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Tsuneaki Kenzaka,1,2 Ayako Kumabe,2 Koki Kosami,2 Yuki Ueda,2 Takeshi Takahashi,3 Yuya Yamamoto,4 Yurika Hayashi,4 Akihito Kitao,4 Masanobu Okayama5 1Division of Community Medicine and Career Development, Kobe University Graduate School of Medicine, Kobe, Japan; 2Division of General Medicine, Center for Community Medicine, Jichi Medical University School of Medicine, Shimotsuke, Japan; 3Department of Community and Family Medicine, Yuzawa Community Medical Center, Yuzawa, Japan; 4Department of General Medicine, Toyooka Public Hospital, Toyooka, Japan; 5Division of Community Medicine and Medical Education, Kobe University Graduate School of Medicine, Kobe, Japan Purpose: The aim of this study was to investigate whether the day of starting oral intake affects the clinical course of patients with aspiration pneumonia.Patients and methods: We conducted a retrospective cohort study of 392 patients who were hospitalized for aspiration pneumonia but tolerated oral intake. Patients were divided into two groups according to the day of starting oral intake: Monday to Friday (midweek group) and Saturday or Sunday (weekend group). Underlying diseases, severity of pneumonia, time to oral intake, hospital duration, discontinuation of oral intake, and death during hospitalization were compared between the groups. Multivariate analysis was performed using hospital duration and discontinuation of oral intake due to aspiration as the dependent variables.Results: The cohort comprised 244 men and 148 women with a mean age of 79.3 ± 13.1 years. The weekend (n = 98) and midweek (n = 294) groups exhibited similar age, sex, and underlying diseases. There were no significant differences in pneumonia-related factors, such as CURB-65 score, A-DROP score, extent of shadow on chest radiograph, incidence of bacteremia, and ventilator use. The weekend group exhibited a significantly shorter time to oral intake and hospital duration, as well as a significantly lower incidence of discontinuation of oral intake than the midweek group. Multivariate analysis revealed that starting oral intake on the weekend was independently associated with a lower incidence of discontinuation of oral intake due to aspiration. Conclusion: The weekend group exhibited a shorter total hospital duration and a lower incidence of discontinuation of oral intake due to aspiration. Keywords: discontinuation of oral intake, hospital duration, health economics, weekend

Tsuneaki Kenzaka,1,2 Taro Takeshima,3 Koki Kosami,2 Ayako Kumabe,2 Yuki Ueda,2 Takeshi Takahashi,4 Yuya Yamamoto,5 Yurika Hayashi,5 Akihito Kitao,5 Masanobu Okayama6 1Division of Community Medicine and Career Development, Kobe University Graduate School of Medicine, Kobe, 2Division of General Medicine, 3Division of Community and Family Medicine, Center for Community Medicine, Jichi Medical University School of Medicine, Shimotsuke, 4Department of Community and Family Medicine, Yuzawa Community Medical Center, Yuzawa, 5Department of General Medicine, Toyooka Public Hospital, Toyooka, 6Division of Community Medicine and Medical Education, Kobe University Graduate School of Medicine, Kobe, Japan Purpose: To assess the factors involved in oral intake discontinuation in elderly patients with recurrent aspiration pneumonia. Patients and methods: This study included patients with pneumonia who were treated at Jichi Medical University Hospital between 2007 and 2013, at Toyooka Public Hospital between 2011 and 2013 and at Yuzawa Community Medical Center between 2010 and 2012. We consecutively enrolled patients with aspiration pneumonia. The primary study point was oral intake discontinuation after the initiation of oral intake during hospitalization in cases of recurrent aspiration. Various parameters were recorded at admission, at the initiation of intake, and during hospitalization; these parameters were statistically evaluated. Results: A total of 390 patients were assigned to either a “no reaspiration of intake” group (n=310) or a “reaspiration of intake” group (n=80), depending on whether intake was discontinued owing to aspiration during hospitalization. At admission, the following items significantly differed between the groups: level of consciousness, respiratory rate, oxygen saturation, CURB-65 