Objective: Primary care physicians on remote islands and specialists in mainland are expected to collaborate using telemedicine. This survey aimed to identify diseases for which primary care physicians on remote islands consider telemedicine necessary.Materials and Methods: A mail survey was conducted at rural public clinics on remote islands. Participants were asked to select diseases for which telemedicine with mainland specialists was necessary.Results: A total of 23 physicians participated in this survey. The most common disease category for telemedicine was psychiatric/psychosomatic diseases, followed by neurological and endocrine/nutrition/metabolic diseases.Conclusion: These data may be useful for the future development of telemedicine involving primary care physicians on remote islands and mainland specialists.

BACKGROUND: Pretesting is the key to understanding how the intended audience will react to the message. Resistant reactions affect message processing or can lead to undesirable boomerang effects. The objective of this study was to develop a rating scale for measuring active (reactance) and passive (disengagement) resistance to persuasive health messages. METHODS: Six candidate items (3 items for disengagement and 3 items for reactance) were generated based on literature review. A web-based survey was conducted among Japanese adults aged 25-64 years to verify the reliability and validity of the 6-item resistance scale. Participants were asked to rate one of the advance care planning (ACP) promotion messages. All scale items were scored on a 1-to-5 point Likert scale and they were averaged to produce the resistance score. RESULTS: Explanatory factor analysis revealed a two-factor solution that agreed with the disengagement and reactance domains, respectively. Correlation coefficients between each set of items ranged between 0.30-0.69. Cronbach alpha (0.86) indicated satisfactory internal consistency of the set of items. Confirmatory factor analysis showed a good fit of the two-factor model with CFI = 0.998, SRMR = 0.011, and RMSEA = 0.041. The resistance score showed a moderate positive correlation with negative emotional responses (displeasure γ = 0.55, anger γ = 0.53) and was significantly inversely related to the persuasiveness score (γ = -0.50). Multivariable logistic regression analysis showed that the odds ratio for ACP intention per 1-point increase in the resistance score was 0.47 (95% confidence interval 0.40-0.56) with adjustment for the persuasiveness score. CONCLUSION: The 6-item resistance scale exhibited adequate reliability and validity for measuring audience resistance when applied to the ACP promotion messages in Japanese people. The scale will be useful for pretesting health messages to make them more acceptable to the intended audience. TRIAL REGISTRATION Not applicable; this is not a report of intervention trial.
Adult ; Factor Analysis, Statistical ; Humans ; Intention ; Middle Aged ; Persuasive Communication ; Psychometrics ; Reproducibility of Results ; Surveys and Questionnaires

BACKGROUND: This study aimed to examine the change in health status of the general public after starting the COVID-19 pandemic and its association with changes in workload and lifestyle. METHODS: A web-based survey was conducted in November 2020, about 9 months after starting the COVID-19 pandemic in Japan, among 8000 Japanese men and women aged 25-64 years. Participants asked for the changes after starting the COVID-19 pandemic in health status, workload, daily life, and health behavior. Ordinal logistic regression was performed to elucidate factors associated with deterioration in general health status. RESULTS: A deterioration in general health status was reported by 17.0% of male and 19.4% of female. There has been a clear shift to sedentary life with decreasing moderate activity and increasing screen time. The multivariate analysis revealed that deteriorated work style, increased burden of housework, decreased moderate activity, increased digital media exposure, and increased body weight were significantly associated with deteriorating health status. CONCLUSION Both men and women have experienced significant changes in workload and lifestyle since the COVID-19 pandemic started. People should be aware of the risks associated with their recent life changes and take self-care measures to prevent serious health consequences.
Adult ; COVID-19/psychology* ; Female ; Health Behavior ; Health Status ; Humans ; Japan/epidemiology* ; Life Style ; Male ; Middle Aged ; Multivariate Analysis ; SARS-CoV-2 ; Surveys and Questionnaires ; Workload

