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.

[Introduction] In accordance with the 2018 revision of the Medical Care Act, prefectures have established career development programs for regional quota physicians aimed at both securing physicians committed to regional medical care and fostering their career development. We have surveyed and reviewed these programs across each prefecture.[Methods] The authors gathered information on the programs, which includes the acquisition of medical specialties, as well as the timing and duration of regional assignments, from the websites of each prefecture. The analysis of start timing and duration was limited to internal medicine.[Results] All prefectures have formulated programs. In more than 30% of the prefectures, regional quota physicians can choose any specialty from all available specialties. The regional assignment typically begins three years post-graduation, with a duration of four years in most cases.[Discussion] This nationwide trend provides a resource to evaluate the state of post-graduate education for regional quota physicians and to consider the future enhancement of these programs.

Objectives: Core hospitals play an important role in rural healthcare, and the dispatch of replacement doctors (DRD) from core hospitals to rural clinics is included in medical care plans at the prefectural level in Japan.Material and Methods: The conditions of DRD implementation in core hospitals (n=345) were observed using national data from 2022.Results: DRD was present in 101 (29.3%) core hospitals. A greater number of doctors per 100 beds (median: 16.7) was observed when DRD was present than when it was absent (median: 11.0; P<0.05).Conclusion: More studies are warranted regarding the number of doctors and their functions in core hospitals to ensure DRD.

Objective: Rural surgical training for residents is expected to increase the number of general surgeons working in rural areas; however, the impact of rural training programs to ensure such surgeons remains to be determined. Therefore, we reviewed the relevance of rural surgical rotation to the increase of general surgeons in rural areas.Materials and Methods: Studies on the outcomes of rural surgical rotations during the residency period in comparison to non-rural surgical rotations were retrieved using electronic databases through April 2022.Results: Among the 514 articles, five were eligible for review. All studies were published in the United States. Four studies reported an increased number of general surgeons in rural areas owing to rural surgical rotations. A meta-analysis of all studies showed a positive impact on the number of general surgeons in rural areas (odds ratio=2.19, 95% confidence interval=1.23–3.91). The programs generally ranged from 2 to 12 months with extensive experience with minor surgery and subspecialties necessary for surgery.Conclusions: Rural surgical rotations during the residency period can increase the number of general surgeons working in rural areas. Further studies are needed to evaluate the placement of general surgeons in rural areas.

Introduction: Early clinical exposure (ECE) is an educational methodology where medical students are exposed to the clinical settings in the undergraduate curriculum. This study aimed to examine the implementation status of ECE at medical schools in Japan. Methods: Based on published syllabi, we investigated the existence, location, and subjects (medical/non-medical staffs) of the training programs in medical schools. Results: Of 78 universities, 74 (95%) offered a total of 173 ECE practical training courses, and 51 (69%) combined on-campus and off-campus ECE training. Regarding the location and subjects, 81% of the on-campus ECE training was for medical personnel, 47% of the off-campus was for non-medical personnel, and 61% of the on- and off-campus was for both medical and non-medical personnel. Conclusions: More medical universities combined ECEs on-campus and off-campus and did not offer exposure only to medical staffs. The national trend can serve as a reference to discuss the circumstance of ECE and to plan ECE courses in the near future.

COVID-19 ; Humans ; Rural Health Services ; Rural Population

Community-based clinical clerkship, which involves travel outside the university or prefecture, was restricted or reduced due to the outbreak of the new coronavirus infection. What kind of shortage of learning this caused and how the shortage was compensated for were discussed in a special symposium at the 53rd Annual Meeting of the Japanese Society for Medical Education. As a result, two “essences” of community-based medical education emerged: 1) to recognize one’s role and responsibility in the future in the context of interprofessional practice, and 2) to look beyond the framework of medical institutions and view the whole scope of medicine with the patient at the center. It was concluded that online supplementary education should be utilized to enhance the value of practical training experience even in the post-Corona era. It was also supposed that this would lead to the “evolution” of community-based medical education itself.

Exercise is important for body composition promotion. Although many studies have indicated that physical competence promotes exercise participation, there are relatively few studies examining the relationships among these factors. The purpose of the present study was to model the relationships among body composition, exercise habits and physical competence by using structural equation modeling. The subjects were 223 Japanese male and female high school students. Height, lean bone mass and bone area ratio were measured. Exercise habits and physical competence scale including three subscales (perceived physical competence, feeling of control and peer and teacher acceptance) were assessed by self-administered questionnaires. Data were analyzed using structural equation modeling. The model showed acceptable fit indices (GFI = .905, AGFI = .863 CFI = .954, RMSEA = .069). The path from peer and teacher acceptance to exercise habit was significant (β = 0.51, p < .001). Moreover, the path from exercise habits and from perceived physical competence to body composition was significant (respectively β = 0.53; p < .001, β = 0.47, p < .001). We could model the relationships among body composition, exercise habits and physical competence. These results indicate that not only exercise habits but also physical competence promoting exercise participation influence on body composition promotion.

INTRODUCTIONGamma-glutamyltransferase (GGT), bilirubin (Bil) and small dense low-density lipoprotein (sdLDL) particles are each known to be risk markers for cardiometabolic diseases which are characterised by oxidative stress conditions. These markers are connected with the oxidative milieu; however, the association between GGT, Bil, and sdLDL has been hardly examined. This hospital-based study investigated the association between GGT and sdLDL, as well as the association between Bil and sdLDL, in asymptomatic subjects.

MATERIALS AND METHODSCardiometabolic variables, GGT, Bil and the mean LDL particle size were measured in 100 asymptomatic subjects attending a clinic for screening dyslipidaemias (36 men and 64 women, mean age 64 years). Correlation analyses of the association between the mean LDL particle size and other variables, such as GGT and Bil, were performed.

RESULTSThe mean (standard deviation) levels of GGT, Bil, and the mean LDL particle size were found to be 21.7 (8.3) IU/L, 14.0 (4.3) μmol/L, and 26.7 (0.6) nm, respectively. An univariate correlation test showed both a significant inverse correlation between the mean LDL particle size and GGT (r = - 0.33, P <0.01) and a significant positive correlation between the mean LDL particle size and Bil (r = 0.32, P <0.01). A multiple regression analysis revealed similarly significant results of their correlations, independent of the other cardiometabolic variables.

CONCLUSIONThese results suggest that the correlation of GGT and sdLDL, as well as that of Bil and sdLDL, may be cooperatively associated with cardiometabolic processes. Further research is warranted in order to confirm the observed association.

Asymptomatic Diseases ; Bilirubin ; blood ; Biomarkers ; blood ; Cross-Sectional Studies ; Dyslipidemias ; blood ; diagnosis ; Female ; Humans ; Lipoproteins, LDL ; blood ; Male ; Middle Aged ; gamma-Glutamyltransferase ; blood