Yonago acta medica最新文献

{"title":"Longitudinal Dynamics of Soluble NKG2D Ligands in Mild and Moderate Coronavirus Disease-2019.","authors":"Kyosuke Nagamizu, Yukari Nishikawa, Miyako Takata, Kosuke Yamaguchi, Yuki Hashimoto, Shota Morishita, Ma'arif Athok Shofiudin, Kensaku Okada, Tsuyoshi Kitaura, Masaki Nakamoto, Akira Yamasaki, Hiroki Chikumi","doi":"10.33160/yam.2026.02.015","DOIUrl":"https://doi.org/10.33160/yam.2026.02.015","url":null,"abstract":"<p><strong>Background: </strong>The soluble form of NKG2D (sNKG2D) ligands has been implicated in the severity of coronavirus disease-2019 (COVID-19). However, their longitudinal dynamics from the acute phase to hospital discharge and their relationships with clinical parameters are unclear. This study aimed to investigate the longitudinal dynamics of these ligands and determine their relationship with clinical parameters.</p><p><strong>Methods: </strong>This retrospective observational cohort study evaluated 64 patients with mild or moderate COVID-19. sULBP-2, soluble MIC-A (sMIC-A), and soluble MIC-B (sMIC-B) concentrations at admission, recovery, and discharge were analyzed. Associations with patient characteristics and laboratory parameters (white blood cell count and C-reactive protein, lactate dehydrogenase, Krebs von den Lungen-6, ferritin, and interleukin-6 levels), natural killer (NK) cell and T cell counts, and severe acute respiratory syndrome coronavirus 2 viral copy numbers were examined. Principal component analysis (PCA) was performed in the moderate group, and the relationship between sNKG2D ligands and clinical parameters using hierarchical cluster analysis.</p><p><strong>Results: </strong>Serum sULBP-2 concentrations were significantly higher in the moderate group at both admission and discharge. In contrast, sMIC-A and sMIC-B levels did not significantly differ. Higher sULBP-2 levels at admission persisted until discharge. PCA demonstrated that admission sULBP-2 levels were associated with inflammatory components; admission sMIC-A levels were associated with components related to NK cells and lung injury. Their discharge levels both converged into a shared principal component closely associated with NK cell. Clusters characterized by older age, elevated sULBP-2, and increased inflammatory responses and lung injury markers had worse disease severity.</p><p><strong>Conclusion: </strong>NKG2D ligand levels increase via distinct mechanisms during acute COVID-19 but converge toward a shared dynamics during recovery. sULBP-2 is the only sNKG2D ligand related with disease severity, and its elevation persists through discharge, suggesting prolonged impairment of NK cell function after clinical recovery. sULBP-2 may be an important biomarker of disease severity.</p>","PeriodicalId":23795,"journal":{"name":"Yonago acta medica","volume":"69 1","pages":"105-118"},"PeriodicalIF":0.6,"publicationDate":"2026-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12910234/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146228850","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Labor Epidural Analgesia with Neonatal Umbilical Arterial Blood pH and Apgar Score: The Japan Environment and Children's Study (JECS).","authors":"Misako Suto, Youichi Kurozawa, Shinji Otani, Toshio Masumoto, Keisuke Miyamoto, Akihiro Otsuki, Hiroki Amano, Akemi Morita","doi":"10.33160/yam.2026.02.003","DOIUrl":"https://doi.org/10.33160/yam.2026.02.003","url":null,"abstract":"<p><strong>Background: </strong>Labor epidural analgesia is recognized worldwide as the gold standard for maternal pain relief during delivery and has been increasingly used in Japan. However, studies on labor analgesia in Japan are scarce, and evaluation of neonatal outcomes associated with this procedure remains limited. Among the key aspects in the safety evaluation of labor epidural analgesia are the potential effects on neonatal umbilical arterial blood pH (UmA-pH) and Apgar score. Therefore, we determined whether labor epidural analgesia during vaginal delivery is associated with neonatal UmA-pH and Apgar score among women delivering in Japan.</p><p><strong>Methods: </strong>In this birth cohort study, we prospectively analyzed data collected from the Japan Environment and Children's Study (JECS). We included Japanese pregnant women who had singleton vaginal deliveries. The primary exposure was labor epidural analgesia, and the primary outcomes were UmA-pH and Apgar score at 1 and 5 min following birth. Multivariate logistic regression was employed to examine the associations between labor epidural analgesia and neonatal outcomes, with adjustment for potential confounders. Adjusted odds ratios (aOR) and 95% confidence intervals (CIs) were reported. Furthermore, a sensitivity analysis using stabilized inverse probability of treatment weighting (IPTW) was conducted.