score, extent of infiltration/opacity on chest radiography, albumin levels, blood urea nitrogen levels, and application of swallowing function assessment. At the initiation of intake, level of consciousness, pulse rate, and albumin levels significantly differed between the groups. The following items did not significantly differ between groups: systolic blood pressure, pulse rate, C-reactive protein, bacteremia, use of ventilator at admission, oxygen administration, respiratory rate, and systolic blood pressure at initiation of intake. Multivariate analysis revealed that application of swallowing function assessment, level of consciousness at the initiation of intake, and extent of infiltration/opacity on chest radiography were significant predictive variables for discontinuation of intake. Conclusion: A low level of consciousness at the initiation of intake and a greater extent of infiltration/opacity on chest radiography and the application of a swallowing function are important factors. These factors may be helpful to determine a suitable timing for resumption of oral intake. Keywords: assessment of swallowing function, level of consciousness, recurrent aspiration, resumption of oral intake

Masanobu Okayama,1,2 Taro Takeshima,2 Masanori Harada,3 Ryusuke Ae,4 Eiji Kajii2 1Division of Community Medicine and Medical Education, Kobe University Graduate School of Medicine, Kobe, Hyogo, 2Division of Community and Family Medicine, Center for Community Medicine, Jichi Medical University, Shimotsuke, Tochigi, 3Department of Support of Rural Medicine, Yamaguchi Grand Medical Center, Hofu, Yamaguchi, 4Division of Public Health, Center for Community Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan Objective: Disclosing genetic testing results may contribute to the prevention and management of many common diseases. However, whether the presence of a disease influences these effects is unclear. This study aimed to clarify the difference in the effects of disclosing genetic testing results of the risk for developing salt-sensitive hypertension on the behavioral modifications with respect to salt intake in hypertensive and nonhypertensive patients.Methods: A cross-sectional study using a self-administered questionnaire was conducted for outpatients aged >20 years (N=2,237) at six primary care clinics and hospitals in Japan. The main factors assessed were medical histories of hypertension, salt preferences, reduced salt intakes, and behavior modifications for reducing salt intake. Behavioral modifications of participants were assessed using their behavior stages before and after disclosure of the hypothetical genetic testing results. Results: Of the 2,237 participants, 1,644 (73.5%) responded to the survey. Of these respondents, 558 (33.9%) patients were hypertensive and 1,086 (66.1%) were nonhypertensive. After being notified of the result “If with genetic risk”, the nonhypertensive participants were more likely to make positive behavioral modifications compared to the hypertensive patients among all participants and in those aged

Masanori Harada,1 Taro Takeshima,2 Masanobu Okayama,2,3 Eiji Kajii,21Department for Support of Rural Health Care, Yamaguchi Grand Medical Center, Hofu, Yamaguchi, 2Division of Community and Family Medicine, Center for Community Medicine, Jichi Medical University, Shimotsuke, 3Division of Community Medicine and Medical Education, Kobe University Graduate School of Medicine, Kobe, Japan Purpose: To identify the differences in genotype frequencies of salt-sensitive genes between residents of fishing communities (FCs) and nonfishing communities (NFCs). Methods: The subjects included 18,156 individuals (8,043 males [44%] and 10,113 females [56%]; average age: 57.2±16.1 years) from the general population who were registered with large-scale genome banks and resided in 30 prefectures and 78 different regions in Japan. The measurement items were age, sex, blood pressure, presence or absence of hypertension, body mass index, alcohol consumption, and smoking habit. Furthermore, to analyze the genotype frequencies of salt-sensitive genes, α-adducin 1 (ADD1), angiotensinogen (AGT), angiotensin II receptor type 1 (AT1), and guanine nucleotide-binding protein β peptide 3 (GNB3) were measured. According to the 2004 government classification of