Search

Increasing numbers of medical students participate in international electives. However, this recent trend has yet to be examined in non-Western high-income countries such as Japan. The aim of this study is to assess recent trends in Japan, and to suggest ways in which those trends might be influenced. A retrospective cross-sectional analysis of responses to an 8-item questionnaire sent in August 2019 to 82 medical schools in Japan is reported. The responses were received in September 2019. Narrative responses were obtained regarding rationales for exchange programs, participant feedback, and challenges encountered. Responses were translated into English and categorized into themes. Of 82 Japanese medical schools, 56 (68%) responded to the questionnaire. Both the number of incoming and outgoing exchange students had increased steadily over the preceding 3-year period. The leading destinations for Japanese students were the United States (30%), other Asian (36%), and European countries (24%). Narrative responses reveal different rationales from those reported by medical schools in Western high-income countries. Only a few Japanese students chose low or middle-income countries as their destinations, as opposed to the trend seen in Western high-income countries. The reported challenges encountered by the exchange programs may provide insights for improvement. Exchanges have been greatly affected by the coronavirus disease 2019 pandemic. The results can serve as prepandemic baseline data and should promote further international collaboration for medical education under current circumstances. [ABSTRACT FROM AUTHOR]

Little is known about Marshallese palliative care practices. We explored traditional and contemporary Marshallese palliative care practices and examined generational differences. We performed three focus groups in 2011-2012 among Marshall Islanders in Hawai'i. A native speaking interpreter assisted group facilitators. Data were analyzed using classical thematic triangulation methods to identify specific Marshallese palliative care practices, the effect of economic and social challenges in Hawai'i, and generational differences comparing young and old. Nineteen persons (10 men and 9 women, youth aged 17-27 years, and elders as defined in Marshallese culture, aged 46-79) participated. A "good death" was defined as "peaceful and pain free," occurring from natural causes. Factors associated with a "good death" included gathering of family to absolve conflicts, and proper and timely cultural practices. Factors associated with "bad deaths" included young age, active suffering, accidents, suicides, "black magic/curses," or lack of timely or proper burial. Comparing generational differences, older Marshallese had differing opinions regarding preferred place of death, burial site, cultural practice preservation, artificial prolongation of life, and cremation. Barriers included mortuary fees, cost of transporting bodies, United States (US) government policies, and wait times for death certificates. Many cultural factors contribute to "good" or "bad" deaths. Attitudes toward palliative care practices differ by generation. Having previously documented different approaches by Yapese, a generalized "one size fits all" approach to Micronesians is inappropriate. Overcoming identified barriers may facilitate practices necessary for a good death in Micronesian populations in their home nations and as they migrate to communities throughout the US. [ABSTRACT FROM AUTHOR]

Introduction: Many Marshall Islanders seek healthcare services in Hawai'i. Little is known about traditional Marshallese palliative care practices. Our purpose was to learn about traditional Marshallese palliative care practices to provide culturally appropriate care. Methods: We performed 2 focus groups in 2011-2012 among Marshall Islanders living in or visiting the island of Oahu, Hawai'i. Group facilitators were uniformly trained to conduct focus groups using prepared script, with a native speaking interpreter. Data were analyzed using classical thematic triangulation methods to identify specific Marshallese palliative care practices and the effect of economic and social challenges in Hawai'i. Results: Six females and seven males, ages 46-79 years, participated. A "good death" was defined as "peaceful and pain free," occurring naturally with avoidance of artificial life prolongation. Factors associated with a "good death" included gathering of family to absolve conflicts, and proper and timely cultural practices such as Ilomej (wake) and Eorak (post-burial memorial service). Dying at home is the norm among people living in the Marshall Islands. After migrating to Hawai'i, having family present at the time of death was more important than the actual locale of death. Factors associated with "bad deaths" included young age, active suffering, accidents, suicides, or "black magic/curses," lack of timely burial or proper burial site. Barriers included mortuary fees, cost of transporting bodies, US government policies, and wait times for death certificates. Conclusions: There are many underlying cultural factors contributing to "good or bad" death. Overcoming identified barriers may facilitate cultural practices necessary for a good death. [ABSTRACT FROM AUTHOR]