</p><p><strong>Results: </strong>Of the 96,443 women who had singleton deliveries in the JECS, 55,227 were included in the final analysis, 1,311 (2.4%) of whom received labor epidural analgesia. In the multivariate logistic regression analysis, a statistically significant association was observed between labor epidural analgesia and a 1-min Apgar score < 7 (aOR: 1.54; 95% CI: 1.03-2.29). However, only one neonate in the labor epidural analgesia group had a 5-min Apgar score < 7. Moreover, no significant association was observed between labor epidural analgesia and UmA-pH < 7.2 (aOR: 0.94; 95% CI: 0.76-1.17). In the IPTW-based sensitivity analysis, the effect estimates were consistent in direction with the primary analysis, supporting the robustness of the main findings.</p><p><strong>Conclusion: </strong>In this large cohort of singleton vaginal births in Japan, the use of labor epidural analgesia had little to no clinically meaningful effect on neonatal outcomes, including UmA-pH < 7.2 and Apgar score < 7. These findings support informed decision-making for pregnant women in Japan who are considering labor epidural analgesia.</p>","PeriodicalId":23795,"journal":{"name":"Yonago acta medica","volume":"69 1","pages":"24-34"},"PeriodicalIF":0.6,"publicationDate":"2026-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12910225/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146221441","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Next-Generation Artificial Intelligence for ADME Prediction in Drug Discovery: From Small Molecules to Biologics.","authors":"Soyoka Tanihata, Hiroaki Iwata","doi":"10.33160/yam.2026.02.001","DOIUrl":"https://doi.org/10.33160/yam.2026.02.001","url":null,"abstract":"<p><p>Pharmacokinetic (PK) behavior, which emerges from the underlying processes of absorption, distribution, metabolism, and excretion (ADME), is central to drug discovery and development, dose optimization, and safety assessment. Despite decades of experimental and computational research, early-stage prediction of human PK remains a major challenge, contributing to clinical attrition and inefficiency in pharmaceutical pipelines. Advances in artificial intelligence (AI) and machine learning (ML) have significantly improved ADME predictions, particularly for small molecules. Traditional descriptor-based quantitative structure-activity relationship and classical ML methods offer interpretability and robust performance on standardized datasets. In contrast, graph neural networks, deep learning architectures, and chemical language models facilitate the learning of complex nonlinear structure-property relationships and multitask predictions. Multimodal frameworks further integrate experimental measurements, structural data, and biological contexts, enhancing predictive accuracy under low-data and heterogeneous conditions. Emerging modalities, including peptides, oligonucleotides, and antibody-based therapeutics, pose additional challenges owing to their sequence-dependent stability, conformational flexibility, and mechanistically distinct determinants of ADME and toxicity (ADMET). AI approaches that incorporate sequence-, structure-, and mechanism-aware representations combined with multimodal data integration have demonstrated improved predictability for medium- and large-molecule therapeutics. Recent developments in foundation-model architectures offer unified representations across chemical, biological, and biophysical domains, enabling cross-modality ADMET modeling with enhanced generalization and mechanistic interpretability. In this review, we summarize the evolution of computational ADME- and PK-oriented prediction frameworks from small molecules to complex biologics, highlighting methodological advances, representative studies, and emerging trends in multimodal and foundation-model approaches. We also discuss the limitations and future perspectives of the practical implementation of AI-driven ADMET predictions to support rational drug design and development.</p>","PeriodicalId":23795,"journal":{"name":"Yonago acta medica","volume":"69 1","pages":"1-13"},"PeriodicalIF":0.6,"publicationDate":"2026-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12910220/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146221033","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors Affecting the Device Life of Voice Prosthesis in Laryngectomized Patients.","authors":"Kenkichiro Taira, Takahiro Fukuhara, Hideyuki Kataoka, Satoshi Koyama, Ryohei Donishi, Kazunori Fujiwara","doi":"10.33160/yam.2026.02.008","DOIUrl":"https://doi.org/10.33160/yam.2026.02.008","url":null,"abstract":"<p><strong>Background: </strong>Voice restoration with a voice prosthesis has recently become popular among laryngectomized patients due to good voice quality and functional outcomes. An important limitation, however, is the need to periodically replace these devices. Factors affecting prosthesis lifespan differ between countries and regions. We assessed determinants of replacement frequency in Japan.