Education policies to increase rural physicians in Japan: a nationwide cohort study

Abstract Background Japan has established comprehensive education-scholarship programs to supply physicians in rural areas. Their entrants now comprise 16% of all medical students, and graduates must work in rural areas for a designated number of years. These programs are now being adopted outside Japan, but their medium-term outcomes and inter-program differences are unknown. Methods A nationwide prospective cohort study of newly licensed physicians 2014–2018 (n = 2454) of the four major types of the programs—Jichi Medical University (Jichi); regional quota with scholarship; non-quota with scholarship (scholarship alone); and quota without scholarship (quota alone)—and all Japanese physicians in the same postgraduate year (n = 40,293) was conducted with follow-up workplace information from the Physician Census 2018, Ministry of Health, Labour and Welfare. In addition, annual cross-sectional survey for prefectural governments and medical schools 2014–2019 was conducted to obtain information on the results of National Physician License Examination and retention status for contractual workforce. Results Passing rate of the National Physician License Examination was highest in Jichi, followed in descending order by quota with scholarship, the other two programs, and all medical graduates. The retention rate for contractual rural service of Jichi graduates 5 years after graduation (n = 683; 98%) was higher than that of quota with scholarship (2868; 90%; P < 0.001) and scholarship alone (2220; 81% < 0.001). Relative risks of working in municipalities with the least population density quintile in Jichi, quota with scholarship, scholarship alone, and quota alone in postgraduate year 5 were 4.0 (95% CI 3.7–4.4; P < 0.001), 3.1 (2.6–3.7; < 0.001), 2.5 (2.1–3.0; < 0.001), and 2.5 (1.9–3.3; < 0.001) as compared with all Japanese physicians. There was no significant difference between each program and all physicians in the proportion of those who specialized in internal medicine or general practice in postgraduate years 3 to 5 Conclusions Japan’s education policies to produce rural physicians are effective but the degree of effectiveness varies among the programs. Policymakers and medical educators should plan their future rural workforce policies with reference to the effectiveness and variations of these programs.

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Urban and Rural Disparities in Hospital Utilization among Indonesian Adults

Iranian Journal of Public Health ◽

10.18502/ijph.v48i2.819 ◽

2019 ◽

Author(s):

Agung Dwi LAKSONO ◽

Ratna Dwi WULANDARI ◽

Oedojo SOEDIRHAM

Keyword(s):

Rural Areas ◽

Multinomial Logistic Regression ◽

Hospital Utilization ◽

Hospital Inpatient ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Healthcare Facilities ◽

Patient’S Satisfaction ◽

Significant Difference ◽

Urban Rural

Background: Equal access to healthcare facilities, patient’s satisfaction, and respect for the desire of the patient were recognized as the basic principles of each of the health care system. Each person must be given the opportunity to access health services in accordance with the requirements of their health. We aimed to prove the existence of disparities hospital utilization based on the category of urban-rural areas. Methods: The research used the 2013 Indonesian Basic Health Survey (RKD) as analysis material, that was designed a cross-sectional survey. With the multi-stage cluster random sampling method, 722,329 respondents were obtained. Data were analyzed using Multinomial Logistic Regression tests. Results: The results showed adults living in urban were likely to use hospital outpatient facilities 1.246 times higher than adults living in rural areas (OR 1.246; 95% CI 1.026 – 1.030). The likelihood of utilizing at the same time outpatient and inpatient facilities at 1.134 times higher in adults living in urban than those in rural areas (OR 1.134; 95% CI 1.025 - 1.255). While for the category of hospital inpatient utilization, there was no significant difference. Conclusion: There was a disparity in hospital utilization between urban-rural areas. Urban show better utilization than rural areas in outpatient and at the same time the use of inpatient care

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Results of physician licence examination and scholarship contract compliance by the graduates of regional quotas in Japanese medical schools: a nationwide cross-sectional survey

BMJ Open ◽

10.1136/bmjopen-2017-019418 ◽

2017 ◽

Vol 7 (12) ◽

pp. e019418 ◽

Cited By ~ 6

Author(s):

Masatoshi Matsumoto ◽

Keisuke Takeuchi ◽

Tetsuhiro Owaki ◽

Seitaro Iguchi ◽

Kazuo Inoue ◽

...

