Nihon eiseigaku zasshi. Japanese journal of hygiene
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Nihon Eiseigaku Zasshi · Jan 2011
Review[Physician shortage in Japan: the new postgraduate medical education program and physicians as a human medical resource].
Japan now faces a serious physician shortage. After introducing the new postgraduate medical education (PGME) system and doctor-to-facility matching system, residents shifted their teaching hospitals from university hospitals to non-university hospitals. Because university hospitals had played a central role in allocating physicians to communities, the decrease in the number of physicians at university hospitals has driven this physician shortage. ⋯ However, a simple increase does not solve the problem of physician shortage unless it also addresses the problem of physician maldistribution. Fourth, the number of females entering medicine is increasing, and women constituted 30% of newly certified physicians in 2010. In this era of physician shortage, female physicians are highly recommended as a human medical resource.
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Nihon Eiseigaku Zasshi · Sep 2009
[Causal inference in medicine part I--counterfactual models--an approach to clarifying discussions in research and applied public health].
A central problem in natural science is identifying general laws of cause and effect. Medical science is devoted to revealing causal relationships in humans. The framework for causal inference applied in epidemiology can contribute substantially to clearly specifying and testing causal hypotheses in many other areas of biomedical research. ⋯ In observational studies, however, there is a greater risk that the assumption of conditional exchangeability may be violated. In summary, in this article, we highlight the following points: (1) individual causal effects cannot be inferred because counterfactual outcomes cannot, by definition, be observed; (2) the distinction between concepts of association and concepts of causation and the basis for the definition of confounding; (3) the importance of elaborating specific research hypotheses in order to evaluate the assumption of conditional exchangeability between the exposed and unexposed groups; (4) the advantages of defining research hypotheses at the population level, including specification of a hypothetical intervention, consistent with the counterfactual model. In addition, we show how understanding the counterfactual model can lay the foundation for correct interpretation of epidemiologic evidence.
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Nihon Eiseigaku Zasshi · Sep 2009
[Causal Inference in Medicine Part II. Directed acyclic graphs--a useful method for confounder selection, categorization of potential biases, and hypothesis specification].
Confounding is frequently a primary concern in epidemiological studies. With the increasing complexity of hypothesized relationships among exposures, outcomes, and covariates, it becomes very difficult to present these hypotheses lucidly and comprehensively. Graphical models are of great benefit in this regard. ⋯ A proper interpretation of the coefficients of a statistical model for addressing a specific research hypothesis relies on an accurate specification of a causal DAG reflecting the underlying causal structure. Unless DAGs correspond to research hypotheses, we cannot reliably reach proper conclusions testing the research hypotheses. Finally, (3) we have briefly reviewed other approaches to causal inference, and illustrate how these models are connected.
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Nihon Eiseigaku Zasshi · Jan 2004
Historical Article[Influence of European social medicine on US public health schools].
The origin of modern social medicine, represented by Hygiene and Public Health, can be traced back to the European social medicines, products of their social mobilization after the Industrial Revolution. Nevertheless, mainstream current social medicines, and particularly their primal source of research methodology, US public health schools, are not, seemingly, faithful successors of the originator in their inclination toward biological reductionism and market economy. This paper, for the purpose of bridging this gap, surveys the rising of European social medicines and illustrates the history of US public health schools, clarifying their academic discontinuation in the early 20th century.
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Nihon Eiseigaku Zasshi · Oct 1997
Review[Low-level lead exposure and children's intelligence from recent epidemiological studies in the U.S.A. and other countries to progress in reducing lead exposure and screening in the U.S.A].
From the 1980s many well-designed epidemiological studies have confirmed that low-level, subclinical lead exposure in early life is associated with decrements in children's intelligence. Neurodevelopmental deficits from exposure to a low level of lead have been held to be not only an American problem, but also a worldwide issue in the past decade. Good epidemiological studies were reported from England, Scotland, Germany, Greece, Australia and New Zealand. ⋯ In cases where these levels persist, there should be environmental investigation and intervention. All children with blood levels of 20 micrograms/dl or greater should receive environmental evaluation and medical examination. Such children may need pharmacological treatment.