</p><p><strong>Methods: </strong>This retrospective, observational study included 45 patients who opted to receive a voice prosthesis after total laryngectomy. Twenty-one patients were excluded, and thus 24 were analyzed. We defined 3 types of factors affecting voice prosthesis replacement: tracheal site factors, esophageal site factors, and types of prostheses. The association of each factor with device lifespan was examined using the Mann-Whitney <i>U</i> test and Kruskal-Wallis test.</p><p><strong>Results: </strong>Twenty-four patients consented to this study and were surveyed about device lifespan. Twenty-one male patients and three female patients underwent voice prosthesis insertion for secondary voice restoration after total laryngectomy. The mean duration before replacement was 85 ± 36 (range 14-434) days. Total follow-up duration and tracheal dryness were both significantly associated with device lifespan.</p><p><strong>Conclusion: </strong>Learning to properly manage the VP over time and preventing tracheal dryness are required to prolong voice prosthesis lifespan in Japan.</p>","PeriodicalId":23795,"journal":{"name":"Yonago acta medica","volume":"69 1","pages":"71-77"},"PeriodicalIF":0.6,"publicationDate":"2026-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12910231/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146221080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Study of Complications Associated with Mandibular Reconstruction Plates Used in Resection of Oral Squamous Cell Carcinoma.","authors":"Takayuki Tamura, Yusei Harada, Kento Ikuta, Yoshiko Suyama, Takayuki Shingu, Yuki Harada, Kousuke Sakai, Kousuke Amatsu, Kiharu Shimizu, Takashi Narai, Shunjiro Yagi, Isamu Kodani","doi":"10.33160/yam.2026.02.018","DOIUrl":"https://doi.org/10.33160/yam.2026.02.018","url":null,"abstract":"<p><strong>Background: </strong>Reconstructive plates used in mandibular reconstruction may lead to complications such as plate fracture or exposure, and their management is often difficult. In this study, we investigated complications associated with mandibular reconstruction plates in patients who underwent resection of oral squamous cell carcinoma in our department.</p><p><strong>Methods: </strong>Twenty-five patients who received mandibular reconstruction plates during oral squamous cell carcinoma resection at our department over approximately the past 10 years were reviewed. Parameters examined included age, sex, tumor location, stage, type and timing of complication, possible causes, and treatments.</p><p><strong>Results: </strong>Plate exposure occurred in 4 patients, and plate fracture occurred in 4 patients. All exposures were on the cutaneous side. Additional findings included screw fractures and bone resorption around screws. Plate fractures tended to occur more often in patients with strong occlusal support. Patients without reconstruction showed a significantly higher incidence of fracture. Plate fracture was also influenced by plate configuration and bending, while plate exposure was attributed mainly to insufficient soft tissue volume.</p><p><strong>Conclusion: </strong>Although plate reconstruction is useful, the relatively high frequency of complications requires careful consideration of multiple factors when determining its application.</p>","PeriodicalId":23795,"journal":{"name":"Yonago acta medica","volume":"69 1","pages":"125-130"},"PeriodicalIF":0.6,"publicationDate":"2026-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12910219/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146220532","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Questionnaire Survey on Human Papillomavirus Vaccination Among Hospital-Based Healthcare Professionals.","authors":"Ayami Kimura, Tetsuro Oishi, Rina Fujioka, Wakae Tashiro, Masakuni Takahashi, Junzo Kigawa, Takashi Irie","doi":"10.33160/yam.2026.02.016","DOIUrl":"https://doi.org/10.33160/yam.2026.02.016","url":null,"abstract":"<p><strong>Background: </strong>Although active human papillomavirus (HPV) vaccination recommendations resumed in Japan in 2022, vaccination rates remain low. Understanding hospital staff attitudes toward HPV vaccination may provide insights into improving vaccine uptake.</p><p><strong>Methods: </strong>An anonymous Google Form survey was conducted among Matsue City Hospital staff in August 2024. The questionnaire addressed knowledge and perceptions of cervical cancer and HPV vaccines, vaccination history, and future vaccination intentions. Respondents were classified as proactive or passive based on their family's vaccination intentions. Statistical analysis was performed using Fisher's exact test, with <i>P</i> < 0.05 considered significant.