Keyword(s):

Medical School ◽

Rural Areas ◽

National Policy ◽

Medical Schools ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Medical Graduates ◽

Intermediate Outcomes ◽

The Government ◽

License Examination

ObjectivesResponding to the serious shortage of physicians in rural areas, the Japanese government has aggressively increased the number of entrants to medical schools since 2008, mostly as achiikiwaku, entrants filling a regional quota. The quota has spread to most medical schools, and these entrants occupied 16% of all medical school seats in 2016. Most of these entrants were admitted to medical school with a scholarship with the understanding that after graduation they will practise in designated areas of their home prefectures for several years. The quota and scholarship programmes will be revised by the government starting in 2018. This study evaluates the intermediate outcomes of these programmes.DesignCross-sectional survey to all prefectural governments and medical schools every year from 2014 to 2017 to obtain data on medical graduates.SettingsNationwide.ParticipantsAll quota and non-quota graduates with prefecture scholarship in each prefecture, and all the quota graduates without scholarship in each medical school.Primary outcome measuresPassing rate of the National License Examination for Physicians and the percentage of graduates who have not bought out the scholarship contract after graduation.ResultsMost prefectures and medical schools in Japan participated in this study (97.8%–100%). Quota graduates with scholarship were significantly more likely to pass the National License Examination for Physicians than the other medical graduates in Japan at all the years (97.9%, 96.7%, 97.4% and 94.7% vs 93.9%, 94.5%, 94.3% and 91.8%, respectively). The percentage of quota graduates with scholarship who remained in the scholarship contract 3 years after graduation was 92.2% and 89.9% for non-quota graduates with scholarship.ConclusionsQuota entrants showed better academic performance than their peers. Most of the quota graduates remained in the contractual workforce. The imminent revision of the national policy regarding quota and scholarship programmes needs to be based on this evidence.

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Differential Prevalence of Malaria Infection in Rural and Urban Out-Patient Clinics in Lagos State, Nigeria

Pan African Journal of Life Sciences ◽

10.36108/pajols/9102/20(0140) ◽

2019 ◽

Vol 2 (1) ◽

pp. 79-84

Author(s):

Taiye S. Olusegun-Joseph ◽

Mary A. Oboh ◽

Godwin O. Ovioma ◽

Ifeoluwa K. Fagbohun ◽

Uneke Okorafor ◽

...

Keyword(s):

Rural Areas ◽

Access To Health Care ◽

Control Measures ◽

Urban Setting ◽

Malaria Vectors ◽

Cross Sectional Survey ◽

Freedom Of Establishment ◽

Cross Sectional ◽

Rural And Urban ◽

Significant Difference

Introduction: Nigeria is a country with diverse weather conditions supporting the substantial breeding of mosquitoes resulting in high malaria transmission. Mapping of malaria prevalence in areas with ongoing trans-mission is critical for effective distribution of control interventions. In this study, a cross-sectional survey was carried out in two different (rural and urban setting) endemic communities within a hypo-endemic state (Lagos) of Nigeria. Methodology: The study targeted patients visiting clinics in both Ijede and Gbagada General Hospital between September and November 2017. All patients visiting each of the two hospitals with febrile complaints were recruited into the survey. Blood samples collected were examined using the standard thick and thin films stained with Giemsa. Results: A total of 342 participants were screened out of which 108 (31.6%) were positive for P. falciparum by microscopy in both centers (Ijede centre 90 [43.9%]; Gbagada 18 [13.1%]). Children aged 1-10 years had the highest prevalence (43.6%) in both locations and this rate was significantly higher (P=0.001) in Ijede (63%) than in Gbagada (17%). There was no significant difference (P>0.05) in infection rate between male (31.9 %) and female (31.3%) participants in both sites. Conclusion: These findings give an overview of the “freedom of establishment” of malaria in an under-resourced area where all conditions serve as motivation for the breeding of malaria vectors. Distribution of control measures should strategically target rural areas where the burden of infection is high, and inhabitants of such areas have a disproportionate access to health care.

