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.

INTRODUCTIONOxidative stress, assessed using 8-hydroxy-2'-deoxyguanosine (8-OHdG), can be associated with arterial stiffness in patients with type 2 diabetes mellitus (T2DM) and/or hypertension (HT). We investigated the correlation between urinary 8-OHdG and pulse wave velocity (PWV) in hypertensive and non-hypertensive T2DM patients with fair glycaemic control to determine the clinical significance of HT as a comorbidity in the diabetic state.

METHODSClinical data, including traditional cardiovascular risk factors, diabetic complications, prescribed agents, urinary 8-OHdG level and brachial-ankle PWV, was collected from T2DM patients with and without HT.

RESULTSThere were 76 patients (45 men, 31 women; mean age 61 years; mean haemoglobin A1c level 6.5%) in the study cohort. T2DM patients with HT had significantly higher mean PWV than patients without HT (1,597 cm/s vs 1,442 cm/s; p < 0.05). Patients with HT showed no significant difference in 8-OHdG levels relative to those without HT (median 7.9 ng/mg creatinine vs 8.8 ng/mg creatinine; p > 0.05). Simple linear correlation and stepwise multiple linear regression analyses revealed that 8-OHdG levels correlated independently, significantly and positively with PWV among T2DM patients with HT (r = 0.33, p < 0.05; β= 0.23, p < 0.05). No significant correlation was observed between 8-OHdG levels and PWV among T2DM patients without HT.

CONCLUSIONIn the hypertensive state, oxidative stress can be responsible for the development of arterial stiffness, even in patients with fairly well controlled T2DM. Oxidative stress management may be necessary for the prevention of cardiovascular disease in this population.

Adult ; Aged ; Aged, 80 and over ; Ankle Brachial Index ; Cohort Studies ; Deoxyguanosine ; analogs & derivatives ; urine ; Diabetes Complications ; urine ; Diabetes Mellitus, Type 2 ; urine ; Female ; Glycated Hemoglobin A ; metabolism ; Humans ; Hypertension ; complications ; urine ; Male ; Middle Aged ; Oxidative Stress ; Pulse Wave Analysis ; Vascular Stiffness