Introduction: The rising poverty rate has spurred concerns regarding income-related disparities in medical-care utilization. This study attempted to investigate physicians'recognition of patients'refraining from medical care for financial reasons and the characteristics of physicians who made efforts to improve such situations.
Methods: A mail survey was conducted between July 1 and September 30, 2014. All internal medicine clinics (n=1989) in 12 municipalities in Tokyo were included. One physician from each clinic was requested to answer the 60-item questionnaire.
Results: Of the 617 questionnaires returned (response rate 31 %), 550 (454 male physicians) complete responses were analyzed. About 90% of physicians recognized that patients refrained from seeking medical care for financial reasons, and used various methods to encourage receipt of treatment (e.g., prescribing inexpensive medicines). Physicians who were 40-59 years old, specialized in general practice, implementing informed consent or shared decision making, and frequently recognizing that patients refrained from seeking medical care were more likely to engage in efforts to encourage treatment seeking.
Conclusion: Our results suggest that physicians in primary care roles such as general practice and utilizing shared decision making are more likely to engage in efforts to encourage medical care utilization in patients who refrain due to financial reasons.

Introduction: We conducted 3 surveys to elucidate the current status of Women's Health (WH) training in Japanese General Practice Residency Programs, and the opinions that the residency program directors and learners have about the training.Methods: Three questionnaire surveys were conducted during Aug-Nov, 2015. Subjects of the surveys were residency program directors (Survey 1), resident physicians (Survey 2) and medical students (Survey 3).Results: Survey 1 (response rate 42.7%): Regarding the programs, 6.8% and 38.9% provided compulsory WH rotations and selective rotations, respectively. Of the respondents, 71.4% wished to improve WH training, whereas 68.0% noted barriers, including the shortage of teaching physicians, and lack of understanding by teaching physicians regarding the needs and objectives of WH training. Survey 2 (response rate 45.8%): Of the residents, 14.5% and 27.9% had compulsory and selective WH rotations, respectively. The WH training was reported to be insufficient by 57.8% of the respondents. Survey 3 (response rate 85.4%): Of the medical students, 97% desired WH training and 97.7% wished to practice WH in the future.Conclusion: Our surveys revealed WH training in current Japanese General Practice Residency Programs to be inadequate, and both trainers and trainees desired further improvement of their training programs.

Introduction: To elucidate the issues surrounding adolescents' Internet use in social minority groups, this study investigated the current situation of Internet addiction among Brazilian students who live in A city in Japan.Methods: The participants were 342 local Brazilian students attending international schools. A cross-sectional study using a self-administered questionnaire in Brazilian-Portuguese was conducted. As a primary outcome, we used Young's Internet Addiction Test (IAT) to evaluate the level of self-reported Internet addiction. Social demographics (i.e. age, sex, etc. ), lifestyle (i.e. the time for Internet use, sleeping hours, etc. ), and depressive tendency (Patient Health Questionnaire 2, PHQ2) were also assessed. The χ-square test and logistic regression analysis were used for analysis.Results: The response rate was 65% (222; 111 males and 111 females). Factors related to an IAT score of 50 or higher were sleeping hours (<7.5 hours) (OR: 0.38, 95%CI: 0.21-0.68), the time for Internet use (≥4 hours) (2.6, 1.4-4.8), and PHQ2 score (≥3) (6.2, 3.3-11.5). On logistic regression analysis, an IAT score ≥50 was positively associated with the time for Internet use and PHQ2 score ≥3.Conclusion: The self-report of high Internet addiction among Brazilian students in A city in Japan was significantly related to the time for Internet use and depressive tendency.

Introduction: Patient-centric treatment is important in primary care, and one of the characteristics of this type of care is shared decision making (SDM) on treatment options between the patient and the doctor. However, no study has examined the circumstances of SDM practice in primary care in Japan. In this study, we investigated the proportion of doctors who practice SDM and examined their characteristics.
Methods: In 2014, we sent a postal survey to one doctor in each of the internal medicine clinics in 10 wards and 2 cities within the Tokyo Metropolitan Area. We evaluated the decision-making methods for treatment using a five-point scale (paternalism, close to paternalism, informed consent, SDM, informed decision making), and evaluated the doctors'background and patient interviews.
Results: Informed consent was the most frequently used decision-making method for treatment (40.8 %), and 14.6% of the doctors opted for SDM. Most of these doctors were in their 50s, and had spent the longest period of their working life in clinics. These doctors also had a tendency to select items that encouraged spontaneous remarks of the patients.
Conclusion: The findings of the present study suggest that the practice of SDM, which is an important factor in patient-centric medicine in primary care, is not very prevalent at present.

Family medicine is a linchpin of most successful health systems in the industrialized world, and is increasingly being seen as crucial in the current distressed financial climate. Japan has not had a robust family medicine infrastructure, but recently has begun to develop family medicine in several locations around the country. However, few of these programs are adequately training the type of family physicians Japan needs. This article discusses the background of what family medicine entails, an example of what a successful family medicine university program can do, and the potential benefits to Japan in adopting true family medicine.

  We require our students in the 4th grade to take an on-site pediatric outpatient clinic course at the Teikyo University Hospital as part of a 4-week on-site training program.  This year, 64 trainees divided into groups of 3 or 4 students took the course between June and August.  In the morning, trainees were asked to conduct clinical interviews with 287 patients’ guardians in the presence of trainers.  This was followed by the observation of consultation and treatment services provided to patients.  In the afternoon, students reported the findings obtained in medical interviews, participated in group discussions, and received supplementary lectures from trainers.  After completing the course, students were asked to fill in a questionnaire.  When asked whether they were satisfied with the course, 62.5% and 37.5% of students said “very satisfied” and “satisfied,” respectively, while 64.1%, 29.7%, and 6.2% of students said the observation of consultation and treatment services was “very good,” “good,” and “cannot say which,” respectively.  About the medical interviews, 64.1% and 34.4% said that it is “very good” and “good” to conduct them, while 1.5% said “cannot say which.”  All students said they could determine the problems faced by guardians regarding drugs in the medical interview.  The on-site pediatric outpatient care course was found to be “very useful” and “useful” by 62.5% and 35.9% of patients, respectively, while 1.6% said “cannot say which.”  In conclusion, most students were greatly satisfied with the medical interview with guardians using a questionnaire and said that it made it possible for them to closely communicate with guardians.  This result was thought to be attributable to the use of the techniques of the medical interview OSCE which the students learned prior to conducing medical interviews with guardians.

Introduction: Patients often refer to information on the Internet when selecting a medical institution, and some patients provide feedback on their experiences. In this study, we analyzed the content of patients' evaluations of medical institutions on Google.Methods: This study evaluated Google reviews and ratings of medical institutions in Shizuoka Prefecture. We coded the reviews with 12 items according to their content, and further categorized them into "positive," "negative," "unclassifiable," and "no description." We used modified Poisson regression analysis to investigate the relationship between ratings and assessment items.Results: Our sample consisted of 2,044 medical institutions. The number of reviews included in the analysis was 13,769. Reviews frequently commented on "doctor's behaviors," and positive comments about doctor's behaviors were significantly associated with high ratings (B: 0.76, 95%CI: 0.70 to 0.82), whereas negative comments were associated with low ratings (−4.65, −5.24 to −4.06).Conclusion: Within the reviews on Google, doctors' behavior had an impact on the ratings of medical institutions.