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AWARENESS ABOUT INDOOR AIR POLLUTION IN GENERAL POPULATION OF RAWALPINDI AND ISLAMABAD

Pakistan Journal of Public Health ◽

10.32413/pjph.v8i2.118 ◽

2018 ◽

Vol 8 (2) ◽

pp. 80-83

Author(s):

Nadia Tariq ◽

Tamkeen Jaffry ◽

Rahma Fiaz ◽

Abdul Majid Rajput ◽

Sadaf Khalid

Keyword(s):

Air Pollution ◽

General Population ◽

Indoor Air ◽

Indoor Air Pollution ◽

Economic Status ◽

Educational Status ◽

Epidemiological Studies ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Significant Difference

Background: Indoor air pollutants are increasingly being associated with respiratory illnesses leading to high degree of morbidity and mortality. There are not sufficient epidemiological studies from Pakistan which assess level of awareness of indoor air pollution resulting in respiratory diseases in population. Methods: This cross sectional survey was carried out on general population of Rawalpindi/Islamabad. Sample size was 223 study subjects selected by non-probability convenient sampling. Knowledge of the study subjects was determined with regard to indoor air pollution, its effects on health and different sources of indoor air pollution with the help of a questionnaire. The influence of age, gender, educational status and socio economic status on the level of awareness was also analyzed. Results: Out of total 223 participants, 115 were males and108 females. Participants aware of indoor air pollution were 91.5% and adequate awareness about its sources was 80.7%. Those who knew indoor air pollution is detrimental to health were 95.1%. Awareness about building construction dust as source of indoor air pollution was maximum (84.8%). There was significant difference in awareness among participants with different monthly incomes and educational status and also between males and females. Conclusion: This study concludes that general population of Rawalpindi/Islamabad has fairly good awareness about sources of indoor air pollution. Use of harmful material causing indoor air pollution should be limited or substituted with better ones where possible.

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Acute food insecurity and short-term coping strategies of urban and rural households of Bangladesh during the lockdown period of COVID-19 pandemic of 2020: report of a cross-sectional survey

BMJ Open ◽

10.1136/bmjopen-2020-043365 ◽

2020 ◽

Vol 10 (12) ◽

pp. e043365

Author(s):

Subhasish Das ◽

Md. Golam Rasul ◽

Md Shabab Hossain ◽

Ar-Rafi Khan ◽

Md Ashraful Alam ◽

...

Keyword(s):

Food Insecurity ◽

Coping Strategies ◽

Rural Areas ◽

Urban Areas ◽

Multinomial Logistic Regression ◽

Rural Households ◽

P Value ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Food Insecure Households

