We investigated attitudes in lifestyle planning of female medical students concerning career continuation and family life and examined how medical education should support future career decisions. We based our study on the following 3 hypotheses: 1)female medical students already experience anxiety about future pregnancy, child raising, and family life; 2)female medical students are highly conscious of these issues in deciding their future lifestyle; and 3)female medical students who already anticipate leaving their jobs in the future for family life have a strong desire to balance work and family life.
Anonymous, voluntary questionnaires concerning prospective lifestyles and career continuation were distributed to all female medical students (n=806) registered at Tokyo Women's Medical University in 2006. The response rate was 75.3%. The results were analyzed statistically.
While the majority of subjects had concerns regarding pregnancy, giving birth, and family life, they also intended to marry. In addition, 79.3% (n=363) of the subjects wished to give birth, and most gave priority to postgraduate clinical training over having children, thereby choosing to plan their pregnancy around their training. Subjects expected that they would use a child-care center (n=269, 58.7%) for child raising rather than that their partner would take parental leave (n=121, 26.4%). Subjects were divided into 2 groups: those anticipating leaving their job for family issues, and those who did not. According to the χ-square test and discriminant analysis, the former group perceived the role of wife as more positive and significant than did the latter group and had greater anxiety about balancing their family life and their work as a physician.
Medical education to help develop self-esteem and self-control in female medical students is essential, such as providing mentors and access to reproductive health education from an early stage. In addition, active support for career continuation and education to maintain a work-life balance are needed for both men and women.

The liver mitochondrial redox state (the liver mitochondrial free NAD+/NADH ratio), which indicates hepatic energy charge, is known to parallel the ketone body ratio (acetoacetate/3-hydroxybutyrate) in liver tissue. Since the ketone body ratio in arterial blood was reported to correlate with that in liver tissue; the arterial ketone body ratio (AKBR) has been widely accepted as a useful measure of the liver function reserve. The liver mitochondrial redox state is known to decrease with the oxidation of ethanol in alcohol abusers. To evaluate whether AKBR reflected the effect of alcohol intake on the liver, AKBR was measured in normal controls (n=8), and patients with alcoholic liver injuries (n=14) and chronic active hepatitis (n=15). The mean AKBRs in the normal control subjects, in patients with chronic active viral hepatitis, and in those with alcoholic liver disease were 1.68±0.77, 2.22±1.02, and 1.55±0.79, respectively. Though the AKBR in patients with alcoholic liver disease tended to be lower than the other groups, there was no significant difference in AKBR among those three groups. In conclusion, this study demonstrated that AKBR was doubtful as an accurate parameter to estimate the changes in the liver mitochondrial redox state by alcoholic intake.

BACKGROUND: physicians' awareness regarding evidence-based medicine (EBM), clinical practice guidelines, and clinical information resources were rarely examined in Japan. We need to know them prior to the initiation of the Medical Information Network Distribution Service (Minds) by the Japan Council for Quality Health Care (JCQHC) .
METHODS: A total of 10, 000 directors/owners of private clinics (CDs: clinic physicians) affiliated with the Japan Medical Association (JMA) and 8682 physicians working for hospitals certified by the JCQHC (HDs: hospital physicians) were randomly selected and surveyed by a mailed questionnaire.
RESULTS: The response rate to the questionnaire was 18.7% (n=1865) among CDs and 67.8% (n=5885) among HDs. The percentage of respondents who uses internet was 39.9% among CDs and 69.3% among HDs. The information resource most commonly used by all respondents was medical journals, followed by textbooks. The percentage of respondents who used medical literature database was 10.8% among CDs and 49.7% among HDs, respectively. Approximately 80% of all respondents approved implementing EBM in daily practice. Fifty percent of all respondents indicated to have used clinical practice guidelines, and 90% of all the guideline users replied that clinical practice guidelines are useful tools for clinical decision-making. Over half of HDs required to access to the abstracts of the literature cited in the guidelines.
CONCLUSIONS: Many physicians who responded to the survey acknowledged that EBM will contribute to improving the quality of medical services. They are positive in using clinical practice guidelines that include a series of recommendations proposed by specialists in the relevant field (s) in accordance to the reviewed evidence.

BACKGROUND: The purpose of our study was to compare the characteristics of medical practitioners who prefer using the Internet as their information resource and those who prefer using printed materials.
METHODS: From December 2002 to January 2003, a non-anonymous questionnaire was sent out by post to members of the Japanese Medical Association (JMA) and physicians working in hospitals. Contributing factors were examined by using logistic regression analysis.
RESULTS: The response rates for the questionnaires were 18.7% (n=1868) for JMA physicians and 68.0% (n=5901) for hospital physicians. Factors associated with the preference for using the Internet were: ‘younger age’; ‘use of the Internet to solve clinical problems and uncertainties’; ‘use of personal computers at work’; and, ‘use of personal computers at home’.
CONCLUSION: The results of this study show that, although some younger physicians prefer printed materials, providing medical information via the Internet is better suited for younger physicians who are making full use of computers. In contrast, older physicians prefer printed materials because they tend to be less familiar with using computers and may have limited accessibility to the Internet. Therefore, using both the Internet and printed materials to provide medical information is necessary to meet the needs of the larger physician population.

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