100 32nd World Congress of Internal Medicine (October 24-28, 2014) WCIM 2014
PS 0206 Family Medicine
Comprehensive Initial Training for Medical Doctors Starting in 1980 in Musashino Red Cross Hospital
Toshihiko HATA1, Hiroyuki SATO1, Ako MACHINO2, Mai WAKABAYASHI3, Morito KISE2, Hiroki OHASHI4, Daisuke YAMASHITA5, Kaoru SAKURAI6, Toru MATSUBAYASHI7, Masahiko HATAO8, Ken UEDA1
Musashino Red Cross Hospital, Japan1, Kuji Clinic, Japan2, Tokyo Medical and Dental University, Japan3, Tama Family Clinic, Japan4, Oregon Health & Science Univercity, USA5, Shiunurigaoka General Hospital, Japan6, St. Joseph Healthcare, USA7, The Japanese Red Cross Akita College of Nursing, Japan8 Background: Medical education for medical school graduates in Japan greatly changed after World War II. From 1948, the General Headquarters (GHQ), the Supreme Commander for the Allied Powers imposed internship medical school graduates as ear- ly clinical training, internal medicine for 5 months, surgery for a month, obstetrics and gynecology for a month, public health for a month, for initial year. This system was unpaid before the nation examination, and abolished in 1968 by the campus dispute spread throughout Japan. Subsequently became mainstream medical center by the universities and colleges, but did not develop the training of general practitioners and family doctors in Japan because of aiming for the priority of specialization by univer- sity faculty of medicine. Musashino Red Cross Hospital (MRCH) started comprehensive initial training for medical doctors since 1980. One of the reason is that The Japan Red Cross Society as the most important philosophy advocates disaster medicine and its realization in general medical education is very important.
Methods: MRCH employed the intern doctors by general invitation examination, and educated them for two years. In principle mandatory training period within 2 years in internal medicine, surgery, pediatrics, obstetrics and gynecology training, psychiatry, and regional medical training.
Results: From 1980 to now MRCH did general medical education to more than 200 doctors. These doctors are working around the world. In Japan, from 2004 Initial gen- eral medical training was compulsory to all new medical doctors for two years.
Conclusions: Comprehensive initial training for medical doctors is very important in general medicine for all the generations and the disaster medicine. In Japan from the year 2020 general medicine training under the new medical program scheduled.
PS 0207 Family Medicine
The Cardiovascular Paradox of Sle in Family Medicine:
A Case-Control Study of the Prevalence and Manage- ment of Cardiovascular Disease in Patients with Sle Followed in a Primary Care Center
Marta PEREZ DE LIS NOVO1, Roberto PÉREZ LVAREZ1, Pilar BRITO ZERÓN2, Antoni SISÓ ALMIRALL3, Belchin KOSTOV3, Mireia MARTÍ VILLALTA3, Albert BOVÉ2, Hoda GHEITASI2, Soledad RETAMOZO2, Rafael RUIZ RIERA3, Manuel RAMOS CASALS2 Meixoeiro Hospital, Spain1, Hospital Clinic, Spain2, Centre D’Assistència Primària ABS Les Corts, CAPSE, Spain3
Background: To analyze the prevalence of SLE in the field of primary care and to evaluate the management of cardiovascular risk factors (CVRF) in comparison with a non-autoimmune control population.
Methods: Analysis of the diagnostic accuracy of SLE by primary care physicians using medical record audit (EMR) in 3 health centers including a population of 44,184 in- habitants. The prevalence of CVRF and clinical cardiovascular disease (CVD) in the SLE population was evaluated and compared with a control population of patients without autoimmune disease matched for gender.
Results: 145 patients were identifi ed as SLE. After a case-by-case audit, 112 (77%) patients were confirmed as having SLE, representing a prevalence of 0.25%; 92%
were women, with a median follow-up of 11.3 years; death was recorded in 8.9%. The comparison of the main characteristics between SLE and the control group showed that SLE patients had a lower mean age (53.2 vs 60.5, p=0.001), a lower frequency of dyslipidemia (26% vs 47%, p=0.001), a lower mean total cholesterol (199.5 vs 211.3 mg/dL, p=0.023) and a lower mean systolic blood pressure (119 vs. 124.2 mmHg, p=0.043). In contrast, patients with SLE had a higher frequency of renal disease (32.1%
vs 12.1, p<0.001), cerebrovascular disease (8.0% vs 1.6%, p=0.027) and non-fatal car- diovascular events (17.0% vs 4.8%, p=0.003).