IntroductionWe conducted a cross-sectional survey to assess the extent and to identify the determinants of food insecurity and coping strategies in urban and rural households of Bangladesh during the month-long, COVID-19 lockdown period.SettingSelected urban and rural areas of Bangladesh.Participants106 urban and 106 rural households.Outcome variables and methodHousehold food insecurity status and the types of coping strategies were the outcome variables for the analyses. Multinomial logistic regression analyses were done to identify the determinants.ResultsWe found that around 90% of the households were suffering from different grades of food insecurity. Severe food insecurity was higher in urban (42%) than rural (15%) households. The rural households with mild/moderate food insecurity adopted either financial (27%) or both financial and food compromised (32%) coping strategies, but 61% of urban mild/moderate food insecure households applied both forms of coping strategies. Similarly, nearly 90% of severely food insecure households implemented both types of coping strategies. Living in poorest households was significantly associated (p value <0.05) with mild/moderate (regression coefficient, β: 15.13, 95% CI 14.43 to 15.82), and severe food insecurity (β: 16.28, 95% CI 15.58 to 16.97). The statistically significant (p <0.05) determinants of both food compromised and financial coping strategies were living in urban areas (β: 1.8, 95% CI 0.44 to 3.09), living in poorest (β: 2.7, 95% CI 1 to 4.45), poorer (β: 2.6, 95% CI 0.75 to 4.4) and even in the richer (β: 1.6, 95% CI 0.2 to 2.9) households and age of the respondent (β: 0.1, 95% CI 0.02 to 0.21).ConclusionBoth urban and rural households suffered from moderate to severe food insecurity during the month-long lockdown period in Bangladesh. But, poorest, poorer and even the richer households adopted different coping strategies that might result in long-term economic and nutritional consequences.

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Career Intentions and Dropout Causes Among Medical Students in Kazakhstan

Medicina ◽

10.3390/medicina49060045 ◽

2013 ◽

Vol 49 (6) ◽

pp. 45

Author(s):

Kamila Faizullina ◽

Galina Kausova ◽

Zhanna Kalmataeva ◽

Ardak Nurbakyt ◽

Saule Buzdaeva

Keyword(s):

Medical Students ◽

Human Resources ◽

Rural Areas ◽

Urban Areas ◽

Human Resources For Health ◽

Medical Schools ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Unequal Distribution ◽

Survey Tool

Background and Objective. The number of new entrants to higher medical schools of Kazakhstan increased by 1.6 times from 2007 to 2012. However, it is not known how it will affect the shortage of human resources for health. Additionally, human resources for health in rural areas of Kazakhstan are 4 times scarcer than in urban areas. The aim of the present study was to investigate the intentions of students toward their professional future and readiness to work in rural areas, as well as to determine the causes for dropping out from medical schools. Material and Methods. A cross-sectional survey was conducted in 2 medical universities in Almaty during the academic year 2011–2012. The study sample included medical students and interns. In total, 2388 students participated in the survey. The survey tool was an anonymous questionnaire. Results. The students of the first years of studies compared with those of later years of studies were more optimistic about the profession and had more intentions to work in the medical field. Only 8% of the students reported a wish to work in rural localities. On the other hand, 4% of the students did not plan to pursue the profession. On the average, every third medical student dropped out on his/her own request. Conclusions. Associations between intentions to work according to the profession and the year of studies, faculty, and residence area before enrolling in a medical school were documented. The majority of the students who came from rural areas preferred to stay and look for work in a city, which might contribute to an unequal distribution of physicians across the country.

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Comparison of two methods to estimate adverse events in the IBEAS Study (Ibero-American study of adverse events): cross-sectional versus retrospective cohort design

BMJ Open ◽

10.1136/bmjopen-2017-016546 ◽

2017 ◽

Vol 7 (10) ◽

pp. e016546 ◽

Cited By ~ 3

Author(s):

Jesus Maria Aranaz Andrés ◽

Ramon Limón Ramírez ◽

Carlos Aibar Remón ◽

Maria Teresa Gea-Velázquez de Castro ◽

Francisco Bolúmar ◽

...

Keyword(s):

Cohort Study ◽

Adverse Events ◽

Retrospective Cohort Study ◽

Medical Records ◽

Retrospective Cohort ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Hospital Size ◽

