論文 - 春田　淳志

学会和文誌新編集長からの挨拶

春田 淳志

日本プライマリ・ケア連合学会誌 （一般社団法人 日本プライマリ・ケア連合学会）  45 （ 4 ） 107 - 107 2022年12月

ISSN  21852928

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What role expectations do primary care physicians hold for physical therapists regarding primary care?

Goto R, Haruta J, Ozone S

Journal of Primary Care & Community Health 2022年11月

研究論文（学術雑誌）, 共著, 査読有り

Design, Synthesis, and Monoamine Oxidase B Selective Inhibitory Activity of N-Arylated Heliamine Analogues.

Yamada M, Hirose Y, Lin B, Fumimoto M, Nunomura K, Natchanun S, Takahashi N, Ohki Y, Sako M, Murai K, Harada K, Arai M, Suzuki S, Nakamura T, Haruta J, Arisawa M

ACS medicinal chemistry letters 13 （ 10 ） 1582 - 1590 2022年10月

ISSN  1948-5875

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Analyzing annual changes in network structures of a social media application-based information-sharing system in a Japanese community

Haruta J., Tsugawa S., Ogura K.

BMC health services research （BMC health services research）  22 （ 1107 ） 1107 - 1107 2022年08月

研究論文（学術雑誌）, 共著, 筆頭著者, 査読有り

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BACKGROUND: Understanding the evolution of social network services (SNSs) can provide insights into the functions of interprofessional information-sharing systems. Using social network analysis, we aimed to analyze annual changes in the network structure of SNS-based information sharing among healthcare professionals over a 3-year period in Japan. METHODS: We analyzed data on SNS-based information sharing networks with online message boards for healthcare professionals for 2018, 2019, and 2020 in a Japanese community. These networks were created for each patient so that healthcare professionals could post and view messages on the web platform. In the social network analysis (SNA), healthcare professionals registered with a patient group were represented as nodes, and message posting and viewing relationships were represented as links. We investigated the structural characteristics of the networks using several measures for SNA, including reciprocity, assortativity and betweenness centrality, which reflect interrelational links, the prevalence of similar nodes with neighbors, and the mediating roles of other nodes, respectively. Next, to compare year-to-year trends in networks of patients overall, and between receiving nursing care levels 1-3 (lighter care requirement) and levels 4-5 (heavier care requirement), we described the annual structural differences and analyzed each measure for SNA using the Steel-Dwass test. RESULTS: Among 844, 940, and 1063 groups in each year, groups for analysis in care levels 1-3/4-5 were identified as 106/135, 79/89, and 57/57, respectively. The overall annual assessment showed a trend toward increased diameter and decreased density, but the differences were not significant. For those requiring care levels 1-3, assortativity decreased significantly, while for those requiring care levels 4-5, reciprocity decreased and betweenness centrality increased significantly. No significant differences were found in the other items. DISCUSSION: This study revealed that the network of patients with a lighter care requirement had more connections consisting of nodes with different links, whereas the network of patients with a heavier care requirement had more fixed intermediary roles and weaker interrelationships among healthcare professionals. Clarifying interprofessional collaborative mechanisms underlying development patterns among healthcare professionals can contribute to future clinical quality improvement.

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Factors associated with interprofessional competencies among healthcare professionals in Japan. Journal of Interprofessional Care

Haruta J, Goto R

Journal of Interprofessional Care    1 - 7 2022年07月

研究論文（学術雑誌）, 共著, 筆頭著者, 査読有り

Verification of a Sense of Community Scale for Hospitals in Japan

Goto R., Haruta J., Ozone S.

Journal of Primary Care and Community Health （Journal of Primary Care and Community Health）  13   21501319221107317 - 21501319221107317 2022年06月