</p><p><strong>Results: </strong>Responses were received from 154 participants (response rate: 23.6%), with 88.3% of participants aged ≥ 27 years. While 89.0% and 82.4% reported being \"well aware\" or \"aware\" of cervical cancer and HPV vaccines, respectively, 40.3% were passive about family vaccination, and 36.4% expressed safety concerns. Acceptance of vaccine efficacy was significantly higher in the proactive group than in the passive group (96.7% vs. 59.7%, <i>P</i> < 0.0001). Safety concerns were significantly lower in the proactive group than in the passive group (25.0% vs. 56.5%; <i>P</i> < 0.0001). Knowledge was associated with understanding of efficacy (85.0% vs. 66.7%, <i>P</i> = 0.0502) but not with safety concerns (36.2% vs. 44.4%, <i>P</i> = 0.5126).</p><p><strong>Conclusion: </strong>Approximately 40% of healthcare workers exhibited passive attitudes toward vaccination, and safety concerns significantly influenced their intentions. Improving accurate knowledge dissemination and addressing negative safety perceptions among hospital staff are crucial for increasing vaccination rates.</p>","PeriodicalId":23795,"journal":{"name":"Yonago acta medica","volume":"69 1","pages":"119-124"},"PeriodicalIF":0.6,"publicationDate":"2026-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12910230/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146221290","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Case of Preserving the Collateral Arterial Arcade in the Head of the Pancreas in a Patient with Celiac Axis Stenosis.","authors":"Mikiya Kishino, Teruhisa Sakamoto, Shinsaku Yata, Kentaro Uehira, Jun Yoshida, Masaki Morimoto, Yuki Murakami, Naruo Tokuyasu, Yoshiyuki Fujiwara","doi":"10.33160/yam.2026.02.017","DOIUrl":"https://doi.org/10.33160/yam.2026.02.017","url":null,"abstract":"<p><p>An 80-year-old man with middle-third cholangiocarcinoma associated with celiac axis stenosis underwent pancreaticoduodenectomy. During surgery, the anterior arcade that had developed in the pancreatic head as a collateral pathway between the superior mesenteric artery and the hepatic artery was preserved as a collateral route to ensure adequate hepatic and gastric perfusion. This may be a useful option for pancreaticoduodenectomy in a patient with celiac axis stenosis.</p>","PeriodicalId":23795,"journal":{"name":"Yonago acta medica","volume":"69 1","pages":"136-138"},"PeriodicalIF":0.6,"publicationDate":"2026-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12910218/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146221346","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cultivating Empathy through Visual Thinking Strategy Workshops for Medical Students and Residents: A Mixed-Methods Study.","authors":"Daisuke Son, Minako Kamimoto, Kazuoki Inoue, Shin-Ichi Taniguchi","doi":"10.33160/yam.2026.02.013","DOIUrl":"https://doi.org/10.33160/yam.2026.02.013","url":null,"abstract":"<p><p>Visual Thinking Strategy (VTS) has been introduced in health professions education as a method for enhancing observational skills, empathy, and communication through group dialogue around artworks. This study explored how VTS workshops might cultivate empathy and related competencies among Japanese medical students and residents. Six participants (three medical students and three family medicine residents) attended eight workshops facilitated by a trained VTS instructor between November and December 2021. Sessions were held four times online and four times in person, using artworks and public sculptures as stimuli. Empathy was assessed before and after the series using the Japanese versions of the Jefferson Scale of Empathy (JSE) and the Interpersonal Reactivity Index (IRI). Participants' reflective writings were analyzed thematically. Quantitatively, mean IRI scores increased from 94.0 to 99.3 (Cohen's <i>d</i> = 0.37), and mean JSE scores increased from 109.3 to 111.7 (Cohen's <i>d</i> = 0.20). Qualitative analysis revealed six thematic categories: clinical observation, empathy/perspective-taking, communication, cultural sensitivity, tolerance for diversity, and self-awareness. These findings suggest that VTS-based workshops may enhance empathy through perspective-taking, tolerance of diverse interpretations, and reflection on one's own biases. Incorporating art-based dialogue in medical education could complement conventional communication training by promoting humanistic awareness in future physicians.