Dynamic knee valgus is considered a risk factor for anterior cruciate ligament (ACL) injuries. This study identified how knee in distance (KID) and hip out distance (HOD) affect one’s lateral trunk lean (LTL). The results were also tested for reliability. Fifteen female basketball players (30 legs) from a university participated in this study. The participants performed single-leg squats by bending the knee of the supporting leg to 60°. The trials were recorded using a video camera. The KID, HOD, and LTL were measured with two-dimensional images using the Dartfish software, which measured the maximal knee valgus. The Pearson’s correlation coefficient was used to measure the correlation between dynamic knee valgus (KID and HOD) and LTL. Additionally, the Interclass Correlation Coefficient (ICC) was used to measure the reliability of the KID, HOD, and LTL data sets. The statistical significance was established at a level of p<0.05. Results showed that the KID and LTL had a significantly negative correlation, measured at r=-0.227, p<0.05. The ICC (2.1) values were: 0.83 for HOD, 0.99 for KID, and 0.96 for LTL; while the ICC (1.2) values were: 0.86 for HOD, 0.83 for KID, and 0.85 for LTL. The two-dimensional analysis technique revealed that the values were highly reliable. In sum, dynamic knee valgus had a negative correlation with LTL during single-leg squats. Therefore, it was suggested that the factors of dynamic knee valgus might be evaluated using LTL on two-dimensional screening test.

BACKGROUND: The persuasive effect of health messages can depend on message features, audience characteristics, and target behaviors. The objective of this study was to compare the responses to persuasive messages encouraging professional help seeking for depression between individuals with and without psychological distress. METHODS: A cross-sectional web-based survey was conducted on Japanese adults aged 35-45 years, who randomly received one of three persuasive messages that aimed to promote help-seeking intentions for depression. The primary message statements were as follows: (1) depression can happen to anyone, (2) depression needs treatment, and (3) depression improves with treatment. Participants rated the messages in terms of comprehensibility, persuasiveness, emotional response, and intended future use. Help-seeking intention for depression was measured using vignette methodology before and after exposure to the messages. Eligible participants who had not received medical treatment for their mental disorders were classified as either distressed (K6 score ≥ 5, N = 824) or non-distressed (K6 score < 5, N = 1133) and analyzed. RESULTS: No significant differences in comprehensibility or persuasiveness scores were observed between the messages, but the distressed group had significantly lower scores than the non-distressed group. Negative emotional responses such as surprise, anger, fear, sadness, guilt, and anxiety were significantly stronger when reading message 2, while a positive emotional response such as happiness was significantly stronger when reading message 3. These emotional responses were more prominent in the distressed than in the non-distressed group. After reading messages 1, 2, and 3, the proportions of participants in the distressed group who reported having a positive help-seeking intention increased by 35.1%, 32.1%, and 27.7%, respectively, and by 6.4%, 17.3%, and 15.2%, respectively in the non-distressed group. Multiple logistic regression analysis among participants having no help-seeking intention before exposure to the messages showed that message 2 had a significantly greater effect of increasing help-seeking intentions in the non-distressed group. CONCLUSION: The exposure to persuasive messages may promote help-seeking intentions for depression. It seems likely that loss framing will work better than neutral and gain framing. Meanwhile, the responses to persuasive messages may differ to some extent between distressed and non-distressed individuals, as individuals with psychological distress are likely to be more susceptible to persuasive messages than those without. TRIAL REGISTRATION Not applicable; this is not a report of intervention trial.
Adult ; Cross-Sectional Studies ; Depression ; therapy ; Female ; Health Promotion ; statistics & numerical data ; Help-Seeking Behavior ; Humans ; Intention ; Male ; Middle Aged ; Persuasive Communication ; Stress, Psychological ; psychology ; Surveys and Questionnaires

It has been reported that physical fitness of breast cancer patients is relatively lower due to the cancer treatment such as surgery, chemotherapy, or endocrine therapy. Previous studies have revealed that not only cardiorespiratory fitness but also muscle strength is lower among breast cancer patients than no disease women and these symptoms may aggravate the health-related quality of life. However, there is no study which has focused the physical fitness level in Japanese breast cancer survivors. The purpose of this study was to investigate the physical fitness level and the relationship between exercise habituation and physical fitness level in Japanese breast cancer survivors. Fifty breast cancer survivors participated in this study. Participants were assigned to either exercise habituation group (n=25) or non-exercise group (n=25). We evaluated exercise habituation using an original questionnaire and examined various physical fitness level. Body weight, body mass index, and percent body fat were significantly lower in the exercise habituation group than non-exercise group. T-score of cardiorespiratory fitness was significantly higher in the exercise habituation group than average Japanese women. These results suggested that exercise habituation is relative to body weight and cardiorespiratory fitness level in Japanese breast cancer survivors.