Background: Unnecessary percutaneous endoscopic gastrostomy (PEG) tube feeding in nursing homes (NH) is a growing concern and an important area of research. Hawaii has one of the highest rates of PEG tube feeding in NH patients in the US, yet has lower rates than many NHs in Asian countries. We examined prevalence and factors associated with PEG tube feeding in NH patients in Hawaii. Methods: We conducted an observational cohort study of all patients admitted between 2003 and 2006 to an urban 180-bed hospital-affiliated NH in Honolulu, Hawaii. Data were collected from time of admission until discharge or death through 6/30/2011, from electronic and paper medical records and Minimum Data Set (MDS). Data included demographic characteristics, baseline medical conditions, functional status, cognitive status and code status. We created a Charlson Comorbidity Index (CCI) score based on baseline medical conditions on admission, and a disability score (ADL score) and Cognitive Performance Score (CPS) using baseline MDS data. Multivariable logistic regression was used to analyze factors associated with PEG tube feeding. Results: Of 238 NH patients aged 45-104 years (mean 83 years), 35 (14.7%) had PEG tube feeding. Of the NH cohort, 130 (54.6%) were female, 218 (92.3%) were Asian, 123 (51.9%) had a prior stroke and 163 (72%) had dementia based on CPS score. Among the 35 PEG tube fed patients, 23 (66%) had PEG placement prior to NH admission, 12 (34%) had PEG placement after NH admission, and 26 (74%) patients had PEG tube feeding until death or the end of follow-up (61 days to 8.4 years, mean 2.4 years). Prior stroke was associated with increased likelihood of PEG tube feeding (aOR = 2.52, 95%CI = 1.03-6.17, P = .04); with borderline increased likelihood for high comorbidity index (aOR = 2.21, 95%CI = 0.89-5.52, P = .09) and high ADL disability score (aOR = 2.03, 95%CI = 0.87-4.73, P = .10). DNR status was inversely associated with PEG tube feeding (aOR = 0.31, 95%CI = 0.11-0.85, P = .02). Age, dementia, Medicaid status, previous speech or physical therapy, and weight loss were not significantly associated with PEG tube feeding. Conclusion: In this predominantly Asian-American NH cohort with high prevalence of PEG tube feeding, prior stroke was strongly associated with PEG tube feeding, while dementia was not. Further study is needed to examine ways to identify and reduce unnecessary tube feeding in this population. [ABSTRACT FROM AUTHOR]

Background: Nursing home residents are at high risk of vitamin D deficiency. There has been only one previous study about vitamin D status on admission to the nursing home, and limited data are available about associations with functional disability and chronic diseases. Methods: Data were collected by retrospective chart review of electronic medical records and Minimum Data Set (MDS) for all veterans admitted to a VA nursing home in Honolulu, Hawai'i, between January 2011 and June 2012. All veterans had a comprehensive geriatric assessment and measurement of serum 25-hydroxyvitamin D level within 7 days of admission. Females, hospice patients, vitamin D supplement users, and those transferred from other nursing homes were excluded, leaving a final analytic sample of 104 patients. Vitamin D deficiency was defined as serum 25-hydroxyvitamin D level <20 ng/mL. Baseline data collected included age, ethnicity, BMI, functional disability (mobility, bathing, dressing, toileting, continence, and feeding) and prevalent chronic diseases to study cross-sectional associations of vitamin D deficiency using logistic regression. Results: Prevalence of vitamin D deficiency on admission to the nursing home was 49.0% (51/104) among male veterans not taking supplements. The mean age was 70.6 years (range 35-95), with ethnicity as follows: 51 (49.0%) White, 34 (32.7%) Asian, and 6 (5.8%) Black. In multiple logistic regression models adjusted for age, ethnicity and BMI, vitamin D deficiency was signiicantly associated with number of ADL disabilities (OR = 1.36 for each increase in ADL disability, 95%CI = 1.03-1.78, P = .03) and prevalent diabetes (OR = 2.99, 95%CI = 1.12-7.99, P = .03). When all six ADL disabilities were entered separately into the multivariate logistic regression model instead of total number of ADL disabilities, only the disability in feeding (OR = 4.74, 95%CI = 0.97-23.23, P = .05) and prevalent diabetes (OR = 2.92, 95%CI = 1.03-8.24, P = .04) remained significant. There were no significant associations between vitamin D deficiency and prevalent hypertension, hypercholesterolemia, coronary artery disease, stroke, cancer, depression or dementia. Conclusions: Almost half the male patients entering a nursing home in Hawai'i had vitamin D deficiency. A high number of ADL disabilities, disability in feeding, and prevalent diabetes were independently associated with vitamin D deficiency. Future studies should focus on targeting these patients for screening and intervention with supplementation to possibly prevent adverse health outcomes of vitamin D deficiency. [ABSTRACT FROM AUTHOR]

The article presents an overview of a discussion on the evolving palliative care practices among Marshall Islanders in Hawaii, at the Third Cross-Cultural Health Care Conference on February 8-9, 2013 in Hawaii.