Footwear used by older people and a history of hyperkeratotic lesions on the foot

: Introduction: In Japanese medical schools, a special regional quota ( chiikiwaku ) system has been widely implemented to increase the number of physicians in medically underserved areas (MUAs). Regional quota students are required to take out a student loan but are exempted from repayment after fulfilling an approximately 9-year obligatory practice period. This study investigated the anticipated willingness of final-year regional quota students to remain in MUAs after their obligatory practice period, as well as factors associated with this willingness during studentsʼ first year. Methods: The participants in this prospective observational study were all regional quota students at Japanese medical schools. Baseline data were collected when students were in their first year, and their anticipated willingness to remain in MUAs after their obligatory practice period was the primary outcome, determined by questionnaire during the studentsʼ final year. The association between baseline data and willingness to remain in MUAs was analyzed by the Χ test and logistic regression analysis. Results: At baseline, 405 first-year students in 38 medical schools answered the questionnaire; of these, 208 (51.4%) students were followed up 5 years later. The proportion of regional quota students who anticipated being willing to remain in MUAs decreased from 52.3% to 19.2% after 5 years. In multivariate analysis, anticipated willingness to remain in MUAs in the sixth year was associated with rural upbringing (odds ratio (OR) 2.1), influence of income on work preference (OR 0.3) and willingness to remain in MUAs as assessed during the first year (OR 3.3). Conclusions: Regional quota studentsʼ anticipated willingness to remain in MUAs decreased as they progressed through medical school. To increase the number of physicians in MUAs, it may be useful to recruit regional quota students who come from rural areas, who do not place a high priority on expected incomes, and who initially anticipate a willingness to remain in MUAs.

[1]  ASHP Statement on Unit Dose Drug Distribution , 2019, Best Practices.

[2]  T. Kawamura,et al.  Factors associated with the difficulty in hospital acceptance at the scene by emergency medical service personnel: a population-based study in Osaka City, Japan , 2016, BMJ Open.

[3]  J. Téllez-Lapeira,et al.  Predictors for choosing the specialty of Family Medicine from undergraduate knowledge and attitudes. , 2016, Sao Paulo medical journal = Revista paulista de medicina.

[4]  T. Evans,et al.  Using economic analysis in health workforce policy-making , 2016 .

[5]  A. Takayashiki,et al.  Motives and factors associated with staying in medically underserved areas after the obligatory practice period among first-year Japanese medical students in a special quota system , 2015 .

[6]  P. López,et al.  Optimal choice of footwear in the elderly population , 2015 .

[7]  M. Kosdak,et al.  Factors affecting the work of physicians in rural areas of Turkey. , 2015, Rural and remote health.

[8]  M. Abe,et al.  Characteristics of Japanese medical students associated with their intention for rural practice. , 2015, Rural and remote health.

[9]  Ana Belen Ortega-Avila,et al.  Changes in the parameters of gait after a mechanical debridement of a plantar callosities. , 2015, Journal of tissue viability.

[10]  L. Roorda,et al.  Use and effects of custom-made therapeutic footwear on lower-extremity-related pain and activity limitations in patients with rheumatoid arthritis: A prospective observational study of a cohort. , 2014, Journal of rehabilitation medicine.

[11]  L. Bentson.  Too Lazy for Primary Care , 2014, Annals of Internal Medicine.

[12]  H. Menz,et al.  Effectiveness of off-the-shelf footwear in reducing foot pain in Australian Department of Veterans’ Affairs recipients not eligible for medical grade footwear: study protocol for a randomized controlled trial , 2013, Trials.

[13]  R. Kravitz,et al.  Lifetime Earnings for Physicians Across Specialties , 2012, Medical care.

[14]  M. Grayson,et al.  Payback time: the associations of debt and income with medical student career choice , 2012, Medical education.

[15]  W. Vernon,et al.  Comparison of shoe-length fit between people with and without diabetic peripheral neuropathy: a case–control study , 2012, Journal of Foot and Ankle Research.

[16]  J. Ripp,et al.  The prevalence and correlations of medical student burnout in the pre-clinical years: A cross-sectional study , 2012, Psychology, health & medicine.

[17]  J. Pallant,et al.  Rural origin plus a rural clinical school placement is a significant predictor of medical students' intentions to practice rurally: a multi-university study. , 2012, Rural and remote health.

[18]  I. Kawachi,et al.  Urbanization and physician maldistribution: a longitudinal study in Japan , 2011, BMC health services research.

[19]  Friedrich Edelhäuser,et al.  Empathy Decline and Its Reasons: A Systematic Review of Studies With Medical Students and Residents , 2011, Academic medicine : journal of the Association of American Medical Colleges.

[20]  R. Schwarzkopf,et al.  Foot and shoe size mismatch in three different New York City populations. , 2011, The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons.

[21]  T. Kelechi,et al.  Managing common foot problems in older adults. , 2010, Journal of gerontological nursing.

[22]  B. Center,et al.  Efforts to Graduate More Primary Care Physicians and Physicians Who Will Practice in Rural Areas: Examining Outcomes From the University of Minnesota–Duluth and the Rural Physician Associate Program , 2010, Academic medicine : journal of the Association of American Medical Colleges.

[23]  José Rubens Rebelatto,et al.  The relationship between foot pain, anthropometric variables and footwear among older people. , 2010, Applied ergonomics.