研究論文（学術雑誌）, 共著, 査読有り,  ISSN  21501319

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Introduction/Objectives: We aimed to verify whether a sense of community scale developed for hospital wards can be applied to hospitals. Methods: A cross-sectional study was conducted using a self-administered questionnaire between July and October 2018 in 3 hospitals in Japan. The subjects were staff members working in these hospitals who provide direct medical or administrative services to patients and their families. The questionnaire inquired about the participants’ basic attributes and workplace satisfaction, and included the sense of community scale and the Japanese version of the Assessment of Interprofessional Team Collaboration Scale-II. We evaluated the scale’s structural validity, internal consistency, and hypothesis testing for construct validity. Results: Of 826 eligible staff members, 539 were included in the analysis. Mean age was 40.4 years and 77.4% were female. Exploratory factor analysis showed that 24 of the 28 items in the sense of community scale could be categorized under 3 factors. Confirmatory factor analysis demonstrated a goodness of fit index of 0.794, adjusted goodness of fit index of 0.752, comparative fit index of 0.885 and root mean square error of approximation of 0.092. Cronbach’s α for score in the sense of community scale was high (.96). Participants who reported high workplace satisfaction had significantly higher scores in the sense of community scale than those who indicated low workplace satisfaction (P <.001). Conclusions: We verified the reliability and validity of the Japanese version of the sense of community scale, which was originally developed for hospital wards, for the community in hospitals. With further verification, we hope the scale will be useful for evaluating the sense of community in hospitals.

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How do medical students learn about SDH in the community? A qualitative study with a realist approach.

Haruta J, Takayashiki A, Ozone S, Maeno T, Maeno T

Medical teacher （Medical Teacher）  44 （ 10 ） 1 - 8 2022年05月

ISSN  0142-159X

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Introduction: The need to learn social determinants of health (SDH) is increasing in disparate societies, but educational interventions are complex and learning mechanisms are unclear. Therefore, this study used a realist approach to identify SDH learning patterns, namely context (C), mechanism (M), and outcomes (O) in communities. Methods: A 4-week clinical practice program was conducted for 5th- and 6th-year medical students in Japan. The program included SDH lectures and group activities to explore cases linked to SDH in the community. The medical students' structural reflection reports for learning SDH were thematically analyzed through CMO perspectives. Results: First, medical students anticipated the concept of SDH and participated in a community in which a social model was central. They then transformed their perspective through observational learning and explanations from role models. Second, medical students’ confrontation of contradictions in the medical model triggered integrated explanations of solid facts. Third, conceptual understanding of SDH was deepened through comparison and verbalization of concrete experiences in multiple regions. Fourth, empathy for lay people was fostered by participating from a non-authoritative position, which differed from that in medical settings. Conclusion: Medical students can learn about the connections between society and medicine through four types of SDH learning patterns.

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特集 ジェネラリストの羅針盤-医学部では教わらなかった28のクエスチョン 知りたい!　仕事とキャリアの話 多職種とどうタスクシェア・シフトすればいいの?

春田 淳志

medicina （株式会社医学書院）  59 （ 6 ） 904 - 911 2022年05月

ISSN  0025-7699

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総合診療医が守るもの

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

文化人類学 （日本文化人類学会）  86 （ 4 ） 674 - 685 2022年03月

ISSN  13490648

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<p>Since early 2020, the COVID-19 pandemic has been a pervasive global issue eliciting various responses at the local level. Drawing upon anthropologist Yanai Tadashi's concept “body social,” this article aims to discuss what Japanese general practitioners have attempted to protect from the uncontrollable “waves” of the pandemic. Based on the vivid narratives about their shifting patterns of responses from July 2020（the beginning of the so-called “second wave”） to February 2021（the end of the “third wave”）, it elucidates how the general practitioners' imaginings of the “body social” to be protected were flexibly transformed according to their perceptions of the pandemic situations in their immediate surroundings, from their physical bodies to their medical institutions, to their <i>chiiki</i> （communities）．Their engagements in expanding cooperation with other medical and non-medical actors to protect their <i>chiiki</i> as “body social” pose valuable lessons for anthropologists of infectious diseases and disasters beyond the realm of medicine.</p>

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総合診療医が守るもの─COVID-19への対応と社会身体

