JMA journal最新文献

{"title":"Regional Barriers to Advancing Genetic Medicine in Japan: Insights from a Shizuoka Prefecture Survey.","authors":"Kou Sueoka, Yuki Mizuguchi, Yasue Horiuchi, Takeshi Usui, Osamu Mochizuki, Hidehiko Miyake, Yuichi Goto","doi":"10.31662/jmaj.2025-0240","DOIUrl":"https://doi.org/10.31662/jmaj.2025-0240","url":null,"abstract":"<p><strong>Introduction: </strong>The expansion of genetic medicine in Japan has created an urgent need for regionally-adaptable systems to ensure equitable implementation. This study examines challenges in developing a sustainable framework for regional genetic medicine, using Shizuoka Prefecture-a non-metropolitan area with average socioeconomic indicators-as a case model.</p><p><strong>Methods: </strong>A two-phase survey was conducted between December 2023 and January 2024. The first phase involved a questionnaire sent to 44 major medical institutions and all board-certified clinical genetics specialists in the prefecture. In the second phase, 20 of the responding institutions completed a more detailed follow-up survey. The surveys assessed human resource capacity, institutional collaboration, and the adoption of digital infrastructure.</p><p><strong>Results: </strong>The results revealed critical shortages in clinical geneticists, certified genetic counselors, and genetic nursing specialists. Inter-institutional collaboration was limited, with few systems in place for data sharing or regional coordination. Digital tools, such as remote consultation systems and information platforms, were underutilized. Respondents identified the need for shared infrastructure, better communication among institutions, and flexible strategies to address geographic and systemic barriers.</p><p><strong>Conclusions: </strong>This study highlights the urgent need for network-based infrastructure and a specialized workforce to support the expansion of genetic medicine in regional settings. The findings from Shizuoka are likely reflective of broader national challenges and underscore the importance of policy and system-level interventions to promote equitable access to genetic healthcare across Japan.</p>","PeriodicalId":73550,"journal":{"name":"JMA journal","volume":"9 2","pages":"525-534"},"PeriodicalIF":1.8,"publicationDate":"2026-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13058675/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147647649","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Urgent Rectus Sheath Hematoma Induced by Severe Coughing.","authors":"Kazuhiko Iwasaki, Satoshi Watanabe, Seiji Yano","doi":"10.31662/jmaj.2025-0229","DOIUrl":"https://doi.org/10.31662/jmaj.2025-0229","url":null,"abstract":"<p><p>Rectus sheath hematoma (RSH) is an uncommon but clinically significant cause of acute abdominal pain, most often associated with anticoagulant therapy, abdominal trauma, or prior surgery. Although coughing is a recognized but rare etiology, cases without anticoagulant exposure are unusual. We report the case of a 57-year-old man with hypertension who presented with acute right abdominal pain after 1 week of persistent cough. Physical examination revealed abdominal wall discoloration, a firm mass, and a positive Carnett sign, suggesting an abdominal wall origin of pain. Laboratory evaluation showed leukocytosis and elevated inflammatory markers, and computed tomography demonstrated bronchopneumonia and multiple hematomas within the right rectus abdominis muscle. The hematomas showed high attenuation, measuring 50-75 Hounsfield units, consistent with acute hematoma. Despite initial hemodynamic stability, the patient rapidly deteriorated with tachycardia and hypotension, necessitating emergency hematoma evacuation. After intensive care and rehabilitation, he was discharged in good condition. This case highlights that cough-induced RSH, although rare, can progress rapidly to hemodynamic instability. Physicians should consider RSH in the differential diagnosis of abdominal pain with abdominal wall discoloration following coughing episodes, even in the absence of traditional risk factors, as timely recognition and intervention are essential to prevent morbidity and mortality.</p>","PeriodicalId":73550,"journal":{"name":"JMA journal","volume":"9 2","pages":"574-577"},"PeriodicalIF":1.8,"publicationDate":"2026-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13058746/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147647693","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rethinking Local Cancer Overscreening in Japan: A Path toward Organized Screening.","authors":"Masanari Minamitani","doi":"10.31662/jmaj.2025-0392","DOIUrl":"https://doi.org/10.31662/jmaj.2025-0392","url":null,"abstract":"<p><p>Japan's cancer screening programs have expanded widely in recent decades, with local governments and workplaces offering screenings beyond national recommendations. Although this flexibility has improved access to screening, it has also contributed to overscreening and the practice of conducting tests beyond evidence-based