Medical Education 2010:
44
: 289–297
Objectives This study analyses and discusses recent changes in young Japanese doctors’ career paths, in terms of their distribution in different types of ...facilities and specialties, following changes to the postgraduate clinical training system in 2004.
Methods Data from the National Survey of Physicians, Dentists and Pharmacists conducted by Japan’s Ministry of Health, Labour and Welfare were used for this study.
Results After the introduction of the new postgraduate training system, 2 years of clinical training became mandatory and a doctor‐to‐facility matching system was introduced. Since then, more young doctors have migrated from academic hospitals to non‐academic hospitals. The number of first‐year doctors at non‐academic hospitals increased, whereas the number at academic hospitals decreased. In terms of the distribution of doctors per specialty, the decreasing tendency of doctors to choose internal medicine and surgery has accelerated. These results illustrate the significant changes that have affected young doctors’ career paths since the new system was introduced.
Conclusions Designing and providing desirable postgraduate clinical training and achieving appropriate doctor distribution are important policy issues. Appropriate policy interventions regarding a mechanism to ensure the appropriate distribution of doctors should be established and attention should be paid to expanding doctors’ choices and increasing patient satisfaction and general cost‐effectiveness.
Aim: A shortage of obstetricians and gynecologists (OB/GYNs) in Japan has been highlighted. We conducted a descriptive and retrospective cohort study using data from the Survey of Physicians in ...Japan, and analyzed the dynamics of OB/GYNs.
Methods: We calculated the total numbers of OB/GYNs, their average age, the percentage of female OB/GYNs, hospital OB/GYNs, and the number of OB/GYNs in rural areas in 1974, 1984, 1994 and 2004. We determined the number of physicians who participated in and left the specialty of obstetrics and gynecology. The withdrawal rates of OB/GYNs who graduated in 1972, 1982 and 1992 were retrospectively followed using survival analysis.
Results: The overall number of physicians has increased, while the number of OB/GYNs has remained almost unchanged over the past 30 years. The percentage of female OB/GYNs has increased. Fewer new graduates chose obstetrics and gynecology, the withdrawal rate of current OB/GYNs decreased, and their average age (50.8 years) increased. The trend in withdrawal rates did not differ significantly among the generations.
Conclusions: The gravest problem in the OB/GYNs workforce is the continued decline in newly graduated OB/GYNs. Improvements in working conditions and job satisfaction are considered vital.
Abstract Background The percentage of females in the physician workforce is increasing in Japan, as in other countries; however, the working status of female physicians has not been sufficiently ...investigated. Methods Original data were obtained from the National Survey of Physicians (NSP) conducted by the Ministry of Health, Labour and Welfare, Japan, from 1984 to 2004. We examined the trend of female physicians’ areas of practice and analyzed their leave, return to work, and change in areas of practice using cohort data. Results The percentage of female physicians has increased significantly in recent generations, especially in surgery, surgical subareas of practice, and obstetrics and gynecology. A remarkable increase was found in obstetrics and gynecology among women under 29 years old from 15.4 to 66.2%. The total number of female physicians on leave has been higher than the number of female physicians returning since 1998. The average percentage of those who changed their area of practice was high in surgery (20.7%) and low in pediatrics (5.0%) and obstetrics and gynecology (1.7%). Conclusions A strategic plan is needed for future health policy to plan for the physician workforce, especially for the areas of practice with increasing proportions of young female physicians.
In 2015, the United Nations General Assembly ratified the Sustainable Development Goals (SDGs), which set 2030 as the target year for their achievement. Maternal and Child Health (MCH) was identified ...as a remaining challenge from the Millennium Development Goals. The SDGs address maternal and child health concerning maternal mortality, under-five and neonatal mortality, young childbirth, and essential health service coverage under Universal Health Coverage, in which everyone has access to quality health services without financial risks, such as access to family planning, prenatal care, child immunization, and child pneumonia treatment. Many of these goals have already been achieved in Japan. Particularly, maternal and child mortality has been improved since 1900 by measures such as the implementation of rural health surveys to assess the health status of mothers and children; the establishment of Aiiku-Kai, community-based maternal and child support activities carried out by local residents; and the promotion of institutional deliveries and health education by municipal maternal and child health centers.Japan lacks primary data regarding access to prenatal care and the treatment of pneumonia in children and there are limitations in the collection of data for SDG indicators related to maternal and child health. Additionally, these goals and indicators are not appropriate for improving the current state of maternal and child health in Japan. Japan cannot monitor achievement of the SDGs' principle of "leaving no one behind" under the current situation. The challenges of maternal and child health as expressed in the SDGs should not be considered issues of the past for Japan. Rather, it is necessary to consider current maternal and child health challenges in Japan from the perspective of initiatives in the SDGs' philosophy of "leaving no one behind."
