Introduction : The purposes of this study is to clarify the roles and competencies necessary for nurses working in primary care setting in Japan.
Methods : Fieldwork was conducted using interview and participation-observation methods with six physicians and 11 nurses working at primary care clinics, followed by a qualitative-inductive analysis.
Results : Three functions of the primary care clinics and four roles of the primary care nurses supporting such clinics were identified. These included : 1) Outpatient Function, 2) Home-care Support Function and 3) Community Support Function for the primary care clinics. For nurses, 1) Protecting Individuals' and Families' Health, 2) Ensuring Comfortable Care and Peaceful Death in Familiar Surroundings, 3) Dealing with Community Health Issues, and 4) Managing Clinics which support these functions. Nine categories of competencies corresponding to the roles and four categories of basic competencies necessary for professionals who practice primary care were identified.
Conclusion : Nurses working in primary care settings in Japan need to fulfill a wide range of roles and competencies.

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Introduction : To promote disease management in the community, general physicians should refer their patients to specialists in a timely and appropriate manner. In this study, we propose an indicator for evaluation of such referrals.
Methods : We analyzed all referrals in an urban clinic from September 1, 2011 to August 31, 2012. Symptoms and diagnoses documented by general physicians were collected from medical records, and the final diagnoses by specialists were collected from their reports. The symptoms and diagnoses were classified using the International Classification of Primary Care second edition (ICPC-2). Referral rates, hospitalization rates, and place of referral were analyzed.
Results : The average number of encounters in the candidate clinic was 1402 per month, and the mean number of referrals was 23 (1.6% of encounters). Of patients who received a referral, 6.75 (29.1%) were admitted to hospitals. The symptoms and diagnoses of the referred patients were distributed across all chapters (A to Z) of ICPC-2. Diagnoses of admitted patients included pneumonia (R81) (24%), urinary tract infection (U70 and U71) (9%), and acute gastroenteritis with dehydration (D73 with T11) (9%).
Conclusion : We identified the referral rates, hospitalization rates, and distribution of referral patients as indicators of the triage function of primary care physicians. These should be evaluated further as potential indicators of “the quality of medical care.”

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Introduction : This study aimed to investigate the age-specific and cause-specific clinical presentations of food-induced anaphylaxis.
Methods : We retrospectively analyzed the medical records of 49 patients aged ≤15 years who visited our emergency department between January 2008 and December 2012 for food-induced anaphylaxis.
Results : Roe (9 cases), egg (8 cases), and buckwheat (8 cases) were the three major foods responsible. In patients aged <1 years, egg was the major culprit, in those aged 1-6 years, roe was the major culprit, and in those aged ≥7 years, buckwheat was the major culprit. Twelve cases were treated by intramuscular administration of epinephrine.
Conclusion : The trend of responsible foods for food-induced anaphylaxis in children is different depending on age. It is therefore necessary to enlighten the public about this age difference. The frequency for roe responsible for anaphylaxis was higher than that found in other reports. We suggest that local eating habits had an effect on this result.

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Purpose : To determine the reasons why terminal cancer patients with do not attempt resuscitation (DNAR) decisions require emergency ambulance transport.
Method : We interviewed 19 paramedics and analyzed their responses.
Result : The reasons why terminal cancer patients who have expressed their wishes for DNAR are taken by ambulance to a hospital include : lack of a legally valid system regarding DNAR ; inadequate knowledge regarding ambulance operations ; lack of medical support for death with DNAR decisions ; inadequate systems for such care in nursing homes ; overreliance on paramedics in emergency situations ; family members' wish to avoid death at home and ; panic and unpreparedness of the family members in the event of an emergency.
Conclusion : We found that against a background of an inadequate social and legal framework for patients with DNAR decisions, such patients were taken by ambulance to hospitals due to a lack of medical support and familys' lack of understanding of DNAR.