municipalities (cities, towns, and villages), communities existing in areas bordering an ocean and with an ocean port were defined as FCs (28 areas). The others were defined as NFCs (50 areas). A logistic regression model was used for comparison of genotype frequencies between subjects residing in FCs and NFCs. Results: Of the included subjects, 4,916 (27.0%) and 13,240 (73.0%) resided in FCs and NFCs, respectively. In FCs, the mean age was 59.4±16.7 years and men accounted for 41.0% of the cohort (n=2,015). In NFCs, the mean age was 56.4±15.8 years and men accounted for 45.5% of the cohort (n=6,028). The adjusted odds ratios of the AA and AG genotypes compared with the GG genotype for AGT were 0.80 (95% confidence interval [CI]: 0.68–0.95) and 0.76 (95% CI: 0.64–0.91), respectively. The adjusted odds ratio of the CC genotype compared with AA for AT1 was 0.63 (95% CI: 0.40–0.93). Conclusion: The incidence of the salt-sensitive genotypes AGT and AT1 in residents of FCs were significantly lower than in NFCs.Keywords: salt-sensitive, hypertension, single-nucleotide polymorphisms, regional difference, lifestyle, behavior

Taro Takeshima,1,2 Maki Kumada,3,4 Junichi Mise,5 Yoshinori Ishikawa,6 Hiromichi Yoshizawa,4 Takashi Nakamura,3,4 Masanobu Okayama,1 Eiji Kajii11Division of Community and Family Medicine, Center for Community Medicine, Jichi Medical University, Shimotsuke, Japan; 2Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan; 3Division of The Project for Integration of Community Health, Center for Community Medicine, Jichi Medical University, Shimotsuke, Japan; 4Department of General Internal Medicine, Chikusei City Hospital, Chikusei, Japan; 5Division of Human Resources Development for Community Medicine, Center for Community Medicine, Jichi Medical University, Shimotsuke, Japan; 6Department of Surgery, Chikusei City Hospital, Chikusei, JapanPurpose: Although many new patients are seen at small hospitals, there are few reports of new health problems from such hospitals in Japan. Therefore, we investigated the reasons for encounter (RFE) and diagnoses of new outpatients in a small hospital to provide educational resources for teaching general practice methods.Methods: This observational study was conducted at the Department of General Internal Medicine in a small community hospital between May 6, 2010 and March 11, 2011. We classified RFEs and diagnoses according to component 1, “Symptoms/Complaints”, and component 7, “Diagnosis/Diseases”, of the International Classification of Primary Care, 2nd edition (ICPC-2). We also evaluated the differences between RFEs observed and common symptoms from the guidelines Model Core Curriculum for Medical Students and Goals of Clinical Clerkship.Results: We analyzed the data of 1,515 outpatients. There were 2,252 RFEs (1.49 per encounter) and 170 ICPC-2 codes. The top 30 RFE codes accounted for 80% of all RFEs and the top 55 codes accounted for 90%. There were 1,727 diagnoses and 196 ICPC-2 codes. The top 50 diagnosis codes accounted for 80% of all diagnoses, and the top 90 codes accounted for 90%. Of the 2,252 RFEs, 1,408 (62.5%) included at least one of the 36 symptoms listed in the Model Core Curriculum and 1,443 (64.1%) included at least one of the 35 symptoms in the Goals of Clinical Clerkship. On the other hand, “A91 Abnormal result investigation”, “R21 Throat symptom/complaint”, and “R07 Sneezing/nasal congestion”, which were among the top 10 RFEs, were not included in these two guidelines.Conclusion: We identified the common RFEs and diagnoses at a small hospital in Japan and revealed the inconsistencies between the RFEs observed and common symptoms listed in the guidelines. Our findings can be useful in improving the general practice medical education curricula.Keywords: general practice, primary care, medical education, International Classification of Primary Care