Cohort Design ◽

Cohort Study Design

BackgroundAdverse events (AEs) epidemiology is the first step to improve practice in the healthcare system. Usually, the preferred method used to estimate the magnitude of the problem is the retrospective cohort study design, with retrospective reviews of the medical records. However this data collection involves a sophisticated sampling plan, and a process of intensive review of sometimes very heavy and complex medical records. Cross-sectional survey is also a valid and feasible methodology to study AEs.ObjectivesThe aim of this study is to compare AEs detection using two different methodologies: cross-sectional versus retrospective cohort design.SettingSecondary and tertiary hospitals in five countries: Argentina, Colombia, Costa Rica, Mexico and Peru.ParticipantsThe IBEAS Study is a cross-sectional survey with a sample size of 11 379 patients. The retrospective cohort study was obtained from a 10% random sample proportional to hospital size from the entire IBEAS Study population.MethodsThis study compares the 1-day prevalence of the AEs obtained in the IBEAS Study with the incidence obtained through the retrospective cohort study.ResultsThe prevalence of patients with AEs was 10.47% (95% CI 9.90 to 11.03) (1191/11 379), while the cumulative incidence of the retrospective cohort study was 19.76% (95% CI 17.35% to 22.17%) (215/1088). In both studies the highest risk of suffering AEs was seen in Intensive Care Unit (ICU) patients. Comorbid patients and patients with medical devices showed higher risk.ConclusionThe retrospective cohort design, although requires more resources, allows to detect more AEs than the cross-sectional design.

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Prevalence of thinness, overweight and obesity among Tibetan adolescents aged 12-17 years

Public Health Nutrition ◽

10.1017/s1368980021000215 ◽

2021 ◽

pp. 1-17

Author(s):

Yunfei Zhang ◽

Jiahong Sun ◽

Min Zhao ◽

Costan G. Magnussen ◽

Xi Bo

Keyword(s):

Sampling Method ◽

Total Sample ◽

Overweight And Obesity ◽

Cluster Sampling ◽

Cross Sectional Survey ◽

Clear Trend ◽

Cross Sectional ◽

Significant Difference ◽

Prevalence Of Obesity ◽

Study Participants

Abstract Objective: To estimate the prevalence of thinness, overweight and obesity among Tibetan adolescents aged 12-17 years. Design: Cross-sectional survey. Setting: Shigatse city of Tibet municipality, with an average altitude of more than 4000 m. Subjects: Study participants included 2,642 adolescents aged 12-17 years selected from 6 schools using a convenient cluster sampling method. Results: The prevalence of thinness/overweight/obesity among Tibetan adolescents was 9.4%/5.4%/1.4% (China definition), 14.7%/4.4%/0.7% (IOTF definition), and 2.8%/5.7%/0.9% (WHO definition). The prevalence of thinness and overweight was significantly different between both sexes based on each of three BMI classification criteria (P <0.001). There was no significant difference in the prevalence of obesity between both sexes according to each of three BMI criteria. There was no clear trend in the prevalence of thinness across ages according to the China or IOTF definition (both P >0.05), whereas an upward trend was observed for thinness in boys according to the IOTF definition (P for trend <0.05). In contrast, the prevalence of thinness tended to decrease with increasing age in girls according to the IOTF definition, and in total sample according to the WHO definition (P for trend <0.05). Conclusions: Among Tibetan adolescents, the prevalence of overweight and obesity is relatively low, while the prevalence of thinness is high, especially in boys. These data suggest urgent attention is needed to control adolescent thinness in Tibet.

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Caregiving, Employment and Social Isolation: Challenges for Rural Carers in Australia

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph15102267 ◽

2018 ◽

Vol 15 (10) ◽

pp. 2267 ◽

Cited By ~ 4

Author(s):

Rafat Hussain ◽

Stuart Wark ◽

Peta Ryan

Keyword(s):

Support Groups ◽

Rural Areas ◽

General Information ◽

Care Recipient ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Family Responsibilities ◽