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Introduction : The appropriate size of the regional coverage area for primary care in Japan has been unclear. The aim of this study was to determine the geographical distribution of primary care clinics for elderly ambulatory diabetic patients.
Methods : Using an insurance claims database, we extracted data of patients aged 75 years and older requiring ambulatory diabetic care in May 2010 in Ibaraki prefecture. The geographical distance from each municipal office to the clinics was analyzed.
Results : A total of 17,717 data points were extracted from the database. Data points that could not be mapped due to coding errors were eliminated, resulting in 17,144 (96.8%) data points that were ultimately analyzed. The median [25th-75th percentile] geographical distance was 5.5 [2.3-9.9] km. The distance was not related to municipal population, aging rate, or area size.
Conclusion : The coverage area for diabetic care in this primary care setting was estimated. For most elderly ambulatory diabetic patients, clinics are distributed within a 10-km radius area. Further investigation is needed to clarify primary care coverage areas that result in the most efficient use of medical resources.

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Purpose : The purposes of this study were to survey the current living conditions and to analyze the characteristics of work and leisure, and to clarify the association of their life with health-related QOL in temporary housing, Minamisoma.
Methods : This survey was taken in August 2012. The 115 participants were asked as follows.
1. Basic information included in sex, age, employment and economic condition.
2. Living survey related to life.
a) Activities of typical day and hour of use.
b) The listed activities for four areas (work, self-care, leisure and rest).
3. Self-health status (the use of SF-36).
Results : Valid responses were 90 (38 men and 52 women, age 69.9±11.9). The values of SF-36 were significantly lower than the Japanese standard values in almost all subparts. Both sexes classified eating into work. Women classified the many activities offered by volunteers into leisure. Whereas men classified little activities into leisure. The leisure time spent by women less than 50 years old was negatively correlated with the health-related QOL (r=-0.89), while, that by women more than 70 years old was positively correlated with the health-related QOL (r=0.48). In contrast, no correlation between leisure time and health-related QOL was observed in men.
Conclusion : Volunteer's activities to support women more than 70 years old were suggested to be effective. While, those for men should be altered to match the concerns for man's characteristics.

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This study examines the local government's response to tornadoes, and the results of this study can be applicable to future tornado responses. Oral interviews were conducted at 2 : 00 pm on 23rd October 2013 at the Koshigaya City Municipal Office. The questions mainly concerned challenges in support for tornado victims. The results of the interviews show that reporting from media was prevalent and responses from the city may have been insufficient. The study concludes that in past tornado disasters, information from the municipality was critical.

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[in Japanese]

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[in Japanese]

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Female physicians in Japan face many difficulties in maintaining their careers.. According to a report, nearly 70% of female physicians prematurely cease to work, with the main contributing factors to this labor shortage being childbirth and child-rearing. In light of this, we sponsored a symposium to consider strategies to help maintain female physicians in the workforce. Four panelists discussed the essential points to consider when introducing preventive measures against female physicians leaving their jobs, what those in and around the workplace could do, and the nature of support required from administration and academic societies. It was felt that academic societies and administrations must implement and support work systems which allow for various ways of working in the medical field. Academic society committees will play an important role in assessing the needs of female physicians in order to promote the establishment and support of such work systems.
-Report of a symposium held as part of the 4th Academy meeting of the Japan Primary Care Association, 18th May, 2013 at Sendai International Center.

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While many hospitals in Japan are certified to train family physician residents, most have limited experience in this training. The training of a family physician to provide primary care requires a unique set of educational experiences compared to the traditional training of other specialists. Family physicians specialize in the breadth of medical care encountered in a primary care setting rather than the depth of care required in a single organ specialty. In addition to training in the family medicine center to develop ambulatory care skills, family physician residents also need to train with other specialists in hospitals and outpatient settings. Specialists of all disciplines have an essential role in training family physician residents, but there is no clear consensus about what family medicine residents should be taught. To maximize the training with other specialists, residents and teaching physicians need rotation-specific educational goals when training with other specialists to realize the expertise needed for the full spectrum of family medicine.

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