Congenital colour vision deficiency (CVD) has a prevalence of 8% for men and 0.4% for women. Amongst people born with normal colour vision, the acquired form of CVD can also affect them at later stages of their lives due to disease or exposure to toxin. Most CVD persons have difficulties dealing with colours in everyday life and at work, but these problems are under-reported due to a lack of its awareness in the general population. This literature review seeks to present findings of studies and reports on the impact of CVD on the affected persons chronologically through different stages of their lives and their coping measures. Scientific publications and corresponding references relating to how CVD affects individuals were searched, identified and retrieved from PubMed, National University of Singapore and Cochrane electronic databases. Books that were not available electronically were manually searched. Paramedical literature was also included through online searches using Google and Google Scholar. Inclusion criteria were English-based studies pertaining to effects of CVD on everyday life and respective coping measures, including experimental, observational studies, symposium proceedings and systematic review. There was no timeframe restriction for these publications. Articles using anecdotal evidence were excluded with the exception of those used to describe the effects of CVD on play age and school age. Our literature search found 136 articles, 60 of which were used in this review based on the respective selection criteria. CVD affects many aspects of life from childhood to adulthood. The implications extend across play, sports, driving, education, occupation, discrimination, and health and safety issues. Awareness of CVD helps to identify and develop corresponding coping strategies. More work needs to be done in raising awareness of CVD and its implications, as well as implementing measures to overcome these difficulties.

BackgroundDespite recent developments in post-graduate family medicine training in Japan, the numbers of junior doctors entering family medicine residencies are still limited. The objective of this qualitative study was to investigate the possible factors associated to the career choice of family medicine, especially in the context of the newly established family medicine programs in Japan.MethodsFrom December 2010 to January 2011, we distributed a semi-structured questionnaire about career choice to 58 physician members of the Japan Primary Care Association, and 41 of them responded. Four researchers used the Modified Grounded Theory Approach (Kinoshita, 2003) for three-stage conceptualization.ResultsWe extracted a conceptual model of the choice of newly established family medicine as a career in Japan, consisting of six categories and 77 subordinate concepts from 330 variations. The subcategories of personal background affecting the family-medicine career choice were characteristics (“self-reliance,” “pioneering spirit”), career direction (“community/rural-orientedness,” “multifaceted orientation”) and experience (e.g., “discomfort with fragmented care”). We divided the influencing factors that were identified for career choice into supporters (e.g., “role model”), conflict of career choice (e.g., “anxiety about diverse/broad practice”), and the dawn of a new era in family medicine in Japan (e.g., “lack of social recognition,” “concern about livelihood,” and “too few role models”).ConclusionsAlthough the dawn of a new era seemed a rather negative influencer, it was unique to our study that the dawn itself could attract those with a “pioneering spirit” and an “attitude of self-training.” Unlike previous studies, the positive factors such as lifestyle and the short residency program were not shown to be part of family medicine's attractiveness. In contrast, “concern about livelihood” was specific among our respondents and was related to career choice in the dawn period. “Community-orientedness” and “multifaceted orientation” (which have aspects in common with previous studies' findings) would appear to be universal regardless of cultural and medical system differences. In our study, these universal factors were also found to be part of the attractiveness of family medicine from the practitioners' viewpoints, and these factors may become great influencers for family medicine candidates.Electronic supplementary materialThe online version of this article (doi:10.1186/s12930-014-0011-2) contains supplementary material, which is available to authorized users.