Eukaryotic elongation factor 2 (eEF2) kinase (eEF2K) repressively regulates protein translation through phosphorylating eEF2. We previously showed that expression and activity of eEF2K are increased ...in isolated mesenteric arteries from spontaneously hypertensive rats (SHR) contributing to development of essential hypertension. Furthermore, we have recently shown that 7-Amino-1-cyclopropyl-3-ethyl-1,2,3,4-tetrahydro-2,4-dioxopyrido2,3-dpyrimidine-6-carboxamide (A484954), a selective eEF2K inhibitor, induces endothelium-dependent relaxation in isolated mesenteric arteries from SHR inducing an antihypertensive effect. In order to test the hypothesis that inhibition of eEF2K activity induces vasodilatation by suppressing sympathetic nerve activity, we examined the effects of A484954 on perivascular sympathetic nerve stimulation-induced contraction in isolated renal artery from normotensive and hypertensive rats. Electrodes were placed near the isolated renal arteries that were applied with transmural nerve stimulation (TNS). Then, contraction of the arteries was isometrically measured. A484954 inhibited TNS-induced contraction. The A484954-mediated inhibition of TNS-induced contraction was significantly prevented by NG-nitro-L-arginine methyl ester. In SHR isolated renal artery, TNS-induced contraction was enhanced compared with normotensive Wistar rats. Furthermore, A484954-mediated inhibition of TNS-induced contraction in SHR was enhanced compared with Wistar rats. In conclusion, this study demonstrates for the first time that A484954 inhibits perivascular sympathetic nerve stimulation-induced vasoconstriction at least in part perhaps through nitric oxide (NO) release from NO-operating nerve.
Exosomes, the smallest extracellular vesicle, contain various molecules and mediate cell-cell communication. A number of studies demonstrate exosomes are involved in important physiological and ...pathological processes. Moreover, microRNA (miRNA) regulating hypertension development through the suppression of certain translation was recently reported. However, roles of exosomes containing various molecules including miRNA on development of essential hypertension have not been examined. We tested the hypothesis that plasma exosomes regulate systemic blood pressure in normotensive and spontaneously hypertensive rats (SHR). Normotensive Wistar Kyoto rats (WKY) and SHR (5-10-week-old) were intraperitoneally administrated with exosomes derived from plasma in WKY or SHR weekly for 6 weeks. Exosomes were isolated by an ultracentrifuge method. SHR-derived exosomes significantly increased systolic blood pressure in WKY, while WKY-derived exosomes decreased it in SHR. In WKY, SHR-derived exosomes induced modest structural changes of thoracic aorta, such as wall thickening and decreased abundance of collagen, which were similar to the changes observed in SHR. On the contrary, WKY-derived exosomes tended to reverse the changes in SHR. WKY-derived exosomes significantly suppressed the increased prostaglandin F2α-induced contraction of mesenteric arterial smooth muscle in SHR. In addition, wet weight and perivascular fibrosis of left ventricles in WKY were significantly increased by SHR-derived exosomes, while the fibrosis but not ventricular weight was significantly decreased by WKY-derived exosomes in SHR. We for the first time demonstrated that plasma exosomes can modulate systemic blood pressure as well as structure and function of cardiovascular tissues in both normotensive and hypertensive rats.
•Roles of exosomes on regulation of essential hypertension remain to be determined.•Plasma exosomes modulated systemic blood pressure in normotensive and hypertensive rats.•Plasma exosomes modestly changed structure and function of cardiovascular tissues.•Present findings indicate exosomes are potential target for treatment of essential hypertension.
Background: Currently, there is a shortage of hospital pediatricians in Japan. In the present study, using data from the Survey of Physicians, Dentists, and Pharmacists in Japan, we analyzed the ...dynamics and distribution of pediatricians, using a time series approach.
Methods: The total number of pediatricians, the ratios of hospital‐working and female pediatricians, their mean age and geographic distribution in 1974, 1984, 1994, and 2004 were determined. The dynamics of pediatricians were analyzed by identifying the annual number of physicians participating in and withdrawing from pediatrics, and by following up withdrawal rates from pediatrics and movement rates from hospitals. The withdrawal rates of male and female pediatricians registered in 1992, 1994, and 1996 were also analyzed.
Results: The number of pediatricians per 10 000 children increased from 1.9 to 7.4 between 1974 and 2004. The percentage of women among pediatricians was significantly higher than that of women among all physicians in 2004 (P < 0.01). The numbers of physicians who withdrew from pediatrics increased from the periods 1985–1994 to 1995–2004. Younger pediatricians tended to leave pediatrics earlier than elder pediatricians. There were no differences in the withdrawal rates of pediatricians between men and women registered in 1992, 1994, and 1996.
Conclusions: It is anticipated that the number of pediatricians in Japan will decrease in the near future unless practical strategies are implemented to improve the early withdrawal of younger pediatricians and the current working conditions of female pediatricians.
Summary Objective To assess the prevalence including asymptomatic infection, infection risk of exposure to patients, and effectiveness of personal protective equipment (PPE) among health care workers ...(HCWs) during the first pandemic (H1N1) 2009 (pH1N1) outbreak in Kobe, Japan in May 2009. Methods A cross-sectional seroepidemiological study was conducted on 268 HCWs in the two hospitals in Kobe to which all pH1N1 inpatients were directed. Participating HCWs completed a self-administrated questionnaire and provided a single serum sample which was analyzed using a hemagglutination-inhibition (HI) antibody test. Results Of 268 subjects, 14 (5.2%) were found to have positive antibodies to the pH1N1 by HI assay; only 1 reported a febrile episode. Among the 14 seropositive cases, 8 received chemoprophylaxis. 162 HCWs (60.4%) had been exposed to patients. The seropositive rate (SPR) for pH1N1 of the exposed group was higher than that of the unexposed group, however not statistically significant (6.8% vs. 3.1%, p = 0.197). There were no statistically significant differences in SPR for any PPE. Conclusion The SPR for pH1N1 in the exposed group was higher than that of the unexposed group in HCWs; however, most of these individuals were asymptomatic. There was no statistically significant association between PPE implementation and pH1N1 seropositivity.
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