for lifestyle-related diseases. The ratio of the normal group (no mutation at the specific site of β3-adrenergic receptor gene) to the mutation group were 73% to 27%. After we explained the results of the genetic testing to the participants, public health nurses encouraged them to change their lifestyle and provided dietary guidance. After 3 and 8 months intervention, reductions in BMI were observed 75% and 57% of the subjects in the normal group, and 92% and 67% of the subjects in the mutation group, respectively. At any time point, the changes were not statistically significant between the normal and mutation groups. Behavior modification was observed 49% of the subjects in the normal group and 75% in the mutation group. More than 80% of the participants were of the opinion that the genetic testing had been useful for them to reconsider their health status.
Mutation ; Receptors, Adrenergic ; Life Style ; Public health service ; gene polymorphism

Introduction: In Japan, the number of female physicians is increasing rapidly. Therefore, surveying female physicians about their current working status, especially about their continuing to work, is important.
Methods: In September 2009, we sent a questionnaire regarding working status to 1403 female physicians who had graduated from Okayama University Medical School or who were working at university-affiliated hospitals or facilities at the time of investigation.
Results: Of the 420 female physicians who responded （response rate, 29.9％）, 46.6％ （n＝191） had left their jobs at some time, and 92.4％ （n＝171） of them had done so within 10 years after medical school graduation. The most common reason for leaving their jobs was childbirth／childcare, and the second most common was their husband’s job transfer. Of those who had ever left their job, 82％ （n＝151） wished to return to work at the time of their leaving. Only 27.2％ （n＝74） took childcare leave.
Discussion: Female physicians have trouble continuing their clinical work and developing their careers while caring for children. A system should be developed to support physicians who wish to continue their clinical work during life events, such as childcare. In particular, career support during the first 10 years after graduation from medical school is extremely important.

Bioethics and palliative care have rarely been taught systematically in Japanese medical schools, and methods for teaching them have not been established. This report is based on a program to teach end-of-life care as part of public health education for fifth-year students at Teikyo University School of Medicine. Medical students participated in an elective program for nursing students in end-of-life care, visited terminally ill patients, and made care plans. Through this experience, students came to understand the purpose of terminal care and became aware of the importance of mental support to patients and teamwork with co-medical staff. Having the opportunity to contemplate human death before starting clinical practice helps students acquire behaviors appropriate for physicians.

The number of female physicians is increasing. In Japan, marriage and child–bearing have been considered barriers preventing female physicians from working continuously. This study investigated the effects of marriage and child–bearing on career satisfaction among female physicians.
1)We surveyed the alumni of two private medical schools (University A: n=646; University B: n=316). The response rate was 38% for University A and 71% for University B.
2)When the subjects were asked if they were satisfied that they had chosen a career as a physician, 85%(n=400) answered that they were satisfied.
3)In total, 348 female physicians (74%) were married, and of them, 280 (80%) had experienced childbirth, and 259 (77%) were married to physicians.
4)Factors that significantly and positively affected career satisfaction were marriage for all female physicians and child–bearing for married female physicians.
5)The results of this study suggest that marriage and child–bearing, rather than being obstacles to career development, have positive effects on the career satisfaction of female physicians.

  Obesity is a major risk factor for lifestyle-related diseases and its prevention is essential in terms of public health. Body weight is influenced by a genetic predisposition as well as food intake, and exercise. In about 30% of the Japanese, a specific mutation [codon 64 TGG (Trp) →CGG (Arg)] of β3-adrenergic receptor gene is observed. The basal metabolic rate is about 200 kcal/day lower in the individuals with this type of mutation than in those without. We conducted a weight loss program which included analysis of β3-adrenergic receptor gene polymorphism, monitoring of eating behavior, and promotion for lifestyle modifications by public health nurses. The subjects for analyses were 39 Japanese men (mean age 37.8±8.6 years) and six Japanese women (46.8±6.4 years), with body mass index (BMI) over 24. They had not been receiving medical treatment for lifestyle-related diseases. The ratio of the normal group (no mutation at the specific site of β3-adrenergic receptor gene) to the mutation group were 73% to 27%. After we explained the results of the genetic testing to the participants, public health nurses encouraged them to change their lifestyle and provided dietary guidance. After 3 and 8 months intervention, reductions in BMI were observed 75% and 57% of the subjects in the normal group, and 92% and 67% of the subjects in the mutation group, respectively. At any time point, the changes were not statistically significant between the normal and mutation groups. Behavior modification was observed 49% of the subjects in the normal group and 75% in the mutation group. More than 80% of the participants were of the opinion that the genetic testing had been useful for them to reconsider their health status.

Background: Internal medicine physicians are able to convert to "general practitioners" in the future.Objective: To examine factors related with "career conversion to a general practitioner" conceived by hospital internal-medicine physicians specializing in organs/regions.Materials and Method: A semi-structured interview was conducted for 20 internal-medicine physicians with their consent from November 2014 to November 2015. The verbatim records were analyzed with the modified grounded theory approach.Results: The facilitating factors for career conversion consisted of "a career plan where characteristics of a general practitioner can be utilized", "high-quality training that combines practical conditions", and "diverse ways of working and a specialist-licentiate who has opportunities for learning".On the other hand, the suppressive factors consisted of "a lack of understanding of general practitioners", "difficulties associated with re-training", and "a feeling of resistance toward comprehensiveness of general practitioners".Conclusions: Career conversion to general practitioner by qualified internal-medicine physicians was suggested to be promoted by enhancing the meaningfulness of the general practitioner license, the training circumstances, and ensuring the professionalism and financial aspects of physician life.

Purpose : To examine the characteristics of second-year residents intending to become primary care physicians.
Methods : Using a self-administered questionnaire, we surveyed 7344 second-year residents in March, 2006. Of the 4167 responders (response rate 56.7%), the 3838 who answered that they intended to make a career choice of being clinical practitioners were taken as subjects for analysis. The odds ratios (OR) for the intention of being a primary care physician was calculated, together with the 95% confidence interval (95% CI), using logistic regression models (primary care physicians intended=1 vs. specialist intended=0)
Results : In total, 56% of the residents affirmed an interest in becoming primary care physicians. Multiple stepwise logistic models showed that residents intending to become primary care physicians planned to open their own clinics in the future (OR 1.44, 95% CI : 1.20-1.73), did not wish to obtain doctor of medical science (DMSc) degrees (OR 1.29, 95% CI : 1.07-1.55), and were more likely to choose internal medicine (OR 1.44, 95% CI : 1.07-1.94).
Conclusion : This study demonstrated that second-year residents who aimed to be primary care physicians were associated with more interest in opening private clinics for their future practice, preferably in the field of internal medicine, and with less interest in earning DMSc degrees.