There have been some studies of common primary care diseases in Japan, but no reports on which diseases it is difficult for general physicians to diagnose in daily practice. In this study, we identified diseases that provided a diagnostic challenge for Japanese general physicians in daily practice. The subjects were new undiagnosed patients referred to the General Outpatient Department of Chiba University Hospital during the one-year period from January 2008. We performed a retrospective chart review to identify the referring doctor, patient demographics, the duration of symptoms, the final diagnosis, and the outcome. Final diagnoses were classified according to the International Classification of Primary Care Second Edition (ICPC-2). In addition, the differences between referrals from general physicians and those from other physicians were assessed. Fisher’s exact test and the Bonferroni-Holm correction were used for statistical analysis. A total of 169 patients were referred by general physicians and 239 patients were referred by other physicians. The most common ICPC-2 diagnosis was “General & Unspecified” conditions (35 patients, 20.7%), followed by “Psychological” conditions (31 patients, 18.3%) and “Musculoskeletal” conditions (21 patients, 12.4%). No significant differences of the ICPC-2 category for the final diagnosis and each diagnosis were found between patients referred by general physicians and those referred by other physicians. The hospitalization rate was lower for patients referred by general physicians than for patients referred by other physicians (4 patients, 2.4% vs. 24 patients, 10.0%) (P = 0.002). Japanese general physicians found difficulty in diagnosing “Psychological” conditions, “Musculoskeletal” conditions, variations within the normal range, and viral infections that required diagnosis by exclusion. Because most of the patients referred by general physicians had mild conditions, further education at outpatient departments and clinics is required to improve diagnostic performance. Additionally, it is important to increase the gatekeeper role of general physicians and further development of the medical system by the government to distinguish the functions of clinics and hospitals is expected.

It is crucial to adapt and improve the (primary) health care systems of countries to prepare for future patient profiles and their related needs. The main aim of this study was to acquire a comprehensive overview of the perceptions of primary care experts in Singapore about the state of primary care in Singapore, and to compare this with the state of primary care in other countries. Notwithstanding ranked 2nd in terms of efficiency of health care, Singapore is facing significant health care challenges. Emails were sent to 85 experts, where they were asked to rate Singapore’s primary care system based on nine internationally adopted health system characteristics and six practice characteristics (response rate = 29%). The primary care system in Singapore received an average of 10.9 out of 30 possible points. Lowest ratings were given to: earnings of primary care physicians compared to specialists, requirement for 24 hr accessibility of primary care services, standard of family medicine in academic departments, reflection of community served by practices in patient lists, and the access to specialists without needing to be referred by primary care physicians. Singapore was categorized as a ‘low’ primary care country according to the experts.

To identify socioeconomic and urban–rural variations in self-reported lifetime prevalence of symptoms of sexually transmitted infections (STI). This cross-sectional study used data from the Bangladesh Adolescents Survey 2005 conducted on 11,986 adolescents, using a cluster sampling methods. Data were analysed using SPSS applying principle components analysis, multivariate logistic regression analysis, and prevalence ratio (PR) with 95% confidence interval (CI). Self-reported lifetime prevalence of STI symptoms was 11.6%. Urban adolescents had 11% lower prevalence than their rural counterparts (PR(U/R) = 0.89; 95% CI = 0.79-1.00). Probability of self-reported lifetime symptoms of STI was highest among 20–24 years old income-generating male educated workers of mid-socioeconomic status living in rural areas (0.31). The residence (urban–rural) factor is more influential than the socioeconomic factor. Simpler and cheaper mode of screening and case finding tools for STIs would greatly help. Health promotion and education programs can decrease the adolescents’ vulnerability to sexually transmitted diseases.

