Nobutaro Ban

Identification of marker genes for differential diagnosis of chronic fatigue syndrome.

Chronic fatigue syndrome (CFS) is a clinically defined condition characterized by long-lasting disabling fatigue. Because of the unknown mechanism underlying this syndrome, there still is no specific biomarker for objective assessment of the pathological fa-tigue.We have compared gene expression profiles in peripheral blood between 11 drug-free patients with CFS and age- and sex-matched healthy subjects using a custom microarray carrying complementary DNA probes for 1,467 stress-responsive genes. We identified 12 genes whose mRNA levels were changed significantly in CFS patients. Of these 12 genes, quantitative real-time PCR validated the changes in 9 genes encoding granzyme in activated T or natural killer cells (GZMA), energy regulators (ATP5J2, COX5B, and DBI), proteasome subunits (PSMA3 and PSMA4), putative protein kinase c inhibitor (HINT), GTPase (ARHC), and signal transducers and activators of transcription 5A (STAT5A). Next, we performed the same microarray analysis on 3 additional CFS patients and 20 other patients with the chief complaint of long-lasting fatigue related to other disorders (non-CFS patients) and found that the relative mRNA expression of 9 genes classified 79% (11/14) of CFS and 85% (17/20) of the non-CFS patients. Finally, real-time PCR measurements of the levels of the 9 involved mRNAs were done in another group of 18 CFS and 12 non-CFS patients. The expression pattern correctly classified 94% (17/18) of CFS and 92% (11/12) of non-CFS patients. Our results suggest that the defined gene cluster (9 genes) may be useful for detecting pathological responses in CFS patients and for differential diagnosis of this syndrome.

Association between the caregiver's burden and physical activity in community-dwelling caregivers of dementia patients

Physical activity in the elderly has a significant influence on their health status. Studies have shown that elderly caregivers have fewer physical activities relative to non-caregivers. The present study aimed to identify factors associated with lower physical activity in elderly caregivers of demented patients. A cross-sectional survey of 50 elderly caregivers living with patients diagnosed with Alzheimers-type dementia showed that the Zarit caregiver burden interview (ZBI) scores were significant predictors of physical activity measured by the questionnaire score (QS) of physical activities. Among the three subscales of the QS, it was only leisure time activity scores (LS) that the ZBI scores significantly predicted. The numbers of chronic diseases were associated with lower household activity scores (HS) and sport activities scores (SS). Physical activities, in particular leisure activities, were found to be inversely associated with care burden assessed by the ZBI. Interventions to increase the physical activity levels of older caregivers may improve their health status and quality of life.

Education for health professionals in Japan—time to change

1206 www.thelancet.com Vol 378 October 1, 2011 a real event cannot be determined from the reports, because the decrease could be a biased value caused by a change in the method of data collection, a change in the behaviours of respondents, such as underreporting, or a change in the age distribution of respondents. The survey has historically been household-based, but this method has been changed to a combination of weighing foods within households and approximating the proportion of foods shared by family members. The individual intake is estimated from this method. Even though the validity of estimated food intake heavily aff ects the results, it is poorly assessed without any consideration of the range of ability of respondents and of various types of foods shared. More importantly, response rates, inclusion and exclusion criteria of respondents for analyses, body sizes of the analysed participants, or their health status are not reported. With regard to nutrients, neither intake of major fatty acids, nor of major types of carbohydrates (including sucrose and fructose) are reported. Even ethanol (alcohol) and water intakes are ignored. As a consequence, the survey has been of very limited use in building evidence in the discipline of nutrition and health. As long as the survey continues to be done and reported in the current manner, it will not fulfi l its potential as a valuable resource for health. This would be a serious loss for Japan and, as a consequence, the world too.

A nationwide survey of standardized patients: Who they are, what they do, and how they experience their work

OBJECTIVE Standardized or simulated patients are widely used in medical training, however, little is known about these individuals and their work experience. The current study was designed to describe the SP workforce and gain insight into the routine tasks, challenges and rewards associated with their work. METHODS Using the full 2005 membership list (n=450) of Association of Standardized Patient Educators (ASPE), one SP educator for each medical school across all states was identified, representing a total of 87 different medical schools. Fifty-seven (65%) of the SP educators approached agreed to participate in the study and distribute surveys to 10 SPs in each program. RESULTS 255 (45%) of the distributed surveys were returned representing the experience of SPs in 57 medical schools across all 6 ASPE geographic regions. Specifics in regard to work scheduling and compensation are reported with some regional differences noted in pay. On the whole, SPs were highly satisfied with their work, but roughly half reported some difficulty with elements of case mastery and providing feedback to learners. CONCLUSION SP satisfaction is high but challenges in case mastery and feedback tasks are evident. PRACTICE IMPLICATIONS Meeting training needs can enhance the utility and effectiveness of this workforce.

Preconception care by family physicians and general practitioners in Japan

BackgroundPreconception care provided by family physicians/general practitioners (FP/GPs) can provide predictable benefits to mothers and infants. The objective of this study was to elucidate knowledge of, attitudes about, and practices of preconception care by FP/GPs in Japan.MethodsA survey was distributed to physician members of the Japanese Academy of Family Medicine. The questionnaire addressed experiences of preconception education in medical school and residency, frequency of preconception care in clinical practice, attitudes about providing preconception care, and perceived need for preconception education to medical students and residents.ResultsTwo hundred and sixty-eight of 347 (77%) eligible physicians responded. The most common education they reported receiving was about smoking cessation (71%), and the least was about folic acid supplementation (12%). Many participants reported providing smoking cessation in their practice (60%), though only about one third of respondents advise restricting alcohol intake. Few reported advising calcium supplementation (10%) or folic acid supplementation (4%). About 70% reported their willingness to provide preconception care. Almost all participants believe medical students and residents should have education about preconception care.ConclusionFP/GPs in Japan report little training in preconception care and few currently provide it. With training, most participants are willing to provide preconception care themselves and think medical students and residents should receive this education.