Conclusions: The level of diagnostic accuracy of SLE in our primary care area was high. We found a ‘cardiovascular paradox “: despite having a signifi cantly better de- gree of control of the main CVRF, and even being a younger population, a higher prev- alence of CVD was observed in SLE patients, suggesting that this autoimmune disease is, per se, a cardiovascular risk factor.
PS 0208 Family Medicine
Marital Satisfaction Levels of Diabetic and Non-Dia- betic Couples
Huseyin Avni SAHIN1, Gulnihal GUVENDI1, Dilek KUSASLAN2
Medical Faculty of Yuzuncu Yil University, Turkey1, High School of Health Sciences, Turkey2
Background: Family dynamics are increasingly recognized as affecting factor of management of Diabetes Mellitus (DM); however, little research has been done until recently.The aim of this study is to compare the marital satisfaction levels of couples with Diabetes and those without the disease in Eastern Turkey.
Methods: This was a cross sectional study conducted among couples during June 2014 at a major tertiary hospital in Van, Turkey. Couples previously diagnosed as Dia- betes Mellitus consisted the Diabetic Group and couples without Diabetes Mellitus and any other chronical disease consisted the Non Diabetic Group. Randomly selected 326 respondents were interviewed using the Turkish version of the Marital Satisfaction Scale to assess the satisfaction levels. Data was analyzed using SPSS computer soft- ware version 21 and the independent sample t-tests were the key statistical test.
Results: The mean age was 53.7 years among Diabetic Group (N=109) and 40.8 among Non-Diabetic group (N=217) (p=0001). The mean Body Mass Index was 31.6 among Diabetic Group and 28.5 among Non-Diabetic group (p=0001). The mean Diastolic Blood Pressure was 84.7 mm Hg among Diabetic Group and 77.3 mm Hg among Non-Diabetic group (p=0.0001). The mean number of children was 5.3 among Diabetic Group and 4.1 among Non-Diabetic group (p=0.0001). The mean Marital Sat- isfaction Score was 107.3 (male=112.2, female=102.8) among Diabetic Group and 99.2 (male=109.4, female=93.5) among Non-Diabetic group (p=0.004).
Conclusions: Diabetes is of growing public health concern in developing countries like Turkey. Marital stasifaction levels of Diabetic couples should be tested in order to identify and implement appropriate interventions. As Marital Satisfaction levels of Non-Diabetic women are lower more care should be given by the physicians to sup- port Non-Diabetic women.
PS 0209 Family Medicine
Myasthenia Gravis: We Looked, but Did We Really See?
Inês CASTIÇO1, Carina FREITAS1 Local Healthcare Unit of Baixo Alentejo, Portugal1
Myasthenia Gravis (MG) is a relatively rare autoimmune disease in which antibodies form against acetylcholine postsynaptic receptors at the neuromuscular junction of skeletal muscles. As a result patients present muscle weakness which is increased by exertion and relieved by rest. Although generalized weakness might be present, initial symptoms are usually confi ned to a specifi c muscle group, frequently the extraocular muscles. We report the case of a 23 year old female patient with no relevant personal or familial history. She fi rst came to our consultation about a year ago because she was pregnant. The pregnancy went well but after 6 months she started complaining of she came for another consultation referring asthenia, double vision and heavy eyelids especially at the end of the day. After a thorough investigation we learned that she was operated to her left eyelid ptosis by an ophthalmologist but with no diagnosis.
Clinical diagnosis of MG was made and the patient was referred to a neurologist who confi rmed our suspicion and initiated pharmacological treatment with Acetylcholine esterase (AChE) inhibitors.
Conclusion: We have seen the patient for 1 year but had never really given impor- tance to her ptosis until it got worse and she complained about it. Do we really see our patients or just look at them?
