Comparison of Subjective/Objective Evaluation of Medical Students at Social Medicine Training between Different Grades in the Same Academic Year: Focus on Student Readiness / 医学教育

Background: The aims of the present study were to reveal the impact of the introduction of social medicine training one year earlier in a new university curriculum on subjective/objective evaluation of medical students, and to discuss the readiness of said students. Methods: In this natural experiment study, subjects comprised 73 third- (n = 31) and fourth-grade (n = 42) medical students who participated in social medicine training, namely “Family Health Practice Tutorial,” in 2017. The data consisted of student’s self-assessment and assessment from clients. The associations between these assessments and student grade were analyzed using the Mann-Whitney U test and ordinal logistic regression. Results: The score for “Language” in the assessment from the clients was significantly lower in the third-grade students than in the fourth-grade students after adjustment for gender (odds ratio = 0.147; 95% confidence interval = [0.027, 0.797]). Discussion: Insufficient readiness for language to residents in the community was found in third-grade medical students. Advanced communication training prior to practice for third-grade students may contribute to sustainable social medicine training in the community.

Social Medicine Training in Fukushima Medical University "Family Health Practice Tutorial" - Present State and Tasks / 医学教育

The Department of Hygiene and Preventive Medicine in Fukushima Medical University has carried out "Family Health Practice Tutorial" as part of social medicine training for undergraduate medical students. In this training, pairs of students, visited the same ordinary homes three times, and studied the Family Health Practices. Further learning was mainly offered in the tutorial, which is regarded as Problem-Based Learning. The visited family evaluated the students and gave feedback to them via their teachers. We herein present the report on the present state, evaluation method and tasks of the training. We also discuss the meaning of this training in medical education as well as future direction.

Dioxins levels in human blood after implementation of measures against dioxin exposure in Japan

BACKGROUND@#Over the past few decades, the Japanese Ministry of the Environment has been biomonitoring dioxins in the general Japanese population and, in response to public concerns, has taken measures to reduce dioxin exposure. The objectives of this study were to assess the current dioxin dietary intake and corresponding body burden in the Japanese and compare Japanese dioxin data from 2011 to 2016 and 2002-2010 surveys. We also examined the relationship between blood dioxins and health parameters/clinical biomarkers.@*METHODS@#From 2011 to 2016, cross-sectional dioxin surveys were conducted on 490 Japanese (242 males and 248 females, aged 49.9 ± 7.6 years) from 15 Japanese prefectures. Blood (n = 490) and food samples (n = 90) were measured for 29 dioxin congeners including polychlorinated dibenzo-para-dioxins (PCDDs), polychlorinated dibenzofurans (PCDFs), and coplanar polychlorinated biphenyls (Co-PCBs) using gas chromatography coupled with high-resolution mass spectrometry. Using the 2006 World Health Organization toxic equivalence factors, the toxic equivalents (TEQs) were calculated. Clinical biomarkers and anthropometric parameters were also measured and information on lifestyle behaviours collected. Data imputations were applied to account for blood dioxins below the detection limit.@*RESULTS@#The median (95% confidence interval or CI) blood levels and dioxin dietary intake was respectively 9.4 (8.8-9.9) pg TEQ/g lipid and 0.3 (0.2-0.4) pg TEQ/kg body weight/day. The median blood dioxin level in the 2011-2016 survey was found to have decreased by 41.3% compared to the 2002-2010 surveys. Participants who were older were found to be more likely to have higher dioxin levels. Blood dioxins were also significantly associated with body mass index, triglycerides, docosahexaenoic acid, eicosapentaenoic acid, and dihomo-gamma-linoleic acid levels in blood. Furthermore, associations between blood dioxin and dietary dioxin intake were evident in the unadjusted models. However, after adjusting for confounders, blood dioxins were not found to be associated with dietary dioxin intake.@*CONCLUSIONS@#Blood dioxin levels declined over the past decade. This study showed that the measures and actions undertaken in Japan have possibly contributed to these reductions in the body burden of dioxins in the Japanese population.

Characteristics of facial expression recognition ability in patients with Lewy body disease

BACKGROUND@#The facial expression of medical staff has been known to greatly affect the psychological state of patients, making them feel uneasy or conversely, cheering them up. By clarifying the characteristics of facial expression recognition ability in patients with Lewy body disease, the aim of this study is to examine points to facilitate smooth communication between caregivers and patients with the disease whose cognitive function has deteriorated.@*METHODS@#During the period from March 2016 to July 2017, we examined the characteristics of recognition of the six facial expressions of "happiness," "sadness," "fear," "anger," "surprise," and "disgust" for 107 people aged 60 years or more, both outpatient and inpatient, who hospital specialists had diagnosed with Lewy body diseases of Parkinson's disease, Parkinson's disease with dementia, and dementia with Lewy bodies. Based on facial expression recognition test results, we classified them by cluster analysis and clarified features of each type.@*RESULTS@#In patients with Lewy body disease, happiness was kept unaffected by aging, age of onset, duration of the disease, cognitive function, and apathy; however, recognizing the facial expression of fear was difficult. In addition, due to aging, cognitive decline, and apathy, the facial expression recognition ability for sadness and anger decreased. In particular, cognitive decline reduced recognition of all of the facial expressions except for happiness. The test accuracy rates were classified into three types using the cluster analysis: "stable type," "mixed type," and "reduced type". In the "reduced type", the overall facial recognition ability declined except happiness, and in the mixed type, recognition ability of anger particularly declined.@*CONCLUSION@#There were several facial expressions that the Lewy body disease patients were unable to accurately identify. Caregivers are recommended to make an effort to compensate for such situations with language or body contact, etc., as a way to convey correct feeling to the patients of each type.