Yutaka Nakashima,1 Tsuneaki Kenzaka,2 Masanobu Okayama,3 Eiji Kajii31Department for Support of Rural Medicine, Yamaguchi Grand Medical Center, 2Division of General Medicine, Center for Community Medicine, Jichi Medical University School of Medicine, Shimotsuke, Japan; 3Division of Community and Family Medicine, Center for Community Medicine, Jichi Medical University School of Medicine, Shimotsuke, JapanAbstract: A 23-year-old man became unconscious while jogging. He immediately received basic life support from a bystander and was transported to our hospital. On arrival, his spontaneous circulation had returned from a state of ventricular fibrillation and pulseless electrical activity. Following admission, hyperthyroidism led to a suspicion of thyroid storm, which was then diagnosed as a possible cause of the cardiac arrest. Although hyperthyroidism-induced cardiac arrest including ventricular fibrillation is rare, it should be considered when diagnosing the cause of treatable cardiac arrest.Keywords: hyperthyroidism, ventricular fibrillation, treatable cardiac arrest, cardiac arrest, cardiopulmonary arrest

Kazuhiro Takamura,1 Masanobu Okayama,2 Taro Takeshima,2 Shinji Fujiwara,3 Masanori Harada,4 Junichi Murakami,5 Masahiko Eto,6 Eiji Kajii21Department of Community Medicine, Obstetrics and Gynecology, Miyazaki Prefectural Miyazaki Hospital, Miyazaki, Japan; 2Division of Community and Family Medicine, Center for Community Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan; 3Mima City National Health Insurance Koyadaira Clinic, Mima, Tokushima, Japan; 4Department of Support of Rural Health Care, Yamaguchi Grand Medical Center, Hofu, Yamaguchi, Japan; 5Division of Chest Surgery, Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan; 6Department of Internal Medicine, Wakuya Medical and Welfare Center, Wakuya, Miyagi, JapanPurpose: A salt preference questionnaire may be a convenient and cost-effective method for predicting salt intake; however, the influence of salt preference on daily salt intake is unclear. This study aimed at revealing the effectiveness of the salt preference question in determining the daily salt intake in primary care outpatients.Patients and methods: This cross-sectional study included 1,075 outpatients (men, n=436, 40.6%) at six primary care institutions in Japan. Primary outcomes included a salty food preference assessed by using one question and a daily salt intake, assessed using early morning second urine samples. Multivariate analyses determined the relationships between the salt intake and the two salt preference levels.Results: The mean age was 67.6±14.6 years, and 594 (55.3%) preferred salty foods. The daily salt intake was 12.3±4.0 g per day and 11.4±3.7 g per day in the salt preference and nonsalt preference groups, respectively (P

Takashi Nakamura, Masanobu Okayama, Masakazu Aihara, Eiji KajiiCenter for Community Medicine, Jichi Medical University, Shimotsuke, Tochigi, JapanBackground: Unintentional injury is a major cause of death across the globe. The accessibility to emergency medical services may affect the rate of preventable trauma deaths. The purpose of this study was to analyze the accessibility to emergency medical hospitals in municipalities in Japan and to clarify whether accessibility was associated with the mortality rate attributed to unintentional injuries.Methods: An observational epidemiological study was conducted in all 1,742 municipalities in Japan. Measurements assessed were population size, accessibility to emergency hospitals, and mortality rates attributed to unintentional injuries. Accessibility of each municipality to their nearest emergency hospital was calculated with a computer simulation using a geographic information system. After calculating demographic statistics and the Gini coefficient of accessibility, multivariate analyses were used to examine the correlation between accessibility time and mortality. Municipalities were divided into six groups according to accessibility time, and we then performed a correlation analysis between accessibility time and mortality using analysis of covariance.Results: The median time of accessibility to emergency hospitals was 34.5 minutes. The Gini coefficient of accessibility time was 0.410. A total of 385 municipalities (23.4%) had an accessibility time of over 60 minutes. Accessibility was significantly related to mortality (beta coefficient =0.006; P30 minutes, and the mortality rate in municipalities with an accessibility time of 30–45 minutes was lower than that in municipalities with an accessibility time of 60–90 minutes (P

