研究者詳細 - 春田　淳志

論文 - 春田　淳志

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Copper Deficiency: An Overlooked Diagnosis.

Fujikawa H, Haruta J

Cureus 15 （ 11 ） e49139 2023年11月

ISSN 2168-8184

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Precision engineered peptide targeting leukocyte extracellular traps mitigate acute kidney injury in Crush syndrome

Okubo K., Takayama K., Kawakami H., Iida K., Miyauchi H., Roppongi Y., Ikeyama H., Hayashi M., Fujishima S., Sasaki J., Haruta J., Hayashi Y., Hirahashi J.

Biochemical and Biophysical Research Communications （Biochemical and Biophysical Research Communications） 671 173 - 182 2023年09月

ISSN 0006291X

Crush syndrome induced by skeletal muscle compression causes fatal rhabdomyolysis-induced acute kidney injury (RIAKI) that requires intensive care, including hemodialysis. However, access to crucial medical supplies is highly limited while treating earthquake victims trapped under fallen buildings, lowering their chances of survival. Developing a compact, portable, and simple treatment method for RIAKI remains an important challenge. Based on our previous finding that RIAKI depends on leukocyte extracellular traps (ETs), we aimed to develop a novel medium-molecular-weight peptide to provide clinical treatment of Crush syndrome. We conducted a structure-activity relationship study to develop a new therapeutic peptide. Using human peripheral polymorphonuclear neutrophils, we identified a 12-amino acid peptide sequence (FK-12) that strongly inhibited neutrophil extracellular trap (NET) release in vitro and further modified it by alanine scanning to construct multiple peptide analogs that were screened for their NET inhibition ability. The clinical applicability and renal-protective effects of these analogs were evaluated in vivo using the rhabdomyolysis-induced AKI mouse model. One candidate drug [M10Hse(Me)], wherein the sulfur of Met10 is substituted by oxygen, exhibited excellent renal-protective effects and completely inhibited fatality in the RIAKI mouse model. Furthermore, we observed that both therapeutic and prophylactic administration of M10Hse(Me) markedly protected the renal function during the acute and chronic phases of RIAKI. In conclusion, we developed a novel medium-molecular-weight peptide that could potentially treat patients with rhabdomyolysis and protect their renal function, thereby increasing the survival rate of victims affected by Crush syndrome.

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Association between family caregivers' primary care experience when they report as patients and their stress related to caregiving: A pilot cross-sectional study

Nakayama G., Masumoto S., Haruta J., Maeno T.

Journal of General and Family Medicine （Journal of General and Family Medicine） 24 （ 4 ） 231 - 239 2023年07月

ISSN 2189-6577

Background: Few studies have examined whether family caregivers' own primary care providers can affect caregiving-specific well-being, such as caregiver stress. In this pilot study, we explored whether primary care experiences when family caregivers report as patients were associated with the stress of caregiving. Methods: We used cross-sectional data from a survey conducted in Japan between November and December 2020. We recruited family caregivers aged 40–74 years who were caring for community-dwelling adults with chronic conditions. We assessed primary care experience using the Japanese version of the Primary Care Assessment Tool Short Form (JPCAT-SF) and caregiver stress using the Japanese short version of the Zarit Caregiver Burden Interview. Results: In total, 406 family caregivers were included in the analysis. The mean JPCAT-SF total score was 42.1 out of 100 points. The proportion of caregivers who had higher caregiver stress was 48.8%. After adjusting for possible confounders, the JPCAT-SF score was found to be significantly associated with caregiver stress (lower stress = 0 vs. higher stress = 1; adjusted prevalence ratio per 1 SD increase in JPCAT-SF score = 0.89; 95% CI 0.80–0.98). Among the subscales of the JPCAT-SF, longitudinality, and comprehensiveness (services available) were associated with caregiver stress. Conclusions: Better primary care experiences when family caregivers reported as patients were associated with lower caregiver stress. Longitudinality, which includes focusing attention on the individual as a whole person, and comprehensiveness in the context of building provider-patient relationships that make consultation easier when needed, were associated with lower stress.

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Association between experience of interprofessional care and self-medication among family caregivers: A cross-sectional study

Masumoto S., Nakayama G., Haruta J., Maeno T.