Residency Status ◽

Australian Bureau Of Statistics ◽

Provision Of Care

Australia has one of the world’s highest life expectancy rates, and there is a rapidly growing need for informal caregivers to support individuals who are ageing, have chronic illness or a lifelong disability. These informal carers themselves face numerous physical and psychological stressors in attempting to balance the provision of care with their personal life, their work commitments and family responsibilities. However, little is known about the specific challenges facing rural carers and the barriers that limit their capacity to provide ongoing support. A cross-sectional survey composed of open-ended responses and demographic/socioeconomic measures used routinely by the Australian Bureau of Statistics (ABS) and the Australian Institute of Health & Welfare (AIHW) was used with a cohort of 225 rurally-based carers within New South Wales, Australia. Demographic questions specified the respondents’ age, gender, employment, caregiving status, condition of and relationship to the care recipient, postcode, residency status, and distance and frequency travelled to provide care. Open-ended comments sections were provided to allow participants to describe any issues and problems associated with caregiving including employment, travel, residency, carer support groups and any other general information. The results show that most rural carers were middle-aged women supporting a spouse or a child. Unpredictability associated with providing care exacerbated demands on carers’ time, with many reporting significant employment consequences associated with inflexibility and limited job options in rural locations. Specific issues associated with travel requirements to assist with care were reported, as were the impacts of care provision on the respondents’ own personal health. The majority of carers were aware of the social supports available in their local rural community, but did not access them, leaving the carers vulnerable to marginalisation. Problems associated with employment were noted as resulting in financial pressures and associated personal stress and anxiety for the caregivers. While this issue is not necessarily limited to rural areas, it would appear that the lack of opportunity and flexibility evident in rural areas would exacerbate this problem for non-metropolitan residents. The participants also identified specific barriers to the provision of care in rural areas, including the significant impact of travel. Access to support services, such as carer groups, were rarely accessed due to a mix of factors including inaccessibility, poor timing and a lack of anonymity. Financially, there was considerable evidence of hardship, and there is an urgent need for a comprehensive review of government and community-based support to better meet the needs of rural carers.

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SELF-REPORTED MALARIA AND MOSQUITO AVOIDANCE IN RELATION TO HOUSEHOLD RISK FACTORS IN A KENYAN COASTAL CITY

Journal of Biosocial Science ◽

10.1017/s0021932005007182 ◽

2005 ◽

Vol 37 (6) ◽

pp. 761-771 ◽

Cited By ~ 12

Author(s):

JOSEPH KEATING ◽

KATE MACINTYRE ◽

CHARLES M. MBOGO ◽

JOHN I. GITHURE ◽

JOHN C. BEIER

Keyword(s):

Rural Areas ◽

Mosquito Control ◽

Control Measure ◽

Control Measures ◽

Level Control ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Household Level ◽

Household Factors ◽

History Of

A geographically stratified cross-sectional survey was conducted in 2002 to investigate household-level factors associated with use of mosquito control measures and self-reported malaria in Malindi, Kenya. A total of 629 households were surveyed. Logistic regressions were used to analyse the data. Half of all households (51%) reported all occupants using an insecticide-treated bed net and at least one additional mosquito control measure such as insecticides or removal of standing water. Forty-nine per cent reported a history of malaria in the household. Of the thirteen household factors analysed, low (OR=0·23, CI 0·11, 0·48) and medium (OR=0·50, CI 0·29, 0·86) education, mud–wood–coral (OR=0·0·39, CI 0·24, 0·66) and mud block–plaster (OR=0·47, CI 0·25, 0·87) wall types, farming (OR=1·38, CI 1·01, 1·90) and travel to rural areas (OR=0·48, CI 0·26, 0·91) were significantly associated with the use of mosquito control, while controlling for other covariates in the model. History of reported malaria was not associated with the use of mosquito control (OR=1·22, CI 0·79, 1·88). Of the thirteen covariates analysed in the second model, only two household factors were associated with history of malaria: being located in the well-drained stratum (OR=0·49, CI 0·26, 0·96) and being bitten while in the house (OR=1·22, CI 0·19, 0·49). These results suggest that high socioeconomic status is associated with increased household-level mosquito control use, although household-level control may not be enough, as many people are exposed to biting mosquitoes while away from the house and in areas that are more likely to harbour mosquitoes.

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