Objectives: The aim of this study was to evaluate the impact of community health worker (CHW) training on recognition and satisfaction regarding the performance of CHWs among members of the community in Amazonas, Brazil, which is a resource-poor area underserved with regard to medical health care accessibility.
Methods: Baseline and endline surveys concerning recognition and satisfaction with respect to CHW performance among members of the community were conducted by interview using a questionnaire before and after implementation of a program to strengthen community health projects in Manicore, Amazonas, Brazil. One of the components of the project was CHW refresher training, which focused on facilitating adequate use of health-care services and providing primary health care, including health guidance. The baseline survey was performed in February 2004 at the beginning of the project, and the endline survey was performed in February 2006 at the end of the project. There were 82 and 120 CHWs working in Manicore at the times of the baseline and endline surveys, respectively. Statistical analysis was performed to determine the significance of changes in experience with CHW activities, expected functions of CHWs, and satisfaction regarding the performance of CHWs between the baseline and endline surveys. In addition, qualitative analysis was conducted to evaluate the acceptability, feasibility, and sustainability of CHW refresher training.
Results: Overall recognition and level of satisfaction regarding CHW performance among members of the community were improved from the baseline to the endline survey, regardless of type of residential area, such as town and/or remote area. Members of the community came to not expect CHWs to “provide strong medicine” (P < 0.001) and “provide injections” (P < 0.001), and came to appreciate “go to hospital with a sick person” (P = 0.031) as a function and role of CHWs.
Conclusions: The results of the present study indicated that steady approaches to motivate and support CHWs in resource-limited settings could improve performance of CHWs and satisfaction of people in the community regarding the activities of CHWs to sustain their health.

Objectives: The aim of this study was to evaluate the impact of community health worker (CHW) training on recognition and satisfaction regarding the performance of CHWs among members of the community in Amazonas, Brazil, which is a resource-poor area underserved with regard to medical health-care accessibility.
Methods: Baseline and endline surveys concerning recognition and satisfaction with respect to CHW performance among members of the community were conducted by interview using a questionnaire before and after implementation of a program to strengthen community health projects in Manicoré, Amazonas, Brazil. One of the components of the project was CHW refresher training, which focused on facilitating adequate use of health-care services and providing primary health care, including health guidance. The baseline survey was performed in February 2004 at the beginning of the project, and the endline survey was performed in February 2006 at the end of the project. There were 82 and 120 CHWs working in Manicoré at the times of the baseline and endline surveys, respectively. Statistical analysis was performed to determine the significance of changes in experience with CHW activities, expected functions of CHWs, and satisfaction regarding the performance of CHWs between the baseline and endline surveys. In addition, qualitative analysis was conducted to evaluate the acceptability, feasibility, and sustainability of CHW refresher training.
Results: Overall recognition and level of satisfaction regarding CHW performance among members of the community were improved from the baseline to the endline survey, regardless of type of residential area, such as town and/or remote area. Members of the community came to not expect CHWs to “provide strong medicine” (P < 0.001) and “provide injections” (P < 0.001), and came to appreciate “go to hospital with a sick person” (P = 0.031) as a function and role of CHWs.
Conclusions: The results of the present study indicated that steady approaches to motivate and support CHWs in resource-limited settings could improve performance of CHWs and satisfaction of people in the community regarding the activities of CHWs to sustain their health.

[Objective] To examine the effect of moxibustion treatment for reducedpain during activity due to hallux valgus.
[Methods] The subjects were five young females with pain due to hallux valgus. Indirect moxibustion treat-ment was carried out on the region of maximum pain to relieve pain. Moxibustion was performed once per day for 2 weeks, for a total of 14 times. Evaluation used the number of side steps performed and the pain (Numerical Rating Scale) at the time of a side step.
[Results] After moxibustion treatment, pain improvement was observed in all subjects at the time of a side step. At the same time, the number of side steps increased. Repeated measurements before and after moxibustion indicated that there was no significant learning effect.
[Discussion and Conclusion] It became clear that the pain due to hallux valgus is mitigated by moxibustion over a fixed period, while athletic ability with respect to side steps is also improved. These results suggested the pain during activity due to hallux valgus is controllable with moxibustion treatment. By controlling pain, moxibustion treatment also temporarily improves athletic ability.

A self-reporting questionnaire was designed and sent to our Jichi Medical School graduates each year since 1980, in order to investigate clinical competence. The format was designed based on several major reports concerning postgraduate clinical training in primary medical care. We found that more than 70% of Jichi Medical School graduates trained in the multi-specialty rotation style in general hospitals that were certified by the Ministry of Health and Welfare. Our results also suggested that these graduates obtained a relatively high level of clinical competence in performing physical examinations, basic laboratory testing, clinical procedures, and various treatments.

A self-reporting questionnaire was designed and sent to our Jichi Medical School graduates each year since 1980, in order to investigate clinical competences attained in certain technical items. The responses from graduates of classes 1984 through 1987 were analysed, and the questionnaire was found to be highly reliable and moderately valid. The coefficient variable was 0.942, and the relevant variable was 0.934 using the half-split method. The content was clear, because items in the questionnaire were selected from published official reports. In the construction validity, 4 meaningful groups of items were found by factor-analysis. Yearly analysis using such a questionnaire may clarify some of the problems experienced by trainees and training hospitals, and would encourage the trainees to undergo a process of selfevaluation.