Objectives Patients’ dissatisfaction with medical practice is driven by several patient- and institution-related factors. However, little is known about the effect of institutional factors on patients’ satisfaction. Accordingly, we examined institutional factors in determining patients’ dissatisfaction using the Patient's Behavior Survey in Japan.
Methods The combined database of the Patient's Behavior Survey, the Patient Survey, and the Survey of Medical Institutions from 2011 was used for the analysis. The item “overall patients’ satisfaction” was used as the outcome for patient dissatisfaction. Medical institution factors were selected from the Survey of Medical Institutions, and patient factors, such as age, sex, and disease, were drawn from the Patient Survey. The analyses were conducted separately for inpatients and outpatients. Mixed-effects logistic regression, which accounts for the heterogeneity of institution type, was used to investigate the relationship between patients’ dissatisfaction and institutional factors.
Results There were 27,842 outpatients and 17,770 inpatients. In outpatients, founders (P<0.001), preventive measures for passive smoking (P<0.001), and training for new employees (P=0.002) were significantly related to patients’ dissatisfaction. In inpatients, founders (P=0.037), preventive measures for passive smoking (P<0.001), the palliative care team (P=0.001), and training for new employees (P=0.013) were significant predictors. The heterogeneity among medical institution types was negligible for both outpatients and inpatients.
Conclusion Patient dissatisfaction was significantly associated with founders, preventive measures for passive smoking, and training for new employees for both outpatients and inpatients and with palliative care team only for inpatients. These items were indicators of improved hospital environments, and they represent key elements to ensure patient satisfaction in hospitals.

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Objectives Promoting social and leisure activity participation in older adults could be effective in preventing their health decline. However, gender or regional differences in those activities remain unclear despite the necessity of gender- or region-specific approaches to their promotion. This study examined gender and urban-rural differences in going-out, social, and leisure activities among community-dwelling older adults.
Methods Data were obtained from the Japan Gerontological Evaluation Study (JAGES). Those analyzed were 103,621 people aged 65 or older who were functionally independent and lived in one of 31 municipalities. A total of seven activity variables were assessed with weekly going out, engagement in paid work, monthly and any frequency of engagement in group activities, monthly and any frequency of contact with friends, and having hobbies. We additionally assessed the contents of the group activities and hobbies. Gender, age groups (young-old: 65–74; old-old: 75 and over), and region groups, which were categorized as rural, urban, or metropolitan, were assessed along with education, depression, and other covariates. A chi-square test and multivariate logistic regression analysis were conducted to examine the age group-stratified differences in the going-out, social, and leisure activities among gender and region groups (P<.01).
Results Multivariate logistic regression analysis showed that men were more likely to engage in weekly going out, paid work, and hobbies but less likely to engage in group activities and contact with friends, either monthly or at any frequency. Most activities were also found to differ significantly among the region groups. For instance, people in metropolitan areas were 2.3 times more likely to engage in weekly going out but were 0.4 (old-old group) or 0.5 times (young-old group) less likely to engage in contact with friends. Percentages of engagement in hobby- or sport-groups were over 20% in all gender and region groups; on the other hand, about 30% differences were found in the percentages of engagement in senior clubs or neighborhood associations between metropolitan and rural men. As for having hobbies, walking/jogging and gardening were popular across all gender and region groups, while the percentages of engagement in a variety of hobbies differed among gender and region groups.
Conclusion Our findings suggest 1) differences in the levels of social and leisure activities among gender and region groups and 2) both similarities and differences in the popular group activities or hobbies among gender and region groups. Activity promotion for older adults should be targeted considering these gender and region group characteristics.

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Objectives Epilepsy is a common chronic neurological disorder characterized by recurrent unprovoked seizures. The prevalence of epilepsy is about 1%, and its incidence is increasing with the aging population. In addition to their medical problems, epilepsy patients face many social problems, including schooling, working, and maintaining their driver's licenses. However, these problems are not fully recognized by the regional healthcare centers (HCCs), and the inadequacy of collaboration between medical services, healthcare, and welfare is sometimes pointed out. Under these circumstances, this fact-finding survey was administered in the form of a questionnaire to HCCs across the nation for the purpose of improving the support system and educational activities for epilepsy in Japan.
Methods A mail-back survey on regional healthcare services for epilepsy patients was sent out to 490 HCCs across the nation. Public health nurses (PHNs) responded to the self-completed questionnaire on behalf of each HCC. The questionnaire was comprised of the presence or absence of consultations on epilepsy, content of the consultations, and holding of workshops, lectures, or conferences in the community covered by the HCC.
Results We obtained responses from 347 HCCs (response rate 71%). Seventy-three percent of the PHNs had experience with consultations regarding the medical and healthcare issues associated with epilepsy. However, only 10% of the PHNs responded that they could provide appropriate consultation for these issues. The content of the consultations mainly included medical services, clinical symptoms of epilepsy, and anxieties about their social life and their future. Workshops, lectures, or conferences on epilepsy were held for residents or health and welfare professionals in only 8% of the communities. This percentage is lower than those (21–70%) for other intractable or mental disorders that are mainly managed by HCCs (P<0.01). On the other hand, 76% of PHNs in the HCCs felt the need for knowledge about epilepsy, and 60% wanted to join the epilepsy educational programs.
Conclusion Although many PHNs belonging to HCCs conduct consultations regarding epilepsy-related issues, many feel they cannot adequately respond to these issues. Furthermore, they feel the need for further knowledge about epilepsy but are not able to gain such knowledge because of financial and geographical restrictions. To improve these situations, regional education programs for epilepsy should be established in each local municipality in the future with support provided by medical facilities, regional medical associations, the Japan Epilepsy Society, and the Government.

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[in Japanese]

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