Research in Social and Administrative Pharmacy （Research in Social and Administrative Pharmacy） 19 （ 5 ） 773 - 777 2023年05月

ISSN 15517411

Background: Although healthcare professionals pay attention to the drugs prescribed by physicians, few studies have assessed self-medication by family caregivers. Family caregivers' experience of interprofessional care in the care of patients can influence caregivers’ health behaviors. Objectives: This study aimed to describe self-medication among family caregivers of community-dwelling adult patients, and to assess association between family caregivers’ experience of interprofessional care and their self-medication, adjusting for possible confounding factors. Methods: We conducted a cross-sectional survey from November to December 2020 in Ibaraki Prefecture, Japan. Family caregivers between 40 and 74 years old and caring for community-dwelling adult patients with chronic conditions were recruited. The use of any self-medication in the last 2 weeks by family caregivers was the outcome variable. The explanatory variable was family caregivers' experience of interprofessional care in the care of patients, using the Japanese version of the Caregivers’ Experience Instrument (J-IEXPAC CAREGIVERS). Adjusted covariates were age, gender, educational attainment, annual household income, self-rated health, and caregiving time of family caregivers. Results: Of 1091 recruited family caregivers, 750 were included in the analysis. A total of 258 (34.4%) family caregivers reported having used self-medication in the past 2 weeks. Logistic regression analysis showed that having a higher score on the J-IEXPAC CAREGIVERS (odds ratio 0.80 per 1 standard deviation increase) was associated with less use of self-medication by caregivers. Conclusions: This study revealed that about one-third of family caregivers self-medicate, and this practice is associated with a less positive experience of interprofessional care. These results suggest that it is important for healthcare professionals to be aware of the health condition of family caregivers and to provide appropriate advice regarding self-medication.

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在宅医はどのように処方薬を評価し,どのような処方行動をとるのか?　質的帰納的研究

舛本祥一, 春田淳志

日本在宅医療連合学会誌（(一社)日本在宅医療連合学会） 4 （ 2 ） 40 - 48 2023年05月

在宅医が在宅患者の処方薬をどのような視点で評価し,どのような処方行動がなされていくのか明らかにするため,個人インタビューを用いた質的帰納的研究を実施した.在宅医療に従事する医師17名に対し,半構造化個別インタビュー調査を行い,録音データを逐語録化し,テーマ分析を行った.在宅医は,薬剤の身体的影響,患者の予後やQOL,患者・家族との関係性などを考慮しつつ,多職種とのやり取りを含めた在宅医療特有の様々な要因を考慮して,処方行動の判断を行っていることが明らかとなった.処方薬変更のプロセスの見える化,多職種間での処方行動への共通理解が進むことで,在宅医療における処方の質向上につながると期待される.(著者抄録)

2. 資質・能力に新設された総合的に患者・生活者をみる姿勢について

春田淳志, 安藤崇之, 遠藤周, 金子惇, 鋪野紀好, 長嶺由衣子, 錦織宏, 藤川裕恭, 山梨啓友

医学教育（日本医学教育学会） 54 （ 2 ） 142 - 148 2023年04月

ISSN 03869644

少子高齢化社会の背景と令和2年度からの調査を踏まえ, 患者の抱える問題を臓器横断的に捉えた上で, 心理社会的背景も踏まえた総合的な視点とアプローチの必要性が示され, 医学教育モデル・コア・カリキュラム (令和4年改訂版) に総合的に患者・生活者をみる姿勢が資質・能力に新設された. 下位目標として「全人的な視点とアプローチ」「地域の視点とアプローチ」「人生の視点とアプローチ」「社会の視点とアプローチ」が位置づけられた. 抽象と具体, 概念と経験, 自己と他者等の視点を統合し, 自己の在り方を省察できるような複数の学習理論を踏まえた教育方法が提案された. このような医学教育を通じて, 患者・生活者のウェルビーイングが向上することを期待する.

7. 方略とGood Practice (1)

松島加代子, 淺田義和, 野村理, 春田淳志, 山口久美子, 近藤猛, 錦織宏, 小西靖彦

医学教育（日本医学教育学会） 54 （ 2 ） 177 - 181 2023年04月

ISSN 03869644

令和4年改訂版医学教育モデル・コア・カリキュラム (以下, コアカリ) では, アウトカム基盤型教育において, さらなる展開として, 新たに『学修方略・評価』の章が追加された. カリキュラムの重要な要素である方略・評価の章を加え, 資質・能力に紐づけることで, 学修者や指導者にコアカリを活用していただけるよう工夫した. また, 教育現場ですぐに実践していただけるように11の方略・評価事例をGood Practiceとして紹介した. ただし, これらのGood Practiceは, 各施設での実施を必須とするものではなく, あくまで参考例として掲載している. 各大学の特徴を生かした独自の方略・評価が策定され, 本章がさらに発展していくことを期待する.