age ranges, intervals, and methods. The underlying principles of organized screening, which emphasize evidence-based methods and quality assurance, have often been overshadowed by administrative and institutional momentum rather than by deliberate, evidence-based planning. In 2024, Miyazaki City initiated a comprehensive review of its cancer screening system under the new medical leadership. The process identified several deviations from national guidelines in target populations and screening methods, leading to a reform policy that discontinued non-evidence-based tests, such as the ABC method (a combination of serum pepsinogen and Helicobacter pylori antibody testing) for gastric cancer, breast ultrasound, and prostate-specific antigen testing. Although implementation is ongoing, this initiative demonstrates how municipalities can begin realigning screening practices with scientific standards. The Japanese case, exemplified by Miyazaki City's initiative, highlights the importance of local leadership and an organizational understanding of the principles of organized screening. Reforming overscreening requires sustained collaboration between policymakers, healthcare providers, and citizens to balance accessibility with evidence-based practices.</p>","PeriodicalId":73550,"journal":{"name":"JMA journal","volume":"9 2","pages":"556-559"},"PeriodicalIF":1.8,"publicationDate":"2026-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13058703/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147647609","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Student Engagement from the Medical Trainees' Perspective and Associated Factors: A Nationwide Cross-Sectional Study.","authors":"Hirohisa Fujikawa, Hidetaka Tamune, Yuji Nishizaki, Hirotake Mori, Sho Fukui, Kiyoshi Shikino, Taro Shimizu, Yu Yamamoto, Hiroyuki Kobayashi, Toshio Naito, Yasuharu Tokuda","doi":"10.31662/jmaj.2025-0448","DOIUrl":"https://doi.org/10.31662/jmaj.2025-0448","url":null,"abstract":"<p><strong>Introduction: </strong>Despite mounting recognition of the importance of student engagement in curriculum development, the current status of student engagement from medical trainees' perspectives has yet to be elucidated. Particularly in Japan, where the educational system places strong emphasis on teacher authority, it is possible that medical student engagement is not promoted as effectively as it could be, and that engagement is not fully perceived by medical students. Thus, we aimed to elucidate the current status of student engagement in curriculum development from the perspective of medical trainees, and to explore factors associated with medical trainees' perceptions of student engagement.</p><p><strong>Methods: </strong>We performed a nationwide cross-sectional study in Japan from April to May 2025. Participants were newly entered medical residents who took the General Medicine In-Training Examination postgraduate \"Year-0.\" They completed an anonymous online self-administered questionnaire. We analyzed the closed-ended questions using descriptive statistics and linear mixed-effects models, and applied inductive content analysis to the open-ended questions.</p><p><strong>Results: </strong>Of 748 examinees, 428 (57.2%) were included in the analysis. A total of 105 (24.5%) did not perceive that there were student engagement initiatives at their medical school. Only 38 (8.9%) reported participation. The trainees' overall perceptions of how well their opinions were reflected in the medical curriculum were moderate, with a mean score of 5.41 out of 10. This result was supported by the content analysis findings, which identified four themes, including \"desire to see more of medical students' opinions reflected\" and \"disappointment that medical students' opinions are not reflected.\" Multilevel analysis demonstrated that females had significantly more favorable perceptions than males.</p><p><strong>Conclusions: </strong>Our findings indicated that awareness, implementation, and perceived value of student engagement remain limited from the perspectives of medical trainees in Japan. Medical educators should implement structural and cultural reforms and develop effective strategies tailored to diverse institutional environments.</p>","PeriodicalId":73550,"journal":{"name":"JMA journal","volume":"9 2","pages":"486-494"},"PeriodicalIF":1.8,"publicationDate":"2026-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13061581/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147647612","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding the Unfamiliar: An Interpretative Phenomenological Analysis of Pediatric Residents' Learning about Children with Severe Motor and Intellectual Disabilities.","authors":"Manami Mizumoto, Junki Mizumoto, Hiroyuki Wakamoto, Mariko Eguchi","doi":"10.31662/jmaj.2025-0504","DOIUrl":"https://doi.org/10.31662/jmaj.2025-0504","url":null,"abstract":"<p><strong>Introduction: </strong>Children with severe motor and intellectual disabilities (SMIDs) require complex care involving both technical skill and emotional presence. Pediatric residents often lack meaningful exposure to such patients, and little is known about how they make sense of these learning experiences.