Yutaka Nakashima,1 Masanori Harada,1 Masanobu Okayama,2 Eiji Kajii2 1Department for Support Rural Medicine, Yamaguchi Grand Medical Center, Yamaguchi, 2Division of Community and Family Medicine, Center for Community Medicine, Jichi Medical University, Tochigi, Japan Background: It is necessary to establish an effective subcutaneous injection procedure for adult and elderly individuals because many drugs such as hormones and interferon are generally delivered by subcutaneous injection. We tested whether pain during subcutaneous injection can be decreased by prior application of localized manual pressure at the injection site. Methods: In this semirandomized, open-label study evaluating the manual pressure method for transient analgesia, physicians applied pressure with their thumbs for 10 seconds to create a nonpainful skin depression at the injection site immediately before subcutaneous injection of the influenza vaccine to patients. Control patients received the vaccine by the same route, but without prior application of focal pressure. In addition to pain, we evaluated patient age, gender, height, weight, body mass index, body temperature, and fat thickness at the brachial triceps muscle. Pain intensity was estimated using a 100 mm visual analog scale (VAS) and the face scale (FS). Categorical variables were compared using Chi-square tests and continuous variables were compared using unpaired t-tests between the intervention group and control group. Multivariate analysis was performed using the VAS or FS score as the dependent variable and weight, age, height, fat thickness at the brachial triceps muscle, and body temperature as independent variables. Results: There were no significant differences in demographic variables, VAS scores (22.5 ± 23.0 versus 21.2 ± 23.6, P = 0.4), or FS scores (2.5 ± 2.1 versus 2.4 ± 2.1, P = 0.4) between the intervention and control groups. There was a significant negative correlation between age and subjective pain intensity (VAS, r = −0.32; FS, r = −0.28). Conclusion: The manual pressure method was not effective in decreasing pain during subcutaneous injection. Alternative methods of focal transient analgesia should be developed to improve vaccination rates and relieve anxiety associated with subcutaneous injection. Keywords: pain, subcutaneous injection, pressure, visual analog scale, analgesia

Taro Takeshima,1,2 Masanobu Okayama,1 Masanori Harada,3 Ryusuke Ae,4 Eiji Kajii1 1Division of Community and Family Medicine, Center for Community Medicine, Jichi Medical University, Tochigi, Japan; 2Department of Healthcare Epidemiology, Kyoto University Graduate School of Medicine and Public Health, Kyoto, Japan; 3Department for Support of Rural Medicine, Yamaguchi Grand Medical Center, Yamaguchi, Japan; 4Department of General Internal Medicine, Hamasaka Public Hospital, Mikata, Japan Background: A few studies have explored the effects of disclosure of genetic testing results on chronic disease predisposition. However, these effects remain unclear in cases of hypertension. Reducing salt intake is an important nonpharmacological intervention for hypertension. We investigated the effects of genetic testing for salt sensitivity on salt restriction behavior using hypothetical genetic testing results. Methods: We conducted a cross-sectional study using a self-completed questionnaire. We enrolled consecutive outpatients who visited primary care clinics and small hospitals between September and December 2009 in Japan. We recorded the patients’ baseline characteristics and data regarding their salt restriction behavior, defined as reducing salt intake before and after disclosure of hypothetical salt sensitivity genetic test results. Behavioral stage was assessed according to the five-stage transtheoretical model. After dividing subjects into salt restriction and no salt restriction groups, we compared their behavioral changes following positive and negative test results and analyzed the association between the respondents’ characteristics and their behavioral changes. Results: We analyzed 1562 participants with a mean age of 58 years. In the no salt restriction group, which included patients at the precontemplation, contemplation, and preparation stages, 58.7% stated that their behavioral stage progressed after a positive test result, although 29.8% reported progression after a negative result (P < 0.001). Conversely, in the salt restriction group, which included patients at the active and