I came, I saw, I reflected: a qualitative study into learning outcomes of international electives for Japanese and British medical students.

Background and aim: Although medical students have increasingly more opportunities to participate in international electives, their experiences are usually unstructured and the literature referring to their learning outcomes, educational environment, and assessment is scanty. This study was undertaken to clarify qualitatively what students learn from their international electives. Methods: We carried out semi-structured individual interviews with 15 Japanese students studying clinical medicine in British medical schools and six British students studying in Japanese medical schools. The thematic synthesis method was used in analysing the transcribed data and triangulation by multiple researchers was used to achieve higher reliability. Results: The main learning outcomes identified were skills in history taking and physical examination with clinical reasoning and in management of diseases rarely seen in the students’ own countries; awareness of clinical ethics and merits and demerits of different systems of healthcare and medical education; sensitivity to issues in doctor–patient relationships and work ethics; enhancement of cultural competence; and personal development. Conclusions: Most learning outcomes of international electives are culture- or system-dependent. Students achieved outcomes related closely to medical professionalism, mainly through reflection. International electives may give students opportunities to learn both professionalism and cultural competence.

Follow the patient: process and outcome evaluation of medical students' educational experiences accompanying outpatients.

Background  To instil patient‐centred attitudes in medical students, several medical schools in Japan have recently started to offer educational experiences in which medical students accompany outpatients throughout entire visits to hospitals.

Family issues and family functioning of Japanese outpatients with type 2 diabetes: a cross-sectional study

BackgroundPrevious studies confirmed that the control of diabetes is related to family functioning, but the validity of the tools used to assess family functioning in these studies is questionable. Few studies have focused on family issues. In this study, we used a new assessment tool to evaluate family functioning and family issues of patients with type 2 diabetes.MethodsA cross-sectional questionnaire was given to outpatients with type 2 diabetes at a community hospital in Aichi, Japan, between August 2001 and March 2002. First, the patients were asked to answer FACESKGIV-16, which measures cohesion and adaptability, questions regarding family issues, daily lifestyle, and HAD. Physical and serological data were measured. Family functioning, family issues, and relationships between each parameter and family functioning or family issues were analyzed.ResultsOf the 133 participants, 121 (33.3%) had some sort of family issue. Family issues included “Health problems of family members” (40.9%), “Family life cycle issues” (22.7%), and others.The best fit multiple regression model (Adjusted R2: 0.494, p = 0.020) included Plasma Glucose as an independent variable, and the squared value of cohesion score, depression score of HAD, Total calorie intake, Exercise time, Housekeeping time, and BMI were dependent variables. The results show that extremes of family cohesion with either too many or too few issues related to family functioning are correlated with the plasma glucose level.ConclusionsFamily issues were common among patients with type 2 diabetes, and the extremes of family cohesion were associated with the glucose level, in contrast to the common wisdom that a well balanced family leads to good control of diabetes.

Can Japanese students embrace learner-centered methods for teaching medical interviewing skills? Focus groups

Background: Students’ perceptions of learner-centered methods for teaching medical interviewing skills have not been fully explored. Aim: To explore Japanese students’ perceptions of learner-centered methods for teaching medical interviewing skills such as role play with student-created scenarios, peer-assisted video reviews, and student-led small group debriefing. Methods: We conducted three focus groups with a total of 15 students who participated in the learner-centered seminars on medical interviewing skills at the Nagoya University School of Medicine. The transcripts were analyzed by two authors independently. Keywords and concepts were identified and a thematic framework was developed. Results: Overall, students valued the experience of writing their own scenarios for role play, but some questioned their realism. Many students commented that peer-assisted video reviews provided them with more objective perspectives on their performance. However, some students expressed concerns about competitiveness during the video reviews. While students appreciated teachers’ minimum involvement in the group debriefing, some criticized that teachers did not explain the objectives of the seminar clearly. Many students had difficulties in exchanging constructive feedback. Conclusion: We were able to gain new insights into positive and negative perceptions of students about learner-centered methods for teaching medical interviewing skills at one medical school in Japan.

Case Report: Intraglomerular Metastasis With Neoplastic Cell Interposition

A case is described of an 88-year-old man with lung cancer, nephrotic syndrome, and renal dysfunction who died suddenly of an acute myocardial infarction and whose autopsy revealed many adenocarcinoma cells stacked within glomerular capillary lumina of his kidney, entering into basement membrane zones (ie, neoplastic cell interposition). In addition, glomeruli showed a lobular transformation, doubling of glomerular basement membrane, and electron dense deposits along the glomerular basement membrane. These changes were similar to those of membraneoproliferative glomerulonephritis. The association of intraglomerular metastasis and membranoproliferative glomerulonephritis-like lesions led the authors to speculate that the latter glomerular change might have provided an attractive opportunity for circulating tumor cells to be trapped and grow within the glomerular lumina. This mode of metastasis has not been well-recognized. The authors describe the experience, review the literature, and discuss its possible pathogenesis.