Foundation for Advanced Studies on International Development

BackgroundTraditional assessments of clinical competence using multiple-choice questions (MCQs) have limitations in the evaluation of real-world diagnostic abilities. As such, recognizing non-verbal cues, like tachypnea, is crucial for accurate diagnosis and effective patient care.ObjectiveThis study aimed to evaluate how detecting such cues impacts the clinical competence of resident physicians by using a clinical simulation video integrated into the General Medicine In-Training Examination (GM-ITE).MethodsThis multicenter cross-sectional study enrolled first- and second-year resident physicians who participated in the GM-ITE 2022. Participants watched a 5-minute clinical simulation video depicting a patient with acute pulmonary thromboembolism, and subsequently answered diagnostic questions. Propensity score matching was applied to create balanced groups of resident physicians who detected tachypnea (ie, the detection group) and those who did not (ie, the non-detection group). After matching, we compared the GM-ITE scores and the proportion of correct clinical simulation video answers between the two groups. Subgroup analyses assessed the consistency between results.ResultsIn total, 5105 resident physicians were included, from which 959 pairs were identified after the clinical simulation video. Covariates were well balanced between the detection and non-detection groups (standardized mean difference <0.1 for all variables). Post-matching, the detection group achieved significantly higher GM-ITE scores (mean [SD], 47.6 [8.4]) than the non-detection group (mean [SD], 45.7 [8.1]; mean difference, 1.9; 95% CI, 1.1‐2.6; P=.041). The proportion of correct clinical simulation video answers was also significantly higher in the detection group (39.2% vs 3.0%; mean difference, 36.2%; 95% CI, 32.8‐39.4). Subgroup analyses confirmed consistent results across sex, postgraduate years, and age groups.ConclusionsOverall, this study revealed that detecting non-verbal cues like tachypnea significantly affects clinical competence, as evidenced by higher GM-ITE scores among resident physicians. Integrating video-based simulations into traditional MCQ examinations enhances the assessment of diagnostic skills by providing a more comprehensive evaluation of clinical abilities. Thus, recognizing non-verbal cues is crucial for clinical competence. Video-based simulations offer a valuable addition to traditional knowledge assessments by improving the diagnostic skills and preparedness of clinicians.

Higher levels of perceived control are important to maintain health. The difference in factors related to perceived control and preventive behaviors during the COVID-19 pandemic between Japanese and American nursing students remains unknown. This study aimed to compare factors related to perceived control and infection preventive behaviors between the two countries. This cross-sectional study included nursing students attending four universities in Japan and one in the United States. Using Google Forms, the participants answered a survey comprising sociodemographic data, the Perceived Control and Self-Efficacy Scale, the Perceived Health Competence Scale, and a preventive behavior questionnaire. The data were collected from November 2020 to May 2021. Linear and logistic regressions were used to analyze the factors related to perceived control and preventive behaviors, respectively. Data from 878 students were analyzed. University/campus emerged as a strong predictor for perceived control and preventive behaviors in both countries, with a positive correlation between perceived control and preventive behaviors. Older age, less frequent alcohol consumption, higher perceived health competence, less frequent work in Japan; and chronic conditions in the United States were associated with frequent preventive behaviors. Younger age was correlated with higher perceived control in Japan, while religion and increased workload were potential factors for American students. Individual factors were pivotal in Japan, whereas interpersonal factors were more likely related to perceived control in the United States. Additionally, in both countries, policy or organizational factors significantly influenced students' preventive behaviors.

BackgroundMentorship is a dynamic, reciprocal relationship in which an advanced careerist (mentor) encourages the growth of a novice (mentee). Mentorship may protect the mental health of residents at risk for depression and burnout, yet despite its frequent use and known benefits, limited reports exist regarding the prevalence and mental effects of mentorship on residents in Japan.MethodsWe conducted a cross‐sectional study involving postgraduate year 1 and 2 (PGY‐1 and PGY‐2) residents in Japan who took the General Medicine In‐Training Examination (GM‐ITE) at the end of the 2021 academic year. Data on mentorship were collected using surveys administered immediately following GM‐ITE completion. The primary outcome was the Patient Health Questionaire‐2 (PHQ‐2), which consisted depressed mood and loss of interest. A positive response for either item indicated PHQ‐2 positive. We examined associations between self‐reported mentorship and PHQ‐2 by multi‐level analysis.ResultsOf 4929 residents, 3266 (66.3%) residents reported having at least one mentor. Compared to residents without any mentor, those with a mentor were associated with a lower likelihood of a positive PHQ‐2 response (adjusted odds ratio [aOR] 0.75; 95% confidence interval [95% CI] 0.65–0.86). Mentor characteristic significantly associated with negative PHQ‐2 response was a formal mentor (aOR; 0.68; 95% CI 0.55–0.84).ConclusionsA mentor‐based support system was positively associated with residents' mental health. Further research is needed to determine the quality of mentorship during clinical residency in Japan.