【Making of医学教育モデル・コア・カリキュラム】資質・能力に新設された総合的に患者・生活者をみる姿勢について

春田淳志, 安藤崇之, 遠藤周, 金子惇, 鋪野紀好, 長嶺由衣子, 錦織宏, 藤川裕恭, 山梨啓友

医学教育（(一社)日本医学教育学会） 54 （ 2 ） 142 - 148 2023年04月

ISSN 0386-9644

少子高齢化社会の背景と令和2年度からの調査を踏まえ,患者の抱える問題を臓器横断的に捉えた上で,心理社会的背景も踏まえた総合的な視点とアプローチの必要性が示され,医学教育モデル・コア・カリキュラム(令和4年改訂版)に総合的に患者・生活者をみる姿勢が資質・能力に新設された.下位目標として「全人的な視点とアプローチ」「地域の視点とアプローチ」「人生の視点とアプローチ」「社会の視点とアプローチ」が位置づけられた.抽象と具体,概念と経験,自己と他者等の視点を統合し,自己の在り方を省察できるような複数の学習理論を踏まえた教育方法が提案された.このような医学教育を通じて,患者・生活者のウェルビーイングが向上することを期待する.(著者抄録)

【Making of医学教育モデル・コア・カリキュラム】資質・能力に新設された総合的に患者・生活者をみる姿勢について

春田淳志, 安藤崇之, 遠藤周, 金子惇, 鋪野紀好, 長嶺由衣子, 錦織宏, 藤川裕恭, 山梨啓友

医学教育（(一社)日本医学教育学会） 54 （ 2 ） 142 - 148 2023年04月

ISSN 0386-9644

What kinds of work do Japanese primary care physicians who derive greater positive meaning from work engage in? A cross-sectional study

Yamamoto Y., Haruta J., Goto R., Maeno T.

Journal of General and Family Medicine （Journal of General and Family Medicine） 24 （ 2 ） 94 - 101 2023年03月

ISSN 2189-6577

Background: Despite the increasing need for primary care physicians (PCPs) around the world, few physicians choose it as a career. PCPs who can find meaning and enjoyment in their work can be role models for medical students and professionals, which may encourage more physicians to specialize in primary care. We aimed to compare the kinds of work that Japanese PCPs who derive greater positive meaning from work engage in versus those who derive less positive meaning from work. Methods: This was a cross-sectional study that used self-administered questionnaires to ask Japanese PCPs about their basic characteristics and engagement in and enthusiasm for various types of work. The outcomes of the Japanese version of the work as meaning inventory (J-WAMI) were also assessed. Participants were divided into high- and low-scoring groups according to the median J-WAMI score, and logistic regression analysis was performed to identify factors related to the high J-WAMI-scoring group. Results: A total of 268 out of 330 participants were included in the analysis. Males comprised 74.3%, and participants' average experience as a physician was 20.2 years. The median overall J-WAMI score was 38. Factors associated with the high J-WAMI scoring group were enthusiasm for outpatient care (OR: 1.04, 95% CI: 1.02–1.06) and engagement in research (OR: 2.74, 95% CI 1.33–5.66). Conclusions: Enthusiasm for outpatient care and engagement in research are associated with greater positive meaning of work among PCPs. Supporting these types of work may enhance PCPs' value of their work.

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Family caregivers' experience with healthcare and social care professionals and their participation in health checkups: A cross sectional study in Japan

Nakayama G., Masumoto S., Haruta J., Maeno T.

Journal of General and Family Medicine （Journal of General and Family Medicine） 24 （ 2 ） 110 - 118 2023年03月

ISSN 2189-6577

Background: For family caregivers, who are generally regarded as a vulnerable population, having regular checkups is a desirable health behavior. This study examined family caregivers' habit of having regular checkups prior to becoming involved with professionals who care for patients, and whether they had had recent checkups. We then examined the association between family caregivers' experience with professionals and their participation in checkups after adjusting for the past habit. Methods: We conducted a cross sectional survey in Japan between November and December 2020. We recruited family caregivers who were aged 40–74 years and caring for community-dwelling adult patients. The outcome variable was whether family caregivers had undergone any health checkups since April 2019. We assessed family caregivers' experience using the Japanese version of the Caregivers' Experience Instrument (J-IEXPAC CAREGIVERS). Results: Of the 1091 recruited family caregivers, 629 were included in the analysis. Of these, 358 had previously undergone regular checkups, and 158 had no checkups or selected the option “unknown.” Outcome rates in each group were 74.6% and 43.0%, respectively, and 62.0% for all 629 caregivers. Multivariate modified Poisson regression analysis revealed that among the J-IEXPAC CAREGIVERS scores, only the domain score for attention for the caregiver was significantly associated with family caregivers' participation in checkups (adjusted prevalence ratio per 1 SD increase = 1.07; 95% CI 1.01–1.14). Conclusions: Among family caregivers' experience with professionals, the factor that focused on caregivers themselves was significantly associated with their participation in checkups. This finding underscores the significance of caregiver-focused care.

