Objective: To clarify the characteristics of medical students' motives for choosing their profession.Methods: A nationwide, cross-sectional, quantitative web survey was conducted using the Profession Choice Motivation Scale for Education Students. Results: Valid responses were obtained from 1,804 medical students, and the applicability of this scale was demonstrated. Medical students considered "contribution to others," "fulfillment in the profession and studying medicine," "financial aspects," and "evaluation by others" to be important, while "mental and physical comfort" was deemed less important. Mean scores for "contribution to others" were significantly higher among female students, public medical school students, students attending their first- or second-choice medical schools, regional quota students, public high school graduates, and first-generation college students. Conversely, students with very low scores for "contribution to others" showed opposite demographic backgrounds. Discussion: The Profession Choice Motivation Scale for Education Students was applicable to the analysis of medical students, and a correlation was observed between demographic backgrounds and profession choice motives.

Objective: Perceptions of citizens and health professions educators towards the socioeconomic backgrounds of medical students were investigated to elucidate the challenges of selecting medical students who will be responsible for the future of healthcare in Japan.Methods: Ten focus groups, comprising 14 citizens and 26 health professions educators, were conducted regarding the presented information on the socioeconomic backgrounds of Japanese medical students. Data were analyzed using an inductive thematic analysis approach.Results: Six themes related to family backgrounds, such as higher economic status, five themes related to social backgrounds, such as social and educational disparity, and four themes related to expectations for medical education, such as selection of medical students with diverse backgrounds were extracted.Discussion: Both citizens and health professions educators were aware of the problem of the skewed socioeconomic backgrounds of medical students and the need to expand diversity. This finding will contribute to the reconsideration of future medical school admission criteria.

Objective: Bevacizumab maintenance therapy following platinum-based combination chemotherapy for metastatic, recurrent, or persistent cervical cancer is not recommended as standard therapy. This pilot study aimed to evaluate the efficacy and safety of bevacizumab maintenance therapy and the contribution of the platinum-free interval to the efficacy of subsequent chemotherapy for advanced cervical cancer. Methods: We retrospectively identified 115 patients with metastatic, recurrent, or persistent cervical cancer treated with platinum-paclitaxel chemotherapy plus bevacizumab at 7 institutions between 2015 and 2020. The primary endpoints were overall survival (OS) and progression-free survival (PFS) in patients who received bevacizumab maintenance therapy and those who did not. We also analyzed the adverse events associated with bevacizumab and survival time from the start of subsequent chemotherapy in both groups. Results: Following platinum-paclitaxel plus bevacizumab chemotherapy, 34 patients received bevacizumab maintenance therapy and 81 patients did not. Of the 115 patients, 56 received chemotherapy for subsequent relapse. Although bevacizumab maintenance therapy prolonged PFS (median of 16.0 months vs. 9.0 months, p=0.041), significant differences were not observed in OS (p=0.374). Furthermore, bevacizumab maintenance therapy did not prolong OS and PFS after the start of subsequent chemotherapy (p=0.663 and p=0.136, respectively). Bevacizumab maintenance therapy significantly increased hypertension (p=0.035) and proteinuria (p=0.005) but did not cause complications leading to death. Conclusion Bevacizumab single-maintenance therapy for advanced cervical cancer can be considered in selected cases, such as those with acceptable bevacizumab-related side effects. The outcomes of our study will likely contribute to decision-making regarding practical treatment strategies.

Context: As a contribution to this special issue of the journal featuring the computerization of the national medical licensing examination (NMLE), this paper seeks to explore the steps to shift the NMLE toward computer-based testing (CBT). Objectives: The purpose of this paper is to explore the movement of the NMLE toward CBT over the last 20 years and the merits and demerits of computerizing the NMLE. Methods: To explore the contents of committees' reports on the improvement of the NMLE, which have been held almost every five years. We also report the results of research we conducted on the computerization of NMLE. The research was supported by a grant from the Ministry of Health, Labor and Welfare (MHLW). Discussion: The former part of this paper explores the reports by the committees to improve the NMLE from 2011 onward. The latter half of this paper focuses on the result of our research from 2018 to 2020, favoring the computerization of NMLE based on the analysis of the merits and demerits of CBT.