</p>","PeriodicalId":23795,"journal":{"name":"Yonago acta medica","volume":"69 1","pages":"139-144"},"PeriodicalIF":0.6,"publicationDate":"2026-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12910221/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146220540","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Appropriate Use of Antibiotics for Acute Respiratory Tract Infections in a Community Hospital in Rural Japan: A Medical Record-Based Study.","authors":"Kazuoki Inoue, Daeho Park, Toshihiro Hamada, Daisuke Son, Young Lee, Shintaro Imaoka, Tsubasa Nakai, Shohei Taniguchi, Minako Kamimoto, Masahiko Koda, Shin-Ichi Taniguchi","doi":"10.33160/yam.2026.02.007","DOIUrl":"https://doi.org/10.33160/yam.2026.02.007","url":null,"abstract":"<p><strong>Background: </strong>Inappropriate antibiotic prescribing remains a global concern, as it contributes to adverse drug reactions, increased healthcare costs, and the spread of antimicrobial resistance. In Japan, several studies have investigated antibiotic prescription patterns; however, most rely solely on insurance claims data, which may not accurately reflect clinical diagnoses. This study aimed to evaluate the appropriateness of antibiotic use for acute respiratory tract infections (ARTIs) by cross-referencing disease names recorded in insurance claims with diagnoses documented in electronic medical records.</p><p><strong>Methods: </strong>We conducted a retrospective review of outpatient records from Hino Hospital, a community-based general hospital providing primary care services, between April 1, 2017, and March 31, 2018. Patients diagnosed with ARTIs were identified through claims data, and their diagnoses were confirmed using their medical records. The appropriateness of antibiotic prescriptions was assessed based on the Japanese clinical guideline, <i>Manual for Appropriate Antimicrobial Use</i>.</p><p><strong>Results: </strong>A total of 485 patients were included. The overall antibiotic prescription rate for ARTIs was 17.1%, and among those prescribed antibiotics, only 14.5% were deemed appropriate. The general medicine department had the lowest prescription rate and the highest rate of appropriate use among all departments.</p><p><strong>Conclusion: </strong>This study provides a chart-based analysis of inappropriate antibiotic use for ARTIs in Japan. To reduce inappropriate antibiotic prescriptions, multifaceted interventions and continuous evaluation will be necessary.</p>","PeriodicalId":23795,"journal":{"name":"Yonago acta medica","volume":"69 1","pages":"63-70"},"PeriodicalIF":0.6,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12910233/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146221375","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fostering Reflective Practice Through Participant Observation: Medical Students' Learning During Community-Based Clinical Training in Japan.","authors":"Minako Kamimoto, Daisuke Son, Kazuoki Inoue, Shintaro Imaoka, Tsubasa Nakai, Yuma Otsuka, Shohei Taniguchi, Shin-Ichi Taniguchi","doi":"10.33160/yam.2026.02.011","DOIUrl":"https://doi.org/10.33160/yam.2026.02.011","url":null,"abstract":"<p><strong>Background: </strong>Since 2011, the Department of Community Medicine at Tottori University has provided community-based clinical training for fourth-year medical students. However, conventional community-based training often remains observational and does not necessarily foster students' critical reflection or active questioning in clinical settings. To address this gap, ethnographic methods from medical anthropology were introduced in 2018, allowing students to engage in participant observation. After each weekly practicum session conducted at a community-based medical facility, students documented the questions that emerged and their reasoning in an electronic portfolio (ePF), receiving individual feedback from faculty.</p><p><strong>Methods: </strong>A qualitative descriptive study was conducted using text data from the 2019 ePF entries of 107 fourth-year medical students. Descriptions of participant observation were analyzed using the text-mining software KH Coder. Co-occurrence network diagrams and textual analysis were used to extract thematic categories.</p><p><strong>Results: </strong>Frequently used words included <i>\"observe,\" \"think,\" \"learn,\"</i> and <i>\"feel.\"</i> Cluster analysis revealed strong associations such as <i>\"question\"</i> with <i>\"have,\" \"university\"</i> with <i>\"community,\"</i> and <i>\"study\"</i> with <i>\"knowledge.\"</i> Students commonly formulated action plans emphasizing active observation and critical questioning for future clinical training.</p><p><strong>Conclusion: </strong>Participant observation enabled students to reflect on differences between community and university-based clinical settings. The exercise promoted the development of critical thinking and multiple perspectives, suggesting the value of incorporating anthropological methods into pre-clinical medical education.</p>","PeriodicalId":23795,"journal":{"name":"Yonago acta medica","volume":"69 1","pages":"95-104"},"PeriodicalIF":0.6,"publicationDate":"2026-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12910223/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146221012","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}