Association between smoking prevention education for elementary and junior high school students and the modification of their parents' smoking behavior — Can child education change parental behavior?
Introduction : This study aimed to investigate an association between a smoking prevention education program for elementary and junior high school students, and the subsequent behavior modifications of their parents.
Methods : Preventative education programs for smoking were provided to four elementary and three junior high schools in Kamisu City, Ibaraki Prefecture, Japan. We encouraged participating students to discuss the knowledge derived from the education sessions with their families. One month after completing the program, questionnaires were distributed to the parents of the students to investigate whether they had modified their smoking behavior as a result of what they had learnt from their children.
Results : Two questionnaires were distributed to each of 1109 families, and 1427 valid responses were received. Analysis showed that 794 parents had been informed about tobacco use from their children (55.6%) and 271 parents had modified their smoking behavior (19.0%) as a consequence. This included smoking cessation, decreasing tobacco consumption, and smoking avoidance in the presence of their children. Behavior modification was significantly correlated with the knowledge they had derived from their children based on the preventative smoking education program (odds ratio = 3.3 ; 95% CI : 2.4-4.6).
Conclusion : Implementation of an education program for smoking prevention focused on elementary and junior high school students can lead to modification of smoking behavior in both students and their parents, respectively.

Objective : To investigate the knowledge of cervical cancer and human papillomavirus (HPV) vaccination amongst vaccinated schoolgirls and their parents.
Methods : All schoolgirls age range 12 to 18 years who received HPV vaccination and their parents, answered a questionnaire concerning the knowledge of HPV, cervical cancer, and vaccine provision at nine primary care clinics in Gifu Prefecture, Japan.
Results : A total of 66 schoolgirls and 57 parents completed the questionnaire. A large proportion of the schoolgirls received information from their schools and their families regarding HPV. Many parents derived information about HPV from their local governments, television commercials, and their children's schools. Half of the schoolgirls were concerned about their decision to receive the HPV vaccination. Fifteen percent of them were hesitant to receive the vaccination because of the fear of pain. However, none of them were concerned about possible infertility or miscarriage. Fifteen percent of the schoolgirls and fifty-four percent of the parents acknowledged that cervical cancer is caused by HPV. Forty-one percent of the schoolgirls and seventy-nine percent of the parents reported that cervical cancer is a sexually transmitted infection. Twenty-one percent of the schoolgirls and sixty-three percent of the parents knew that a medical examination exists for detection of cervical cancer, whereas seventy-one percent of the former and ninety percent of the latter reported that the schoolgirls should receive an appropriate medical examination.
Conclusion : Currently, schoolgirls' knowledge of the HPV vaccine in the Gifu area of Japan is inadequate and therefore, it is imperative to provide better healthcare education.

Introduction : As one of the strategies for the introduction of collaborative drug therapy management (CDTM) into a community healthcare system in Japan, we constructed a ‘positive list’ which was agreed by a family physician in advance, and subsequently validated the effects on healthcare insurance fees, the number of prescription question and the changes of utilization rate for generic drugs.
Methods : The items that replaced prescription questions with regard to ex post facto approval were defined as ‘Resolved Questions’ in our constructed positive list. By adopting the ‘Resolved Questions’, we then examined the effect on healthcare insurance fees, prescription questions and the changes of utilization rates for generic drugs.
Results : Among all prescription questions accepted from January through May 2012 inclusive, 178 (22.7%) were ‘Resolved Questions’, without there being change in the therapeutic strategies by the prescribing physicians. During this period, 17,455 healthcare insurance fees were reduced. In addition, the utilization rate for generic drugs were increased up to 46.6%.
Conclusion : The reduction of healthcare insurance fees, prescription questions and the increased utilization rates of generic drugs were facilitated by prudent pharmacist judgements based on ‘Resolved Questions’.

Objective : The purpose of this study was to examine the relationships between levels of self-efficacy on health behavior of outpatients with rheumatoid arthritis (RA) and patient's assessment of RA conditions.
Methods : A cross-sectional study was performed using a self-administered anonymous questionnaire between October and December 2010 on 406 RA outpatients who consecutively visited 3 urban hospitals in Japan. The following variables were investigated ; (1) the scale of self-efficacy on health behavior in chronic disease patients (CD-SES), which has 2 subscales : active coping behavior with disease (14 items) and controllability for health (10 items). (2) The demographic data ; age, gender, duration of disease, treatment. (3) patient's assessment of RA conditions : painful joint count, swollen joint count, serum C reactive protein (CRP), patient estimate of global status (PGS) which was measured on a 100-mm visual analogue scale (0=best score), functional disability according to Japanese version of modified Health Assessment Questionnaire.
Results : CD-SES data were obtained from 191 patients. 80% was female with mean age 64.4 yr. Total CD-SES scores significantly correlated with age, PGS and functional disability. The scores of active coping behavior with disease correlated with age, and the scores of controllability for health correlated with PGS. The other variables such as painful joint counts, swollen joint counts, and serum CRP showed no relationship with the scores of self-efficacy.
Conclusion : Self-efficacy on health behavior of RA patients related to PGS and functional disability. The longitudinal study is necessary to ascertain whether the psychological support enhances self-efficacy, and affects clinically important outcome measures such as PGS.

Purpose : The purpose of this study was to review strategies and evidence about effective outpatient precepting in the Western literature.
Methods : The authors searched MEDLINE for studies on family medicine or general medicine outpatient precepting. From 309 papers, the authors applied inclusion and exclusion criteria to identify relevant studies applicable to residency training in family medicine in Japan, and the resulting 18 studies were then analyzed systematically.
Results : Using a dedicated preceptor is the most effective precepting style. In a typical five-minute precepting encounter, most of the time is spent on the diagnosis and management. Insufficient time is spent on the discussion of evidence based medicine (EBM), psychosocial issues, or feedback. To resolve this, precepting techniques such as ‘one-minute precepting’ and SNAPPS can be effectively implemented.
Conclusion : In outpatient precepting, educational discussions incorporating EBM and psychosocial issues as part of standard practice, in addition to providing effective feedback are advocated.

In Japan, young generalists work in various clinical settings depending on the needs ; they work as family physicians, geriatricians, and hospitalists/general internists. In this symposium, four young generalists from different backgrounds discussed the future of primary care medicine in Japan. First, they presented their dream of primary care. Secondly, geriatric end-of-life issues were discussed, and the suggestion was made that the obtaining of informed consent at an earlier time in an outpatient setting while including patients' families is important in terms of successful advanced care planning. Finally, the issues of career planning for young generalists were focused on. It was revealed that most young generalists understand the importance of obtaining various work-related experiences to develop their skills, but they find it difficult to set their career plan because of the lack of a support system. A stronger support system provided by the JPCA and enhanced solidarity among young generalists are needed.
-Report of a symposium held as part of the 8 th Winter Seminar of Family Medicine for Young Doctors, 3rd March, 2013 at Tokyo University.