Introduction: The aim of this study is to explore career perceptions of male and female medical students.
Methods: Semi-structured interviews to 16 medical students (9males, 7 females) were undertaken.
Results: Qualitative data analysis showed that development of their career perceptions were affected by “gender view”, “interests in medicine” as well as their “perceptions of family”. Specifically, female students in the lower grades felt difficulty in making decisions on career choices due to the conflict between carrying out family responsibilities (e.g., housework and childcare) and interests in medicine. After clinical clerkships, their perceptions of a career were formed in one of two ways: giving priority to family responsibilities or interest in medicine. On the other hand, male students in lower and higher grades consistently gave priority to their interests in medicine for their career choices.
Conclusion: Differing career perceptions between male and female medical students emerged from this study, and supports the need for undergraduate education on gender-equality in society.

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Purpose: To analyze “solitary deaths” in Hitachiomiya city through postmortem examination results, and contribute to formulation of preventative measures.
Methods: The author surveyed 149 cases of elderly individuals found deceased in their house during the period between January 2008 and December 2014. All had lived alone or almost alone in social isolated conditions.
Results: There were more males than females. Men were in a wide range of ages, while women were predominantly in their 80's and 90's. Nearly all cases were found within 2 days following death and deaths occurred more frequently in the winter and spring. Cardinal causes of death, were acute cardiac disorders and cerebrovascular diseases. Malignancy and pneumonia were less frequent. More than 90% of the corpses were found by their family members or relatives, and others by nursing service providers or neighbors.
Conclusion: This analysis of “solitary deaths” in Hitachiomiya city showed predominance of men and shorter intervals between death and being found than those of metropolis after death.

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Introduction: Patient-centric treatment is important in primary care, and one of the characteristics of this type of care is shared decision making (SDM) on treatment options between the patient and the doctor. However, no study has examined the circumstances of SDM practice in primary care in Japan. In this study, we investigated the proportion of doctors who practice SDM and examined their characteristics.
Methods: In 2014, we sent a postal survey to one doctor in each of the internal medicine clinics in 10 wards and 2 cities within the Tokyo Metropolitan Area. We evaluated the decision-making methods for treatment using a five-point scale (paternalism, close to paternalism, informed consent, SDM, informed decision making), and evaluated the doctors'background and patient interviews.
Results: Informed consent was the most frequently used decision-making method for treatment (40.8 %), and 14.6% of the doctors opted for SDM. Most of these doctors were in their 50s, and had spent the longest period of their working life in clinics. These doctors also had a tendency to select items that encouraged spontaneous remarks of the patients.
Conclusion: The findings of the present study suggest that the practice of SDM, which is an important factor in patient-centric medicine in primary care, is not very prevalent at present.

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Introduction: The rising poverty rate has spurred concerns regarding income-related disparities in medical-care utilization. This study attempted to investigate physicians'recognition of patients'refraining from medical care for financial reasons and the characteristics of physicians who made efforts to improve such situations.
Methods: A mail survey was conducted between July 1 and September 30, 2014. All internal medicine clinics (n=1989) in 12 municipalities in Tokyo were included. One physician from each clinic was requested to answer the 60-item questionnaire.
Results: Of the 617 questionnaires returned (response rate 31 %), 550 (454 male physicians) complete responses were analyzed. About 90% of physicians recognized that patients refrained from seeking medical care for financial reasons, and used various methods to encourage receipt of treatment (e.g., prescribing inexpensive medicines). Physicians who were 40-59 years old, specialized in general practice, implementing informed consent or shared decision making, and frequently recognizing that patients refrained from seeking medical care were more likely to engage in efforts to encourage treatment seeking.
Conclusion: Our results suggest that physicians in primary care roles such as general practice and utilizing shared decision making are more likely to engage in efforts to encourage medical care utilization in patients who refrain due to financial reasons.

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Purpose: The present study was conducted to elucidate the gap in awareness of experience of care management and the actual work of being responsible for this field by spotlighting on the attributes of of case managers and who are in charge of care management of terminal cancer patients at home.
Methods: Anonymous individual style questionnaire investigation was conducted against a target of 443 care managers.
Results: 70.3% had experience being in charge of terminal cancer patients and there was a significant difference in that this was found in those of more than 5 years of experience and among those of full timer status. As for experience in regard to those with or without experience being in charge by basic type of job, there was not much significant difference.
As for awareness regarding being in charge of terminal cancer patients, those who felt “I want to avoid it”, remained in 25% and found more in non-fulltimers (P<0.05). As for those who thought that “health care providers are more suited to be in charge”, this was found in 70% of health care providers and 40% in welfare related individuls (P<0.05) and a significant difference was noted. As for awareness of “should not depend on specific profession and should be done fairly among professions and which was found in 80% of those who have less than 5 years among care support specialist profession and hence compared to those with more than 5 years, it was many, and a significant gap was found. Regarding need of education and training about care management of terminal cancer patients, 95% agreed there is.
Conclusion: Approximately 70% of all had experience with terminal cancer patients and particularly, among those with over 5 years as care support specialist, it became clear that full timers were in charge. However, about awareness of being in charge of care management, it became clear that there was an positive attitude toward who takes in charge without being restricting to specific individuals and not selecting by number of years of experince as care managers nor by basic job types. Therefore, it can be concluded that opportunity for education and training about care management of terminal cancer patients and consolidating education environment for self training is important.

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Introduction: The present study was conducted to identify the influence of self-efficacy score and having an action plan on “stages of change” for exercise after one year.
Methods: Physical functions and psychological factors at baseline and after one year in 105 elderly individuals who participated in a preventive care program. The subjects were classified into four groups by using the stages of change scale for physical activity.
The cause related to impact on physical activity and action stage change (stage) after one year later with having or not having action plan for preventive care program in elderly at home in community as well as sense of self efficacy was investigated.
Results: Self-efficacy scored significantly higher in the usual activity group with continuity of stage activity both at baseline and one year later. The relative risk of having an action plan at baseline for exercise after one year was 2 . 90 (95% CI: 1.52-5.55). This value significantly influenced the maintenance of physical activity after one year.
Conclusion: The results of this study suggest that showing an action plan was effective in maintenance of physical activity.

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[in Japanese]

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[in Japanese]

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[in Japanese]

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