Excessive salt intake raises blood pressure and increases the risk of non-communicable diseases (NCD), such as CVD, chronic kidney disease and stomach cancer. Reducing the Na content of food is an important public health measure to control the NCD. This study quantifies the amount of salt reduced by using umami substances, i.e. glutamate, inosinate and guanylate, for adults in the USA. The secondary data analysis was performed using data of the US nationally representative cross-sectional dietary survey, the National Health and Nutrition Examination Survey (NHANES) 2017-2018. Per capita daily salt intake corresponding to the NHANES food groups was calculated in the four hypothetical scenarios of 0 %, 30 %, 60 % and 90 % market share of low-Na foods in the country. The salt reduction rates by using umami substances were estimated based on the previous study results. The USA. 4139 individuals aged 20 years and older in the USA. Replacing salt with umami substances could help the US adults reduce salt intake by 7·31-13·53 % (7·50-13·61 % for women and 7·18-13·53 % for men), which is equivalent to 0·61-1·13 g/d (0·54-0·98 g/d for women and 0·69-1·30 g/d for men) without compromising the taste. Approximately, 21·21-26·04 % of the US adults could keep their salt intake below 5 g/d, the WHO's recommendation in the scenario where there is no low-Na product on the market. This study provides essential information that the use of umami substances as a substitute for salt may help reduce the US adults' salt intake.

Disasters, pandemics, and their response measures can have secondary effects on the physical and psychological health of affected populations. Using health insurance receipt data from 2009 to 2020, we assessed changes in the prevalence of major non-communicable diseases (NCDs), including hypertension, hyperlipidemia, diabetes, and mental disorders, among affected populations before and after the Fukushima disaster and coronavirus disease (COVID-19) outbreak in Japan. Furthermore, age and sex groups with the largest increases in prevalence after these events were identified. The participants of this study were employees of large companies and their dependent family members who were insured by health insurance societies (HIS). The dataset was provided by JMDC Inc. The annual age-adjusted prevalence of each disease belonging to the HIS scheme was used to calculate the ratio of disease prevalence before and after the events. After the Fukushima disaster, hypertension, hyperlipidemia, and diabetes generally increased over a 9-year period in Fukushima Prefecture. The increase in the prevalence rate of these three NCDs and mental disorders was the highest among females aged 40–74 years compared to males and the other age groups. The prevalence of all four diseases increased after the COVID-19 outbreak in Japan, with a marked increase in males aged 0–39 years. Changes in prevalence ratios of NCDs after the COVID-19 outbreak among the areas affected by the Fukushima disaster were lower than in the whole of Japan. It is important to provide tailor-made public health support among populations in accordance with the type of disasters and pandemic.

In line with the Sustainable Development Goals (SDGs), the reduction of the under-5 mortality rate to ≤25 deaths per 1000 live births by 2030 is the primary target of Myanmar’s national strategic plan for newborn and child health [1]. Myanmar made considerable strides in decreasing under-5 mortality with a 61% reduction between 1990 and 2019; […]

As people move around using public transportation networks such as train and airplanes, it is expected that emerging infectious diseases will spread on the network. The scan statistics approach has been frequently applied to identify high-risk locations, and the results are widely used for making a clinical decision in a timely manner. However, they are not optimally designed for modeling the spread and might not effectively work in the emergency situation where computational time is essentially important. We propose a new scan statistics approach for the public transportation network, called PTNS (Public Transportation Network Scan). PTNS utilizes the available network structure to construct potential candidates of clusters, and thus it can work well especially in situations where public transportation is the main medium of the infection spread. Further, it is designed for rapid surveillance. Lastly, PTNS is generalized to detect space-time clusters by customizing the iteration for potential clusters creation. Using the simulation data generated with a real railway network, we showed that, PTNS outperformed the conventional methods, including Circular- and Flex-scan approaches, in terms of the detection performance, while the computational time is feasible.

BackgroundExcessive weight gain during pregnancy results in maternal and fetal complications and could further impact offspring. The evidence regarding the association between regular weighing during the antenatal period and excessive weight gain is limited.MethodsWe will systematically review individual and cluster randomized controlled trials that evaluated regular weighing as an intervention compared to weighing only at the first booking of the antenatal visit. Trials that assessed the effectiveness of exercise, diet, or other behavioral interventions will be excluded. Pregnant women with a singleton pregnancy and no preexisting health complications are eligible for the review. The primary outcome will be the proportion of women at term who exceed the upper limit of the target range of weight as defined by the guidelines or recommendations for the population. We will search MEDLINE (via PubMed), Embase (via EMBASE.com), Scopus, the Cumulative Index to Nursing and Allied Health Literature (CINAHL via EBSCO), The Cochrane Central Register of Controlled Trials (CENTRAL) and the trial protocol registers, ClinicalTrials.gov, and the International Clinical Trials Registry Platform (ICTRP) search portal. Full-text articles, unpublished studies, and ongoing trials reported in any language will be included. Two review authors will independently examine and screen for eligible studies and extract data for synthesis.DiscussionWe will discuss the effectiveness of regular weighing as a single intervention on reducing the proportion of women who have excessive gestational weight gain. This study will provide key information for countries to develop guidelines on antenatal care and strategies to tackle excessive gestational weight gain. We will create a “Summary of findings” table (Summary of findings table 1) according to the methods described in the Cochrane Handbook for Systematic Reviews of Interventions.Systematic review registrationPROSPERO CRD42020212581