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Current status of interprofessional competency among healthcare professions in Japan: A cross-sectional web-based survey

Goto R., Haruta J.

Journal of General and Family Medicine （Journal of General and Family Medicine） 24 （ 2 ） 119 - 125 2023年03月

ISSN 2189-6577

Background: Self-assessment of professionals' interprofessional competency is meaningful for benchmarking oneself and helping to identify training needs. We aimed to clarify differences in self-assessment of interprofessional competency in Japan by profession and type of facility. Methods: We conducted a cross-sectional study using a web survey among primary healthcare providers in Japan, especially members of the Japan Primary Care Association, between June and October 2020. After sampling using the e-mail list, we used an exponential nondiscriminative snowball method as purposive sampling through key professional informants between November 2020 and February 2021. The questionnaire covered items including participant demographics (age, gender, years of experience as professionals, years of experience working at the current institution, attendance type (regular or part-time work), administrative experience, profession, and facility type) and included the Japanese version of the Self-assessment Scale of Interprofessional Competency (JASSIC). Differences between healthcare professions (physician, nurse, pharmacist, rehabilitation therapist, and social worker) and between types of facility (university hospital, medium-sized hospital, small hospital, and clinics) were compared using the Kruskal–Wallis test. Results: A total of 593 people responded to the survey. Their mean age was 41.2 ± 11.3 years, and 312 (52.6%) were female. JASSIC scores of physicians and social workers were significantly higher than those of rehabilitation therapists (p < 0.01). Concerning facilities, professionals working in clinics rated themselves higher than those in medium-sized hospitals (p < 0.01). Conclusions: We revealed that self-assessment of interprofessional competency in Japan varied by profession and type of facility.

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<活動報告> プライマリ・ケアの現場で医療従事者は新型コロナウイルス感染症（COVID-19）に対してどのような経験をしたのか？ : 2020年前半についての報告

木村, 周平, 飯田, 淳子, 小曽根, 早知子, 後藤, 亮平, 照山, 絢子, 金子, 惇, 濵, 雄亮, 堀口, 佐知子, 宮地, 純一郎, 春田, 淳志

歴史人類（筑波大学大学院人文社会ビジネス科学学術院人文社会科学研究群人文学学位プログラム歴史・人類学サブプログラム） 51 45 - 90 2023年02月

ISSN 0385-4795

Association Between Varicella-Zoster Virus Vaccination and Patient Experience in Elderly Japanese Outpatients: A Case-Control Study

Inaba T., Haruta J., Goto R., Maeno T.

Journal of Primary Care and Community Health （Journal of Primary Care and Community Health） 14 21501319231192760 2023年01月

ISSN 21501319

Background: This study examined the association between patient experience (PX, events experienced by patients during primary care that are an indicator of patient-centered quality) of primary care and varicella-zoster virus (VZV) vaccine uptake in older adults. Methods: A case-control study of VZV vaccination was conducted at a community hospital in Ibaraki, Japan. Patients aged 65 years or older who had continuously been patients of the hospital between April 2018 and April 2021 were included in the study. The vaccinated group consisted of 166 VZV-vaccinated patients. The controls consisted of 29 age- and sex-matched patients who did not receive VZV vaccination. A self-administered questionnaire was distributed between August and September 2021. It included the Japanese version of the Primary Care Assessment Tool Short Form (JPCAT-SF) to evaluate PX and included questions about recommendations for VZV vaccination by a physician and the vaccination history of relatives. Multivariable and intermediate factor analyses were used to assess whether there was an association between VZV vaccination and PX. Results: Questionnaires were sent to 457 subjects. Responses from 228 (116 in the vaccination group and 112 in the non-vaccinated group) were included in the analysis. Multivariable analysis, which excluded physician recommendation for VZV vaccination as a variable because it was an intermediate factor in the analysis, showed an association between PX and VZV vaccination (odds ratio, 1.38; 95% confidence interval, 1.00-1.92; P =.049). Conclusions: PX was associated with past VZV vaccination. Physician recommendation for VZV vaccination was an intermediate factor between PX and VZV vaccination.

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日本のプライマリ・ケア医のコロナワクチン接種の実践についての文化人類学的考察——スケーラビリティとノンスケーラビリティのはざまで

木村木村周平，堀口堀口佐知子，後藤後藤亮平，飯田飯田淳子， ...