maintenance stages, 9.2% stated that they would quit restricting salt intake following a negative test result, and 2.2% reported they would quit following a positive result (P < 0.001). Age < 65 years (adjusted odds ratio [OR] 1.74; 95% confidence interval [CI] 1.12–2.71), female gender (adjusted OR 1.84; CI 1.29–2.62), graduation from college or university (adjusted OR 1.66; CI 1.11–2.49), and desire for genetic testing (adjusted OR 4.53; CI 3.13–6.57) were associated with progression of behavioral stage in the no salt restriction group. Conversely, salt preference (adjusted OR 2.13; CI 1.31–3.49) was associated with quitting salt restriction in the salt restriction group. Conclusion: Patients in the no salt restriction group show the possibility of progression from the behavioral stage to the action stage after testing positive for salt sensitivity. Conversely, patients in the salt restriction group, particularly those with a salt preference, would quit salt restriction after testing negative. Keywords: behavioral change model, salt restriction, hypertension, genetic testing

Tsuneaki Kenzaka,1 Masanobu Okayama,2 Shigehiro Kuroki,1 Miho Fukui,3 Shinsuke Yahata,3 Hiroki Hayashi,3 Akihito Kitao,3 Eiji Kajii,2 Masayoshi Hashimoto41Division of General Medicine, 2Division of Community and Family Medicine, Center for Community Medicine, Jichi Medical University School of Medicine, Shimotsuke; 3Department of General Medicine, Toyooka Public Hospital, Toyooka; 4Department of Family and Community Medicine, Kobe University Graduate School of Medicine, Kobe, JapanBackground: The aim of this study was to evaluate the clinical usefulness of a semiquantitative procalcitonin kit for assessing severity of sepsis and early determination of mortality in affected patients.Methods: This was a prospective, observational study including 206 septic patients enrolled between June 2008 and August 2009. Disseminated intravascular coagulation (DIC), Sequential Organ Failure Assessment (SOFA), Acute Physiology and Chronic Health Evaluation (APACHE) II scores were measured, along with semiquantitative procalcitonin concentrations. Patients were divided into three groups based on their semiquantitative procalcitonin concentrations (group A,

OBJECTIVE: To show the relationship between the personal and educational backgrounds of rural doctors and their intention to continue a rural career. Design: Nationwide postal survey. Setting: Public clinics or hospitals in municipalities that are classified as 'rural' by the national government. SUBJECTS: A total of 4896 doctors working for 828 public clinics and hospitals. MEASUREMENTS: A questionnaire was mailed. The questionnaire inquired about the subject's age, sex, hometown, exposure to rural practice in undergraduate education, postgraduate training, continuing medical education, current position and affiliation status with a medical school, as well as his or her intention to continue a rural career. RESULTS: Response rate was 64%; 26% answered that they intended to continue a rural career. Postgraduate training in general internal medicine, general surgery, anaesthesiology, paediatrics and gastroenterology were positively related with the intention to continue a rural career (odds ratio = 2.045, 1.59, 1.30, 1.48, 1.38). Rural background, undergraduate exposure to rural practice, multispecialty-rotation in postgraduate training and current administrative position had positive correlations with the intention to continue in logistic regression analysis (odds ratio = 1.80, 2.47, 1.54, 2.17). Affiliation with a medical school department was negatively related with the intention to continue (odds ratio = 0.45). CONCLUSION: In addition to the rural background of physicians, some undergraduate and postgraduate factors were independently associated with the intention to continue a rural career. [ABSTRACT FROM AUTHOR]