</p><p><strong>Methods: </strong>We conducted a qualitative study using an interpretative phenomenological analysis to explore how pediatric residents experienced a three-month rotation at a facility for children with SMID in Japan. Four residents were interviewed twice during their rotations. Interviews were transcribed verbatim and analyzed through iterative coding and thematic development.</p><p><strong>Results: </strong>Three main themes emerged: (1) bewilderment at the unfamiliar and its overcoming, (2) confrontation with complex, ambiguous, and unstable medical conditions, and (3) psychological barriers to communication and their resolution. Initially, residents felt discomfort and emotional distance owing to unfamiliar devices, patients who were non-verbal, and the ambiguity of symptoms. However, through repeated contact, observational learning, and active participation in daily care, residents gradually developed intuitive judgment, comfort with uncertainty, and emotional connection. These experiences shifted their perceptions of children with SMID from passive and unknowable to responsive and relational. Residents also began to reconceptualize their role-not merely as problem-solvers but as care companions who tolerate ambiguity and foster connection.</p><p><strong>Conclusions: </strong>Pediatric residents initially struggled with unfamiliarity and uncertainty in caring for children with SMID. However, sustained exposure and interprofessional learning fostered emotional growth, intuitive competence, and epistemic humility. Training programs should provide longitudinal, hands-on experiences with patients with SMID and support reflective learning to cultivate more compassionate and capable pediatricians.</p>","PeriodicalId":73550,"journal":{"name":"JMA journal","volume":"9 2","pages":"547-555"},"PeriodicalIF":1.8,"publicationDate":"2026-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13058700/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147647633","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Massive Vaginal Hemorrhage after Cesarean Delivery: A Newly Recognized Mechanism of Postpartum Hemorrhage due to Lateral Uterine Artery Injury.","authors":"Yutaka Iwagoi, Munekage Yamaguchi, Kana Hirao, Jun Sakata, Yasuhiro Yamamoto, Akihito Sagara, Saori Yoshimura, Fumitaka Saito, Takeshi Motohara, Eiji Kondoh","doi":"10.31662/jmaj.2025-0531","DOIUrl":"https://doi.org/10.31662/jmaj.2025-0531","url":null,"abstract":"","PeriodicalId":73550,"journal":{"name":"JMA journal","volume":"9 2","pages":"571-573"},"PeriodicalIF":1.8,"publicationDate":"2026-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13058709/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147647608","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Oral Squamous Cell Carcinoma Incidence in Japan Based on National Cancer Registry Data 2016-2019.","authors":"Shihoko Koyama, Toshitaka Morishima, Kayo Nakata, Nao Nishimura, Miki Ishibashi, Isao Miyashiro","doi":"10.31662/jmaj.2025-0409","DOIUrl":"https://doi.org/10.31662/jmaj.2025-0409","url":null,"abstract":"<p><strong>Introduction: </strong>No comprehensive national profiles of oral squamous cell carcinoma (OSCC) have been established in Japan. We set out to describe the profiles of OSCC cases, including demographic characteristics, regional disparities, and survival time on a national basis, using a population-based dataset in Japan.</p><p><strong>Methods: </strong>Using the national cancer registry (NCR) of Japan, we aggregated data on cases of OSCC from 2016 to 2019 that were classified according to the diagnostic criteria specified in the Japanese oral cancer guidelines. We calculated annual, detailed site-specific distributions by sex and age-standardized incidence rates for each year. The standardized incidence ratios by prefecture were computed using 2016 to 2019 data. One-year overall survival was estimated using the Kaplan-Meier method. Univariate and multivariate analyses were conducted using the Cox proportional hazards model.</p><p><strong>Results: </strong>Between 2016 and 2019, data were obtained on 30,537 OSCC incidence cases. In the most recent year, 2019, 57.0% of patients were men, and the mean age was 70.3 years. Among the specific OSCC sites, the tongue was the most common, accounting for more than half the cases. Over half the cancers were localized at the time of diagnosis. The age-standardized incidence rate in 2019 was 5.12 per 100,000 population. The standardized incidence ratios of OSCC among different prefectures ranged from 0.77 (Gifu Prefecture) to 1.37 (Miyagi Prefecture). The one-year survival rate for all OSCC cases diagnosed between 2016 and 2019 was 83.5%. Cox proportional hazards model analysis, adjusted for all covariates, revealed that women had a significantly lower risk of death within one year than men (hazard ratio = 0.81, 95% confidence interval = 0.76-0.87).