3． 木村周平; 飯田淳子; 照山絢子; 堀口佐知子; 宮地純一郎; 濱雄亮; 春田淳志; 小曽根 早知子; 金子惇; 後藤亮平

文化人類学 88 （ 4 ） 674 2022年03月

研究論文（学術雑誌）, 共著, 査読有り

訪問看護サービス利用の有無と，家族介護者からみた多職種によるケアの質評価との関連

中山元、舛本祥一、春田淳志、前野哲博

日本老年医学界雑誌 （(一社)日本老年医学会）  59 （ 2 ） 209 - 218 2022年02月

研究論文（学術雑誌）, 共著, 査読有り,  ISSN  0300-9173

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目的:家族介護者からみた医療介護福祉職らによるケアのプロセス評価に,訪問看護サービス利用の有無という違いが影響するかを検討するために,両者の関連性について横断的に検証した.方法:対象者はA県3自治体で介護認定を受けて1年以上になり,慢性症状を抱え在宅療養している人を介護する40～74歳の家族介護者で,2020年11～12月に介護支援専門員を通じて質問票を配布した.アウトカムは,慢性症状を抱える人とその家族介護者に対する多職種ケアのプロセスを,家族介護者が定量的に評価する日本語版IEXPAC CAREGIVERS(以下,当尺度)の総合得点と各下位尺度得点とした.当尺度は評価対象を多職種とし,家族介護者が多職種とかかわるなかで経験した具体的事象を量的に測定する.下位尺度は「患者に焦点」と「介護者に焦点」である.要因を訪問看護の利用の有無,共変量を家族介護者の社会経済的要因や訪問診療の有無等とした.当尺度得点を中央値で2群化し,2項ロジスティック回帰分析で解析した.結果:解析対象者は566人で,家族介護者の年齢中央値62歳,女性73.3%であった.訪問看護サービスの利用があったのは86ケース(15.2%)であった.ロジスティック回帰分析の結果,訪問看護サービス利用の有無(なし=参照)と当尺度の総合得点の高低(低群=0,高群=1)とは有意に関連した(オッズ比3.02;95%信頼区間1.54～5.91).各下位尺度得点では,「患者に焦点」では有意差を認めた一方,「介護者に焦点」では有意差を認めなかった.結論:訪問看護サービスが導入された家族介護者は,導入していない家族介護者と比べて当尺度の総合得点ならびに下位尺度の「患者に焦点」得点が有意に高かった.この結果は,訪問看護師が在宅療養する患者のケアにかかわる多職種協働の中核として,その役割期待に応えている可能性を示唆した.(著者抄録)

Disparities in co-payments for influenza vaccine among the elderly, during the COVID-19 pandemic in Japan

Ando T., Maruyama T., Tamai A., Murakami T., Kido Y., Ishida T., Taya H., Haruta J., Sugiyama D., Fujishima S.

Journal of Infection and Chemotherapy （Journal of Infection and Chemotherapy）  28 （ 7 ） 896 - 901 2022年

ISSN  1341321X

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Introduction: Seasonal influenza vaccination for the elderly is highly recommended during the COVID-19 pandemic. In Japan, the amount of subsidy for influenza differs among municipalities. Thus, we investigated the amount of and variation in subsidy for influenza vaccination for the elderly in 2020. Methods: This was an ecological study of 1,922 municipalities in Japan. The amount of subsidy for influenza vaccines for the elderly in each municipality was surveyed through websites or via telephone. Geographic and financial data for municipalities and prefectures were obtained from the open data. The amount of co-payment for the influenza vaccine and the geographical and financial status of each municipality were compared, according to the aging rate. Univariate logistic regression analysis was performed to explore factors related to the free influenza vaccine. Results: Municipalities with higher aging rates tended to have higher median co-payments for vaccines in 2020. (0 yen vs 1000 yen, p < 0.001) In addition, they tended to have worse financial conditions and lower per capita incomes. A similar trend was observed in the analysis by prefecture, i.e., a higher influenza mortality rate in prefectures with a higher aging rate. Despite having lower incomes, municipalities and prefectures with higher aging populations had higher mortality rates from influenza and higher co-payments for influenza vaccination. Conclusions: In Japan, there is a disparity among elderly people; areas with an aging population have higher co-payments for influenza vaccines despite lower incomes, suggesting that the government needs to implement corrective measures to reduce this disparity.

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Factors associated with self-medication among family caregivers: A cross-sectional study

S Masumoto, G Nakayama, J Haruta, T Maeno

2022年

日本のプライマリ・ケア医のコロナワクチン接種の実践――スケーラビリティとノンスケーラビリティのはざまで

木村周平、堀口佐知子、後藤亮平、小曽根早知子、金子惇、照山絢子、濱雄亮、春田淳志

F1000Research （F1000 Research Ltd）  11   1268 - 1268 2022年

研究論文（学術雑誌）, 共著, 最終著者, 査読有り

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<p>Vaccine rollouts have been underway to combat the COVID-19 pandemic globally. Based on ongoing interviews with ten primary care physicians ‘in the field’, this paper elucidates how in practice the vaccinations were carried out in Japan in 2021. We examine what the primary care physicians did to prepare for the rollouts, what problems they faced, and how they responded to these problems. Large-scale vaccination projects are supposed to proceed smoothly and quickly, or to have what Anna Tsing calls ‘scalability’. In practice, however, they required a variety of tasks for coordination, information sharing, and promotion. Despite feeling stressed by the lack of information and exhausted by the work overload, the primary care physicians carried out the vaccinations as an important service to their patients and communities. The findings of this paper will provide valuable materials for improving future vaccine rollouts.</p>

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What kinds of work do Japanese primary care physicians who derive greater positive meaning from work engage in?