OBJECTIVES: The purpose of this paper was to discover to what degree Japanese rural doctors are satisfied with various aspects of their jobs and lives, and to find out whether they intend to continue their rural careers. DESIGN: Nationwide postal survey. SETTING: Public clinics or hospitals in municipalities that are authorised as 'rural' by the national government. SUBJECTS: A total of 4896 doctors working for public clinics or hospitals. INTERVENTIONS: Self-evaluation questionnaires were mailed. The rural doctors were asked to evaluate their satisfaction with 19 items related to their job conditions and 10 items concerning life conditions, using a four-point scale. They also were asked to evaluate their intent to stay in rural practice until retirement. RESULTS: The response rate was 64%. Overall, rural doctors were satisfied with both their work and life conditions. However, only 27% of respondents hoped to continue rural practice beyond the usual age of retirement. Among job-related items, continuing medical education and interactions with municipal governments were rated as least satisfactory. Among lifestyle-related items, duration of holidays and workload were unsatisfactory. Subgroup analysis revealed male doctors showed greater intent to stay in rural practice. Doctors aged > 50 years were more satisfied with most aspects of their job and lifestyle than younger doctors. A strong correlation was found between the degree of intent to stay and several items such as interactions with municipal government, human interactions salary and job fulfillment. CONCLUSIONS: Strategies, based on the results of this survey, should be implemented. Particularly in Japan, positive interaction between doctors and municipal governments is crucial. WHAT THIS PAPER ADDS: Though rural doctors in Japan in general were satisfied with their lifestyle and work conditions, they have low intentions to stay in rural areas. Among the various factors that can cause this dissociation between satisfaction and intention to stay, doctors' interactions with municipal governments play a pivotal role. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to examine the factors affecting prescription of antibiotics for acute bronchitis in ambulatory care settings in Japan.Method: A prospective study was conducted on 92 physicians engaged in primary care regarding their prescription behaviour for a series of 20 new patients with acute respiratory diseases seen during November 1996 and the background factors affecting the behaviour.Results: A total of 1755 patients were registered during the study period, 302 (17.2%) of whom were diagnosed with acute bronchitis and 1165 (66.4%) with upper respiratory tract infection. Independent background factors related to diagnosis of acute bronchitis included self-care prior to visit (odds ratio 1.93, 95% CI 1.33-2.80), complaints such as cough (8.80, 4.77-16.2), sputum (2.24, 1.59-3.14) and purulent sputum (6.47, 3.02-13.9). The odds ratio was high in patients with more severe findings of the chest (5.00, 3.64-6.85), given chest X-ray (2.68, 1.33-5.38) while it was low in those feeling cold (0.68, 0.48-0.96), and those with a sore throat (0.63, 0.45-0.90), nasal symptoms (0.75, 0.54-1.04) and more severe findings of the pharynx (0.74, 0.58-0.92). In those with an upper respiratory tract infection, the odds ratio was high for complaints such as feeling cold (1.51, 1.11-2.05) and nasal symptoms (1.39, 1.04-1.86), while it was low for complaints such as cough (0.67, 0.48-0.95), sputum (0.43, 0.30-0.62), purulent sputum (0.19, 0.08-0.44), wheeze (0.34, 0.13-0.92), in those with more severe findings of the tonsil (0.36, 0.29-0.44) and the chest (0.30, 0.19-0.47) and given chest X-rays (0.29, 0.12-0.66). For acute bronchitis, antibiotics were administered to 67.5% and symptomatic therapy concurrently given to 64.9%. As for independent background factors related to prescription of antibiotics for acute bronchitis, the odds ratio was higher in physicians denying the efficacy of antibiotics for treating a cold (4.58, 1.94-10.8), and the patients with complaints such as purulent sputum (22.9, 2.66-197.2), more severe findings of the pharynx (2.26, 1.34-3.79) and of the chest (2.73, 1.53-4.88), and those who had a body temperature measurement taken (4.42, 1.71-11.4) and a chest X-ray (6.11, 1.07-34.9), but was lower in those complaining of chills (0.16, 0.04-0.66) and diarrhoea (0.11, 0.01-1.11).Conclusions: A majority of patients receiving medical care for acute bronchitis are given an unnecessary antibiotic prescription. The result of this study may be useful for the finding of appropriate forms of intervention for changing physicians' prescription behaviour. [ABSTRACT FROM AUTHOR]