[24]  R. Hays,et al.  Perceptions of UK medical students on rural clinical placements. , 2009, Rural and remote health.

[25]  H. Menz,et al.  Distribution and correlates of plantar hyperkeratotic lesions in older people , 2009, Journal of foot and ankle research.

[26]  Brian Edwards,et al.  Why do medical graduates choose rural careers? , 2009, Rural and remote health.

[27]  M. Matsumoto,et al.  Long-term effect of the home prefecture recruiting scheme of Jichi Medical University, Japan. , 2008, Rural and remote health.

[28]  T. Hiyama,et al.  New occupational threats to Japanese physicians: karoshi (death due to overwork) and karojisatsu (suicide due to overwork) , 2008, Occupational and Environmental Medicine.

[29]  Jerome Danoff,et al.  A comparison of different assessment techniques for measuring foot and ankle volume in healthy adults. , 2008, Journal of the American Podiatric Medical Association.

[30]  G. Leese,et al.  Do patients with diabetes wear shoes of the correct size? , 2007, International journal of clinical practice.

[31]  M. Fetters,et al.  Factors considered by medical students when formulating their specialty preferences in Japan: findings from a qualitative study , 2007, BMC medical education.

[32]  Rodney A. Hayward,et al.  Predictors of Physician Career Satisfaction, Work–Life Balance, and Burnout , 2007, Obstetrics and gynecology.

[33]  J. Welge,et al.  Use of monofilament in the detection of foot lesions in older adults. , 2006, The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons.

[34]  S. Shaffer,et al.  RELIABILITY AND VALIDITY OF SEMMES-WEINSTEIN MONOFILAMENT TESTING IN OLDER COMMUNITY-DWELLING ADULTS. , 2005 .

[35]  J. Diamond,et al.  Long-Term Retention of Graduates from a Program to Increase the Supply of Rural Family Physicians , 2005, Academic medicine : journal of the Association of American Medical Colleges.

[36]  Georgios Grouios,et al.  Corns and calluses in athletes’ feet: a cause for concern , 2004 .

[37]  M. Pattillo.  Therapeutic and healing foot care: a healthy feet clinic for older adults. , 2004, Journal of gerontological nursing.

[38]  W. Kukull,et al.  Biomechanical Properties of Shoes and Risk of Falls in Older Adults , 2004, Journal of the American Geriatrics Society.

[39]  T. Wilkinson,et al.  What evidence-based undergraduate interventions promote rural health? , 2004, The New Zealand medical journal.

[40]  G. Koch,et al.  Outcomes of States’ Scholarship, Loan Repayment, and Related Programs for Physicians , 2004, Medical care.

[41]  M. Tinetti.  Clinical practice. Preventing falls in elderly persons. , 2003, The New England journal of medicine.

[42]  A. Helfand.  Assessing hyperkeratotic lesions in the older patient. , 2003, Clinics in podiatric medicine and surgery.

[43]  DOUGLAS G. Smith,et al.  Footwear used by individuals with diabetes and a history of foot ulcer. , 2002, Journal of rehabilitation research and development.

[44]  Russell E. Mardon,et al.  The Roles of Nature and Nurture in the Recruitment and Retention of Primary Care Physicians in Rural Areas: A Review of the Literature , 2002, Academic medicine : journal of the Association of American Medical Colleges.

[45]  D. B. Freeman.  Corns and calluses resulting from mechanical hyperkeratosis. , 2002, American family physician.

[46]  H. Menz,et al.  Foot pain impairs balance and functional ability in community-dwelling older people. , 2001, Journal of the American Podiatric Medical Association.

[47]  J. Michelson,et al.  Sensory Thresholds of Normal Human Feet , 2000, Foot & ankle international.

[48]  M. J. Potter,et al.  Effect of callus removal on peak plantar pressures , 2000 .

[49]  H. Menz,et al.  Footwear and postural stability in older people. , 1999, Journal of the American Podiatric Medical Association.

[50]  D G Smith,et al.  Causal pathways for incident lower-extremity ulcers in patients with diabetes from two settings. , 1999, Diabetes care.

[51]  W. Jeffcoate,et al.  Factors contributing to the presentation of diabetic foot ulcers , 1997, Diabetic medicine : a journal of the British Diabetic Association.

[52]  A. Boulton,et al.  The Association Between Callus Formation, High Pressures and Neuropathy in Diabetic Foot Ulceration , 1996, Diabetic medicine : a journal of the British Diabetic Association.

[53]  L. Greenberg,et al.  Foot problems in the US. The 1990 National Health Interview Survey. , 1993, Journal of the American Podiatric Medical Association.

[54]  D. George.  Management of hyperkeratotic lesions in the elderly patient. , 1993, Clinics in podiatric medicine and surgery.

[55]  B. Walters,et al.  Where have all the primary care applicants gone? , 1992, The New England journal of medicine.

[56]  J. Garrow,et al.  Quetelet's index (W/H2) as a measure of fatness. , 1985, International journal of obesity.

[57]  F. Tovey.  The Manufacture of Diabetic Footwear , 1984, Diabetic medicine : a journal of the British Diabetic Association.

[58]  F. Woringer.  [Aging of the skin]. , 1951, Strasbourg medical.