Yamamoto Y, Haruta J, Goto R, Maeno T

Journal of General and Family Medicine 2022年

研究論文（学術雑誌）, 共著, 査読有り

Family caregivers’ experience with healthcare and social care professionals and their participation in health checkups

Nakayama G, Masumoto S, Haruta J, Maeno T

Journal of General and Family Medicine 2022年

研究論文（学術雑誌）, 共著, 査読有り

【私のIPE体験】慶應義塾大学

尾崎 真友, 春田 淳志

日本保健医療福祉連携教育学会学術誌・保健医療福祉連携 （日本保健医療福祉連携教育学会）  15 （ 2 ） 114 - 115 2022年

ISSN  18836380

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What Role Expectations Do Primary Care Physicians in Japan Hold for Physical Therapists Regarding Primary Care?

Goto R., Haruta J., Ozone S.

Journal of Primary Care and Community Health （Journal of Primary Care and Community Health）  13   21501319221124316 - 21501319221124316 2022年

ISSN  21501319

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Introduction/Objectives: This study aimed to clarify what primary care physicians (PCPs) in Japan understand of the role of physical therapists (PTs) through the experience of working with PTs in hospitals, and what roles PCPs expect for PTs in future primary care. Methods: Semi-structured interviews were conducted individually with 9 purposively sampled PCPs with sufficient experience of collaboration with PTs. Interview data were analyzed by theme analysis focusing on “What does the PCP understand about the role of PTs through the experience of working with PTs in hospitals?” and “What roles and purposes does the PCP wish for PTs in primary care settings?” Results: PCPs viewed PTs as providers of rehabilitation in the traditional medical model, and understood their role as an occupation having a mono-causal viewpoint, namely a specific and well-defined outcome for individual patients, and intervening with patients within a short clinical course with the aim of improvement or maintenance of the patient’s condition. With regard to future primary care, PCPs expected that PTs would interpret various factors related to patient lives from the viewpoint of causal interactions; become important stakeholders in the community; and respond flexibly to patients and the environmental factors around them with continued support to the individual. Conclusions: PCPs understood the role of PTs in hospitals as “Rehabilitation in the traditional medical model,” and expected the future role of PTs in primary care as “Rehabilitation in integrated community care.”

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Relationship between the use of home-visit nursing services and family caregivers’ experience of interprofessional care

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

Japanese Journal of Geriatrics （Japanese Journal of Geriatrics）  59 （ 2 ） 209 - 218 2022年

ISSN  03009173

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Aim: To examine the relationship between the use of home-visit nursing services (VNS) for patients and their family caregivers’ experience of interprofessional care, which is an indicator of the care process. Methods: We used data from a cross-sectional survey in Japan, 2020. Family caregivers 40-74 years old and caring for community-dwelling patients with chronic conditions were recruited. The outcome variable was family caregivers’ experience, reflecting the quality of interprofessional care for patients and their caregivers. We used the Japanese version of the Caregivers’ Experience Instrument (J-IEXPAC CAREGIVERS), which includes two domains: attention for the patient and attention for the caregiver. The main factor was the use of VNS, and covariates were socioeconomic factors of the caregivers and the use of other health and social care services. J-IEXPAC CAREGIVERS scores were divided into two groups by median values and analyzed by multivariate logistic regression analyses. Results: A total of 566 caregivers were included in the analysis. The median age was 62 years old. VNS was used in 86 cases (15.2%). Logistic regression analyses revealed that the use of VNS was significantly associated with a higher total score group for J-IEXPAC CAREGIVERS (odds ratio = 3.02; 95% confidence interval 1.54-5.91). Of the J-IEXPAC CAREGIVERS domains, attention for the patient was significant. Conclusions: We found that the use of VNS was likely to provide a better experience among family caregivers. Our findings sug-gest that visiting nurses fulfill their expected role as core members of a multidisciplinary team.

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Japan's General Practitioners' Responses to COVID-19 Transformations of the" Body Social" in Between Pandemic Waves

S Kimura, J Iida, J Teruyama, S Horiguchi, J Miyachi, Y Hama, J Haruta, ...

Japanese Review of Cultural Anthropology 23 (1), 337-342 2022年