　The WHO reported the importance of IPE (Interprofessional Education) in order to implement team-based medicine smoothly. Some Japanese medical educational institutes presented their IPE programs, which involved real patients, but most IPE programs used scenario-based or standardized patients. Moreover, few reports showed IPE programs for diabetic patient education. We created a new program, called the "Diabetes education class IPE" . Participants were 2 medical, 4 nursing, 4 pharmacy, and 3 dietician students. The students experienced the planning and management of and reflection on diabetes education classes. As a result of reflection, the "Diabetes education class IPE" was viewed as a useful IPE program.

A 52 year-old man was admitted to our institution with sudden onset of severe chest and back pain. The electrocardiogram showed ST segment depression in leads I, II, aVL, aVF, V3-6. Emergent coronary angiogram was performed, but the catheter did not reach to the coronary ostia, and it only performed false lumen aortogram. Computed tomography showed acute Stanford A aortic dissection. Ultrasound echocardiography also showed aortic regurgitation 3/4 degree. We decided to perform an emergency operation. During anesthesia induction, systemic blood pressure fell below 80 mmHg during systolic period, and pulmonary pressure raised to 60 mmHg. Transesophageal echography showed the movements of dissection flap intermittently obstructed the coronary blood flow and aortic valve annuls. Those flap movements, so called ‘flap suffocation’ was thought to be the cause of cardiac failure. Intra-operative findings of the ascending aorta showed an entry of dissection just above the left coronary ostia, and the entire detachment of intima to aortic wall. We performed ascending aorta replacement with aortic valve resuspension and fixation of coronary ostia. The postoperative course was uneventful, and he was discharged on the 25th postoperative day. For the precise treatment of acute Stanford A aortic dissection with such coronary ischemia, quick diagnosis and operative correction is essential.

Objective: We investigated subjective effects of a lactoferrin (LF) -containing supplement on cold-like symptoms and gastroenteritis symptoms.
Method: Healthy women were divided into a LF-consumption group and a non-consumption group. The former intaked LF-containing tablets for 90 days. Subjects filled out questionnaires about cold-like symptoms, gastroenteritis symptoms, and drug use.
Results: Significant decreases were found in the onset of cold-like symptoms and gastroenteritis symptoms in the LF-consumption group compared with non-consumption group.
Conclusion: These results suggest the possibility that LF intake inhibits the onset of common cold and gastroenteritis.

Objective: In our country, the measure for the spread of the generic has been introduced over several-time as part of the moderation in health care cost plan.  However, not having related to an enough spread unlike Europe and America yet is a current state.  Then, we investigated from the view point of patients.  A detailed examination was performed for the acknowledgment level and attitude toward the generic drug.
Design and Method: The questionnaire survey was performed for the patient who used the community pharmacy for dispensing prescription.  The investigation was performed for two weeks (June and July, 2008) at the 50 drugstores in Hokkaido.  The patient attribute, source of information, and kind of the taking medicine were examined as a factor to affect decision making for generic drug substitution.
Result: The main results are as follows.  The patients who did not know generic drugs accounted 52% of the total and the patients who did not know the words called generic drugs was 16%.  This result shows that the degree of the recognition about generic drugs at that time was still low.  The information source for the patients who learned generic drugs were articles of the newspaper, a TV program, and advertising with accounted 52% of the total.  Also, the patients who prefer generic drugs in the future were 64%.  In the relationships between presence of wish for generic drugs and the source of information, the case of from the doctor, was significant (p<0.05) and the case from the pharmacist showed the tendencies of statistical significance (p=0.076).
Conclusion: From the viewpoint of medicine costs restraint in our country, it seems that the pharmacist contributes for the patient’s generic drugs selection expected positively.