F1000Research 11, 1268 2023年

在宅医はどのように処方薬を評価し，どのような処方行動をとるのか？～質的帰納的研究～

舛本祥一, 春田淳志

日本在宅医療連合学会誌（一般社団法人日本在宅医療連合学会） 4 （ 2 ） 40 - 48 2023年

在宅医が在宅患者の処方薬をどのような視点で評価し，どのような処方行動がなされていくのか明らかにするため，個人インタビューを用いた質的帰納的研究を実施した．在宅医療に従事する医師 17 名に対し，半構造化個別インタビュー調査を行い，録音データを逐語録化し，テーマ分析を行った．在宅医は，薬剤の身体的影響，患者の予後や QOL，患者・家族との関係性などを考慮しつつ，多職種とのやり取りを含めた在宅医療特有の様々な要因を考慮して，処方行動の判断を行っていることが明らかとなった．処方薬変更のプロセスの見える化，多職種間での処方行動への共通理解が進むことで，在宅医療における処方の質向上につながると期待される．

What kinds of work do Japanese primary care physicians who derive greater positive meaning from work engage in? A cross‐sectional study

Y Yamamoto, J Haruta, R Goto, T Maeno

Journal of General and Family Medicine 24 (2), 94-101 2023年

Has novel coronavirus infection affected the professional identity recognised by medical students?-A historical cohort study

Haruta J., Takayashiki A., Goto R., Maeno T., Ozone S., Maeno T.

Asia Pacific Scholar （Asia Pacific Scholar） 8 （ 1 ） 3 - 12 2023年

ISSN 24249335

Introduction: The pandemic caused by the novel coronavirus (COVID-19) has produced dramatic changes in the learning environment for clinical practice in medical education, and the impact on medical students has been significant. However, few program evaluation studies involving professional identity, now emphasised in medical education, have compared current with pre-COVID-19 programs. Here, we compared the professional identity recognised by medical students in the years before and during COVID-19. Methods: Medical students who participated in clinical practice were evaluated using the Japanese version of the Professional Self-Identity Questionnaire (PSIQ), a 9-item inventory rated using 7-point Likert scales. They answered on the first day of a 4-week clinical practice module within a community-based medical education (CBME) program and at graduation in 2018-2019 (pre-COVID-19 pandemic) and in 2019-2020 (during-COVID-19 pandemic). We compared the mean difference in total PSIQ score of the 2019-2020 students to those of the 2018-2019 students as a historical cohort using an unpaired t-test. Results: Participants were 104 medical students in the 2018-2019 academic year and 92 in the 2019-2020 academic year. PSIQ was increased at graduation. Mean difference in total PSIQ score was statistically higher for the 2019-2020 students (13.5 ± 9.4) than for the 2018-2019 students (10.3 ± 8.1) (t =2.6, df =195, p = 0.01). Conclusion: Although clinical practice was restricted by COVID-19, this had some positive impact on the strengthening of professional identity recognised by medical students. This finding may have been influenced by the imprinting of professional norms and changes in society.

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Factors associated with interprofessional competencies among healthcare professionals in Japan

Haruta J., Goto R.

Journal of Interprofessional Care （Journal of Interprofessional Care） 37 （ 3 ） 473 - 479 2023年

ISSN 13561820

We aimed to explore factors associated with interprofessional competencies among healthcare professionals in Japan. From June to October 2020, we conducted a cross-sectional survey via a validated self-administered web-based questionnaire using the Japanese version of the Self-assessment Scale of Interprofessional Competency (JASSIC). We recruited participants from an e-mail list. The questionnaire asked about JASSIC, basic demographic information, whether they had undertaken pre- and post-licensure interprofessional education (IPE), and administrative experience; as well as an organizational climate scale, including “Plan, Do, See” factor for management (PDS factor), and the “Do” factor in a leader-centered direction for people who work unwillingly. Factors associated with the total JASSIC score as interprofessional competencies were determined using multiple regression analysis. We analyzed data from 560 participants with an average age of 41.0 years, comprising 132 nurses, 127 doctors, and 120 social workers. The median of the total JASSIC score was 72/90 (range: 66–78). On multiple regression analysis, total JASSIC score was significantly associated with age, PDS factor, administrative experience, pre-licensure IPE, and pos-licensure IPE. These findings emphasize the importance of pre- and post-licensure IPE, and administrative experience for improving interprofessional competencies in Japan.

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Current status of interprofessional competency among healthcare professions in Japan: A cross‐sectional web‐based survey

R Goto, J Haruta

Journal of General and Family Medicine 24 (2), 119-125 2023年

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