BackgroundRevitalising primary health care (PHC) and the need to reach MDG targets requires developing countries to adapt current evidence about effective health systems to their local context. Timor-Leste in one of the world’s newest developing nations, with high maternal and child mortality rates, malaria, TB and malnutrition. Mountainous terrain and lack of transport pose serious challenges for accessing health services and implementing preventive health strategies.MethodsWe conducted a non-systematic review of the literature and identified six components of an effective PHC system. These were mapped onto three countries’ PHC systems and present a case study from Timor-Leste’s Servisu Integrado du Saude Comunidade (SISCa) focussing on MDGs. Some of the challenges of implementing these into practice are shown through locally collected health system data.ResultsAn effective PHC system comprises 1) Strong leadership and government in human rights for health; 2) Prioritisation of cost-effective interventions; 3) Establishing an interactive and integrated culture of community engagement; 4) Providing an integrated continuum of care at the community level; 5) Supporting skilled and equipped health workers at all levels of the health system; 6) Creating a systems cycle of feedback using data to inform health care. The implementation case study from Timor-Leste (population 1 million) shows that in its third year, limited country-wide data had been collected and the SISCa program provided over half a million health interactions at the village level. However, only half of SISCa clinics were functional across the country. Attendances included not only pregnant women and children, but also adults and older community members. Development partners have played a key role in supporting this implementation process.ConclusionThe SISCa program is a PHC model implementing current best practice to reach remote communities in a new developing country. Despite limited resources, village level healthcare and engagement can be achieved but takes a long-term commitment and partnership.

ObjectiveThe aim of the present study was to determine the importance of physician attire in inspiring confidence in patients, patient preferences and factors influencing the impression made by the clothing worn by doctors.MethodsSelf-administered questionnaires were distributed and completed in five pharmacies across Japan (April–October 2012) to patients or their carers (aged ≥20 years). The survey was performed over 2 consecutive days in each pharmacy. To estimate patient confidence in doctors, questions were asked addressing six items, namely doctors’ attire, speech (way of speaking, volume, tone etc.), age, gender, title (professor, PhD etc.) and reputation. Participants were shown photographs of five different types of attire for male and female doctors (i.e. white coats, scrubs, semiformal, smart casual and casual wear) and asked to rate the appropriateness of each clothing style using a five-point Likert scale.ResultsOf the 1411 patients or carers who attended the pharmacies, 530 responded to the questionnaire, with 491 complete responses used in subsequent analyses. The mean age of respondents was 51.9 years and 40.3% were male. Speech was the most important factor (mean score 4.60) in determining confidence in doctors, followed by reputation (4.06) and attire (4.00). With regard to attire, regardless of a doctor’s gender, the white coat was judged to be the most appropriate style of dress, followed by surgical scrubs. Only the preference for scrubs was significantly affected by age, gender and region (P < 0.05). Using binomial logistic regression analysis, we evaluated the effects of age on the appropriateness (Likert score 3–5) versus inappropriateness (score 1–2) of scrubs. There was a significant increase in the number of subjects aged 50–64 and >65 years of age who thought scrubs were inappropriate compared with those aged 20–34 years (adjusted odds ratios of 4.30 and 12.7 for male doctors, and 3.66 and 6.91 for female doctors).ConclusionsAttire is one of the important factor that inspires patient confidence in physicians. White coats were deemed the most appropriate clothing style for doctors, followed by scrubs. However, older participants perceived scrubs to be less appropriate attire than younger subjects.

BackgroundNoncommunicable chronic diseases (NCDs) are global public health issues. Physical activity, exercise and sedentary behavior are important lifestyle factors to determine risk of NCDs. Immigrant studies have shown higher risk of developing NCDs among immigrants. Less physical activity among Japanese immigrants to westernized environment was also documented. However, little is known about detailed physical activity, exercise and sedentary behavior among Japanese residing in westernized environment. This cross-sectional study was conducted to analyze physical activity in daily life, exercise, and sedentary behavior among Japanese in westernized environment and then to compare the results to native Japanese in Japan.MethodsJapanese adults in Pittsburgh who were registered at an urban primary care clinic were surveyed in terms of physical activity in daily life, exercise, and sedentary behavior. The results were compared to age- and gender-matched Japanese averages from the national data (Japanese National Health and Nutrition Survey, J-NHANS).ResultsOf 97 identified for inclusion, all responded. Japanese in Pittsburgh did not engage physical activity in daily life as compared to J-NHANS results (p < .001 for both genders). Only 45.0% and 26.3% of Japanese men and women in Pittsburgh, respectively, reached the recommended level of exercise. The prevalence of regularly engaging moderate or vigorous level of exercise was significantly lower among Japanese in Pittsburgh than age- and gender-matched J-NHANS results. The prevalence of 2 hours or more per week of exercise at moderate or higher level among Japanese men and women in Pittsburgh were lower than J-NHANS results. Women in Pittsburgh showed significantly less sedentary time as compared to J-NHANS results, while men only showed significantly less sitting/lying time during weekend. We found no association between sedentary time (time in sitting/lying and TV/computer) and exercise time during weekday or weekend in the target population.ConclusionsAlthough Japanese in Pittsburgh showed lower prevalence of sedentary behavior, prevalence of regular physical activity and exercise were less than prevalence of native Japanese.

