Previous studies have examined short-term changes in health care utilization during the COVID-19 pandemic, but research on long-term post-pandemic effects remains limited. We aimed to evaluate health care utilization after the pandemic based on the ecology of medical care model and to compare it with the results before and during the pandemic in Japan.
We conducted a nationwide repeated cross-sectional survey of a representative sample of the general Japanese adult population in 2021 and 2024. The main outcomes were health care utilization for new health problems. We estimated the number of each health care utilization per 1000 population per month and compared it with the previous study conducted before the pandemic.
Data from a total of 2992 participants were analyzed. Visits to physicians' offices that primarily provide primary care declined during the pandemic and increased after the pandemic, but have not fully recovered to pre-pandemic levels. The recovery in physician's office visits between during and after the pandemic tended to be smaller among younger adults, females, those with lower education levels, those with higher incomes, and those without chronic conditions. On the other hand, emergency room visits, which declined during the pandemic, increased to higher levels than before the pandemic.
Primary care utilization has not recovered to pre-pandemic levels, while emergency room visits have increased to higher levels than before the pandemic. Understanding long-term changes in health care utilization behaviors after the pandemic can help policymakers strengthen primary care systems.
Subjective cognitive decline (SCD) is characterized by the perception of cognitive dysfunction, and it could be one of the early signs of dementia. While SCD is a common phenomenon in old persons, little is known about how it affects interpersonal relationships.
We conducted a cross-sectional study involving 16 patients with SCD and 39 volunteers recruited from the COSCODE study. The Hazan and Shafer questionnaires were used to assess patients' attachment styles. The Experience in Close Relationships Scale was used to assess individual differences in attachment-related anxiety and attachment-related avoidance. A Wilcoxon rank-sum test was performed to test for differences between groups, and p-values were Bonferroni-corrected.
SCD is associated with lower disorganized attachment scores (p = 0.01). SCD was not associated with experience in close relationships.
Coping with progressive cognitive decline is a difficult mission. The results of our study on persons with SCD help us to better understand changes in couple relationships before the onset of dementia.
Patient satisfaction is a key indicator of healthcare quality. While physician-related factors are well studied, less is known about how non-physician staff contribute to satisfaction in primary care. This study examined the association between patient satisfaction and multidisciplinary staff involvement in a Japanese primary care clinic.
We conducted a secondary analysis of patient satisfaction survey data collected from 2019 to 2022. The primary outcome was overall satisfaction with the visit, dichotomized as “highly satisfied” versus “less than highly satisfied.” Modified Poisson regression with robust standard errors estimated prevalence ratios (PRs) and 95% confidence intervals (CIs). Multivariable models included satisfaction with non-physician staff, patient demographics, and physician-related satisfaction via principal component analysis. Sensitivity analyses included consultation duration and access to care.
Among 1415 patients, higher satisfaction with the demeanor of nursing staff (PR 2.06, 95% CI 1.39–3.05) and waiting time care (PR 1.43, 95% CI 1.33–1.54) were significantly associated with greater overall satisfaction. Receptionist demeanor also showed a modest but significant association (PR 1.30, 95% CI 1.05–1.61). In the sensitivity analysis, these associations persisted for nursing staff (PR 1.64, 95% CI 1.20–2.24) and waiting time care (PR 1.08, 95% CI 1.02–1.14), while the receptionist association was attenuated (PR 1.15, 95% CI 0.97–1.35).
Beyond physician-related factors, nursing staff demeanor and waiting time care were found to be associated with patient satisfaction. These findings support the importance of multidisciplinary contributions to patient-centered care in primary care clinics.
Neisseria meningitidis can cause invasive meningococcal disease (IMD). Individuals with primary complement deficiencies are at a higher risk of developing IMD. However, cases of IMD associated with complement deficiency have rarely been reported in Japan. In this case, a 35-year-old Japanese man presented with fever and a spreading skin rash. Blood culture identified N. meningitidis serogroup B. The patient was treated with antibiotics and fully recovered. Genetic analysis revealed a deficiency in complement component 7. This case highlights that IMD can occur in young, otherwise healthy individuals, some of whom may have underlying complement deficiency.
Japan's 2022 Model Core Curriculum (MCC) recommends community-based clinical clerkships spanning at least three consecutive weeks to foster generalism competency, although empirical evidence supporting this guidance remains limited.
We used an explanatory sequential mixed-methods design. Fifth-year Chiba University medical students (n = 112) completed a three-week community-based clinical clerkship from September to November 2024. Self-assessed attainment of the 18 MCC generalism learning objectives was measured pre- and post-clerkship. Daily reflection sheets (n = 1680) were deductively coded to analyze the learning processes using content analysis.
Mean self-assessment scores increased significantly for all the objectives (p < 0.001), with effect sizes ranging from small (d = 0.37) to very large (d = 1.40). Content analysis of the reflection sheets yielded 539 reflection codes across 16 objectives, with all the students contributing. The most frequently coded objectives were “primary care at home” (106 codes from 58 students), “geriatric stage” (79 codes from 44 students), “primary care in the community” (64 codes from 42 students), and “end-of-life care” (62 codes from 43 students).
A three-week community-based clinical clerkship produced significant self-assessed gains across all 18 generalism learning objectives and generated 539 reflection-based learning units, including 16 objectives, confirming that students actively engaged with the full breadth of generalism in practice. These findings should be interpreted as indicating perceived growth rather than objective competence, given the reliance on self-assessments, and exposure opportunities varied across clerkship sites. Further multi-site studies are needed to clarify whether 3 weeks is the optimal duration.
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