Purpose: To investigate the influence of multiple recurrences and repeated surgeries of Hunner lesions on bladder capacity under general anesthesia in patients with interstitial cystitis (IC). Methods: We retrospectively reviewed the clinical records of Hunner-type IC (HIC) patients who underwent transurethral fulguration or resection of Hunner lesions combined with hydrodistension by a single surgeon between 2011 and 2020. Recurrence was defined as reappearance of uncontrolled urinary symptoms in association with new Hunner lesions identified by cystoscopy. Recurrent Hunner lesions were then treated by transurethral surgeries. The recurrence-free rate, potential predictive factors of recurrence, and changes in bladder capacity under anesthesia were examined at each surgical procedure. Results: A total of 92 surgeries were performed in 47 HIC patients, 23 (49%) of whom required multiple procedures (range, 1–5 times). The mean recurrence-free time after the first surgery was 21.7 months. The recurrence-free rate was 53% at 24 months, and decreased to 32% at 48 months. There were no significant differences in age, sex, bladder capacity under anesthesia at the first surgery, duration from symptom onset to the first surgery, O’Leary-Sant questionnaire including symptom and problem indexes, visual analogue scale pain score, and the number of comorbidities between the cases with or without recurrence. Bladder capacity under anesthesia was gradually decreased as the number of surgeries was increased, and bladder capacity at the fourth procedure was significantly decreased to 80% of the capacity at the first surgery. Conclusions These results suggest that multiple recurrences and repeated surgeries of Hunner lesions result in a reduction of bladder capacity under anesthesia in HIC patients although no predictive factors for recurrence of Hunner lesions were detected.

Over the past 20 years, the Center for Medical Education Development Center, Gifu University has been working on training medical educators across the country. The Center offers a wide variety of programs to meet participants’ various needs and levels, targeting medical educators and administrative staff in various fields such as dentistry, pharmacy, nursing, physical therapy, and occupational therapy. This paper introduces the “Medical Education Starter Kit,” “Fellowship Program,” and “Master’s Course of Health Professions Education” among the programs. The objectives, target participants, and features of each program are outlined, including future prospects.

The patient was a six-month-old girl with an anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA). She had fever and visited a family physician at 5 months of age. Because of poor oxygenation, she was referred to our pediatric department and intubated soon after hospitalization. Echocardiography showed that the orifice of left coronary artery was just above pulmonary commissure, the left ventricular ejection fraction was 9%, and the level of mitral regurgitation was moderate. Right coronary angiography showed that the left coronary artery contrasted against the collateral arteries. The left coronary artery originated from the left side of the pulmonary trunk. After recovery of the general condition with medical therapy, the patient underwent coronary artery reconstruction by the modified spiral cuff technique on the 21st day of hospitalization. The temporary detachment of pulmonary valve and its commissure for making a margin around the left coronary artery enabled us to make the spiral cuff in almost the usual manner. She was moved to the intensive care unit with the support of extracorporeal membrane oxygenation (VA-ECMO) and was successfully weaned off the VA-ECMO 5 days after the surgery. The postoperative course was good, and she was discharged from our hospital 3 months after the surgery. The echocardiogram one year after the surgery showed a left ventricular ejection fraction of 30%, mild mitral regurgitation, and mild pulmonary regurgitation. Our experience indicates that the spiral cuff technique is a useful coronary reconstruction method for the treatment of ALCAPA, especially in cases presenting a considerable distance between the origin of the left coronary artery and the transplantation site. There are few reports regarding the surgical treatment of infantile ALCAPA showing reduced left ventricular function. Coronary artery reconstruction using the spiral cuff method and planned VA-ECMO are useful surgical procedures in such cases. Our experience also suggests that the establishment of a treatment strategy including mechanical support is essential to improve the results in severe ALCAPA cases.

BACKGROUND: The gender-specific characteristics of individuals at an increased risk of developing depression currently remain unclear despite a higher prevalence of depression in women than in men. This study clarified socioeconomic and lifestyle factors associated with an increased risk of subclinical depression in general Japanese men and women. METHODS: Study participants were residents not receiving psychiatric treatments in 300 sites throughout Japan in 2010 (1152 men, 1529 women). Multivariable-adjusted odds ratios (OR) and 95% confidence intervals (95%CIs) for socioeconomic factors and lifestyle factors were calculated using a logistic regression analysis. RESULTS: Risk of depressive tendencies was significantly higher in men who were single and living alone (OR, 3.27; 95% CI, 1.56-6.88) than those married. The risk was significantly lower in women who were not working and aged ≥ 60 years (OR, 0.39; 95% CI, 0.22-0.68) and higher in men who were not working and aged < 60 years (OR, 3.57; 95%CI, 1.31-9.72) compared with those who were working. Current smoking was also associated with a significantly increased risk of depressive tendencies in women (OR, 2.96; 95% CI, 1.68-5.22) but not in men. CONCLUSIONS Socioeconomic and lifestyle factors were associated with an increased risk of depressive tendencies in general Japanese. Related factors were different by sex.
Adult ; Aged ; Community Psychiatry ; statistics & numerical data ; trends ; Depression ; epidemiology ; Female ; Health Surveys ; Humans ; Japan ; epidemiology ; Life Style ; Male ; Middle Aged ; Odds Ratio ; Prevalence ; Risk Factors ; Socioeconomic Factors