Introduction : This study was conducted to estimate actual reasons for encounters and health problems, which is difficult to assess in a free-access system, in an area with limited access to advanced care by using the International Classification of Primary care second edition (ICPC-2).
Methods : We conducted a retrospective open cohort study on an isolated island in Okinawa Prefecture, Japan. We encoded reasons for encounter (RFE) and health problems of all patients using ICPC-2.
Results : The total number of visits to the clinic was 5682 a year (age 0-14 years, n=862 ; age 15-64 years, n=2205 ; age 65 or older, n=2615). The top 3 RFE classified by organic systems were R (respiratory), S (skin) and L (musculoskeletal). Dementia (ICPC-2 code : P-70) was eighth in the rank of chronic health problem among elderly people. Visits due to health maintenance/prevention (ICPC-2 code : A-98) was third in the rank of new health problem among children.
Conclusion : In the present study, rankings of major RFE and health problems are similar to those in previous studies. Among elderly people, however, the rank order of dementia among chronic health problems was higher than that in previous studies. In addition, among children, the rank order of health maintenance/prevention among new health problems was higher than that in previous studies.

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Introduction : The purpose of this study was to approach issues related to end-of-life care by investigating elderly people's own thoughts about surrogate decision making by family members.
Methods : Semi-structured interviews were carried out with 30 elderly people 60 years of age and older to determine whether or not they trust in surrogate decision making by their family members, and to examine the reasons for their thoughts. Each of the respondents' statements were categorized by level of confidence, and their reasons were analyzed.
Results : Respondents were divided into two main groups : a “trusting” group and an “anxious” group. Seventy percent of respondents were in the “trusting” group. In both groups, the most common reason given was related to the desire to directly communicate one's wishes to one's surrogates. Following that, in the “trusting group”, the main reasons were related to the thoughts of the interviewee and the characteristics of the surrogates. In the “anxious group”, the main reasons were issues of end-of-life care related to the feelings of surrogates, the attitude of medical staff, and other background factors.
Conclusion : To resolve issues of surrogate decision making related to end-of-life care, it is important in primary care practice to provide encouragement and support to elderly people to allow them to clearly communicate their wishes. We recommend further study and ethical discussion about end-of-life care to establish appropriate legal and institutional frameworks.

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Introduction : Family medicine residency programs (PGs) have been increasing in Japan, but the Japan Primary Care Association (JPCA) does not publicly provide employment information. We conducted a complete survey on PGs, and elucidated the actual online provision of information required to assess risk factors influencing career development.
Methods : We conducted an online investigation in January 2013 of the JPCA-certified PGs updated as of December 18, 2012, regarding the main facility type, benefits, terms of employment, and the type of employment by the duration of the contract.
Results : There were 160 PGs in total. Those affiliated with universities were excluded and the remaining 129 PGs were analyzed. No salary/wage information was provided by 40 PGs (31.0%). Full-time employment was indicated by 64 PGs (49.6%), of which 6 had fixed-term employment. Only 11 PGs (8.5%) were confirmed to offer indefinite-term employment.
Conclusion : From the information provided online, it was difficult to identify the type of employment by the duration of the contract. Currently, JPCA does not impose regulations on the terms of employment to be posted. Therefore, it would be desirable for the JPCA to take the initiative in collecting and disclosing accurate and adequate information.

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[in Japanese]

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[in Japanese]

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The concept of sexual minority contains lesbian, gay, bisexual, transgender (LGBT) and disorders of sex development. Despite many recent advances in rights for sexual minorities in the world, bias against them still exit. We held a workshop ‘toward better care for sexual minorities' on the 6th Annual Conference of Japan Primary Care Association 2015. Four lecturers talked about health disparities among sexual minority patients. We want this paper help reducing the readers' prejudice towards the sexual minorities and thus impact their future clinical practice.

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[in Japanese]

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