</p><p><strong>Conclusions: </strong>Our study provides an overview of OSCC epidemiology in Japan using the NCR population-based dataset.</p>","PeriodicalId":73550,"journal":{"name":"JMA journal","volume":"9 2","pages":"467-475"},"PeriodicalIF":1.8,"publicationDate":"2026-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13058742/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147647620","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Latent Class Analysis of Suicide Methods and Associated Background Characteristics: A Forensic Epidemiological Study in Osaka.","authors":"Ryu Murakami, Daigo Morioka, Kenko Fukui, Atsushi Hiraide, Hisanaga Kuroki","doi":"10.31662/jmaj.2025-0376","DOIUrl":"https://doi.org/10.31662/jmaj.2025-0376","url":null,"abstract":"<p><strong>Introduction: </strong>Suicide remains a major public health issue in Japan, where the suicide mortality rate is high across all age groups. While existing national statistics provide limited insight into the individual backgrounds of those who die by suicide, detailed forensic data offer an opportunity to explore the characteristics associated with different methods of suicide.</p><p><strong>Methods: </strong>We conducted a retrospective study using anonymized data extracted from police documents submitted to the Osaka Medical Examiner's Office for medicolegal investigation. Among 1,129 individuals who died by suicide in 2017 and 2019, 669 cases with complete data were analyzed. Latent class analysis (LCA) was used to classify individuals based on variables, including suicide method, age group, sex, occupation, psychiatric consultation history, suicide attempt history, and living arrangement.</p><p><strong>Results: </strong>Latent class analysis identified three distinct classes. Class 1 (38.1%) consisted mainly of middle-aged unemployed females with a history of psychiatric consultation, living with others, and frequently jumping from heights. Class 2 (35.1%) was characterized by elderly unemployed males with no history of psychiatric consultation and no suicide attempt history, predominantly using hanging. Class 3 (26.8%) comprised younger employed males with no history of psychiatric consultation and no suicide attempt history, also showing a high proportion of hanging and jumping from heights, and poisoning.</p><p><strong>Conclusions: </strong>The use of LCA revealed distinct subgroups of suicide deaths characterized by background factors and method choice. These findings may aid in identifying vulnerable populations and inform the development of targeted suicide prevention strategies in Japan. More broadly, our results highlight the value of combining medicolegal information with data-driven classification methods to better understand suicide in other settings.</p>","PeriodicalId":73550,"journal":{"name":"JMA journal","volume":"9 2","pages":"476-485"},"PeriodicalIF":1.8,"publicationDate":"2026-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13058713/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147647663","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anxiety and Well-Being: A Factorial and Regression Analysis of Life Satisfaction Determinants in a Japanese Population.","authors":"Haruka Ishii, Yoko Ishii","doi":"10.31662/jmaj.2025-0383","DOIUrl":"https://doi.org/10.31662/jmaj.2025-0383","url":null,"abstract":"","PeriodicalId":73550,"journal":{"name":"JMA journal","volume":"9 2","pages":"563-570"},"PeriodicalIF":1.8,"publicationDate":"2026-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13058695/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147647455","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From Isolation to Inclusion: Circus Performances as Social Catalysts for Children with Medical Complexities.","authors":"Emiko Karakawa, Yudai Kaneda, Akihiko Ozaki, Makoto Kosaka, Hiroyuki Beniya","doi":"10.31662/jmaj.2025-0276","DOIUrl":"https://doi.org/10.31662/jmaj.2025-0276","url":null,"abstract":"<p><p>Recent advances in medical care have increased the number of children with medical complexity (CMC) requiring daily support, yet their opportunities for social participation remain limited. We involved a 6-year-old CMC in circus performances held in three Japanese cities. Despite medical challenges, the child safely participated and experienced psychological growth through nervousness, ambition, and communication. This initiative required close interdisciplinary collaboration and highlighted the importance of trust between families and healthcare providers. Our experience illustrates how creative, community-based efforts can reduce barriers and promote inclusion for CMCs, contributing to a more equitable and supportive society.</p>","PeriodicalId":73550,"journal":{"name":"JMA journal","volume":"9 2","pages":"560-562"},"PeriodicalIF":1.8,"publicationDate":"2026-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13058702/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147647573","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}