BackgroundThe practice of family medicine is not well established in many developing countries including Sri Lanka. The Sri Lankan Government funds and runs the health facilities which cater to the health needs of a majority of the population. Services of a first contact doctor delivered by full time, vocationally trained, Family Physicians is generally overshadowed by outpatient departments of the government hospitals and after hours private practice by the government sector doctors and specialists. This process has changed the concept of the provision of comprehensive primary and continuing care for entire families, which in an ideal situation, should addresses psychosocial problems as well and deliver coordinated health care services in a society. Therefore there is a compelling need to teach Family Medicine concepts to undergraduates in all medical faculties.DiscussionA similar situation prevails in many countries in the region. Faculty of Medicine Peradeniya embarked on teaching family medicine concepts even before a department of Family Medicine was established. The faculty has recognized CanMed Family Medicine concepts as the guiding principles where being an expert, communicator, collaborator, advocate, manager and professional is considered as core competencies of a doctor. These concepts created the basis to evaluate the existing family medicine curriculum , and the adequacy of teaching knowledge and skills, related to family medicine has been confirmed. However inadequacies of teaching related to communication, collaboration, management, advocacy and professionalism were recognized. Importance of inculcating patient centred attitudes and empathy in patient care was highlighted. Adopting evaluation tools like Patient Practitioner Orientation Scale and Jefferson’s Scale of Empathy was established. Consensus has been developed among all the departments to improve their teaching programmes in order to establish a system of teaching family medicine concepts among students which would lead them to be good Family Physicians in the future.SummaryTeaching Family Medicine concepts could be initiated even before establishing departments of family medicine in medical faculties and establishing the practice of family medicine in society. Family medicine competencies could be inculcated among graduates while promoting the establishment of the proper practice of Family Medicine in the society.

BackgroundCommunity based education (CBE), defined as “a means of achieving educational relevance to community needs and, consequently, of implementing a community oriented educational program,” is reported to be useful for producing rural physicians in Western countries. However, why some physicians withdraw from their teaching roles is not well known, especially in Asian countries. The aim of this study was to clarify the requisites and obstacles for taking part in CBE.MethodsWe combined two steps: preliminary semi-structured interviews followed by workshop discussions. First of all, we interviewed four designated physicians (all male, mean age 48 years) working in one rural area of Japan, with less than 10,000 residents. Secondly, we held a workshop at the academic conference of the Japan Primary Care Association. Fourteen participants attending the workshop (seven male physicians, mean age 45 years, and seven medical students (one female and six male), mean age 24 years) were divided into two groups and their opinions were summarized.ResultsIn the first stage, we extracted three common needs from interviewees; 1. Sustained significant human relationships; 2. Intrinsic motivation; and 3. Tangible rewards. In the second stage, we summarized three major problems from three different standpoints; A. Preceptors’ issues: more educational knowledge or skills, B. Learner issues: role models in rural areas, and C. System issues: supportive educational system for raising rural physicians.ConclusionsOur research findings revealed that community physicians require non-monetary support or intrinsic motivation for their CBE activities, which is in accordance with previous Western studies. In addition, we found that system support, as well as personal support, is required. Complementary questionnaire surveys in other Asian countries will be needed to validate our results.