Development of a novel self–assessment system for the clinical competence of medical students / 医学教育

To accurately assess the clinical competencies of medical students at Fukushima Medical University, we have developed a novel online self–assessment system, which covers all goals in the "Model Core Curriculum for Medical Education in Japan." We added "Emergency," "Communication skills with staff," and "Simulation–based learning." Following their clinical clerkships, 79 sixth–year medical students assessed themselves and their clinical clerkships.<br>1)This novel online self–assessment system, consisting of 68 checklists in 15 fields, easily informs us of the actual conditions of clinical clerkships and students' confidence in their clinical competencies.<br>2)This internet–based self–assessment system revealed the current status and problems of clinical clerkships, prompting feedback to clinical instructors and members of the instruction committee.<br>3)Students felt "confident" or "confident to a certain degree" in most learning areas; however, simulation–based learning seems to be necessary in several areas, such as clinical skills, where feelings of shame or discomfort may be associated with patient care.<br>4)Students who had high total self–assessment scores evaluated clinical clerkships favorably. In contrast, students whose self–assessments frequently included "no learning experience" evaluated their clerkships negatively in the educational aspects of "skill" and "attitude."

Supporting the well-being of first- and second-year medical students / 医学教育

To investigate the effects of generational factors on the lives of medical students in the first and second years, we surveyed students about the frequency of problems and the seeking of advice.1) A questionnaire was distributed to first- and second-year students in January 2009 asking about problems regarding academic work, mental health, financial concerns, career options, physical wellness, and interpersonal relationships.2) About 70% of the students had sought advice regarding academic work and interpersonal relationships. Also, about 50% had sought advice regarding mental health.3) Students chose potential advisors depending on the type of problem; however, they preferred to consult with their classmates and upperclassmen. In addition, their parents played a role. In contrast, students rarely consulted with teachers.4) High percentages of first- and second-year medical students had various problems. Creating a support system to address these problems is important.

The relationship between clustering health-promoting components of lifestyle and bone status among middle-aged women in a general population

<p><b>OBJECTIVE</b>The association between clustering health-promoting components of lifestyle and bone status was examined among middle-aged women.</p><p><b>METHODS</b>A cross-sectional study was conducted in Tadami Town, Fukushima Prefecture, Japan, in 2007. A total of 305 middle-aged women (mean age 55.2 years) participated. The Health-Promoting Lifestyle Profile II was used to assess health-promoting components of lifestyle. Participants' bone status was examined using quantitative ultrasonic calcaneal measurement.</p><p><b>RESULTS</b>A total of 139 participants (45.6%) were defined as having low bone stiffness. In the low bone stiffness group, the mean age was significantly higher, and prevalence of interpersonal relationships score over 3.0 was lower than that in the normal bone stiffness group. There were significant trends in the prevalence of low bone stiffness, each health-promoting component of lifestyle, and presence of hypertension and diabetes mellitus, based on the number of frequently selected health-promoting components of lifestyle. The number of frequently selected health-promoting components of lifestyle correlated negatively with the prevalence of low bone stiffness in both crude and adjusted results.</p><p><b>CONCLUSION</b>This research is particularly important as we suggest health-promotion strategies for the prevention of osteoporosis. A synthetic approach, which includes health responsibility, spiritual growth, interpersonal relations, and stress management, and physical activity and nutrition, may be effective and complement traditional strategies.</p>

Niacin metabolism and Parkinson's disease

Epidemiological surveys suggest an important role for niacin in the causes of Parkinson's disease, in that niacin deficiency, the nutritional condition that causes pellagra, appears to protect against Parkinson's disease. Absorbed niacin is used in the synthesis of nicotinamide adenine dinucleotide (NAD) in the body, and in the metabolic process NAD releases nicotinamide by poly(ADP-ribosyl)ation, the activation of which has been reported to mediate 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine-induced Parkinson's disease. Recently nicotinamide N-methyltransferase (EC2.1.1.1) activity has been discovered in the human brain, and the released nicotinamide may be methylated to 1-methylnicotinamide (MNA), via this enzyme, in the brain. A deficiency in mitochondrial NADH: ubiquinone oxidoreductase (complex 1) activity is believed to be a critical factor in the development of Parkinson's disease. MNA has been found to destroy several subunits of cerebral complex 1, leading to the suggestion that MNA is concerned in the pathogenesis of Parkinson's disease. Based on these findings, it is hypothesized that niacin is a causal substance in the development of Parkinson's disease through the following processes: NAD produced from niacin releases nicotinamide via poly(ADP-ribosyl)ation, activated by the hydroxyl radical. Released excess nicotinamide is methylated to MNA in the cytoplasm, and superoxides formed by MNA via complex I destroy complex 1 subunits directly, or indirectly via mitochondrial DNA damage. Hereditary or environmental factors may cause acceleration of this cycle, resulting in neuronal death.

The effect of heavy metals on nicotinamideN-methyltransferase activityin vitro relating to Parkinson's disease

<p><b>OBJECTIVE</b>The aims of this study were to determine the effects of heavy metals such as manganese on nicotinamideN-methyltransferase (EC 2.1.1.1) (NNMT) activity and to consider the possibility of involvement of NNMT activation in the pathogenesis of heavy metal induced Parkinson's disease.</p><p><b>METHODS</b>NNMT activity in supernatants separated from brain, liver and kidney homogenates of 5 elderly male Wistar rats by centrifugation were measured by high performance liquid chromatography system with fluorescence. NNMT activity under the conditon of 0.5 or 5.0 mM Mn(2+), Fe(2+), Cu(2+) or Cd(2+) was compared with control (no metal ion existence).</p><p><b>RESULTS</b>NNMT activities in rat brain, liver and kidneys were significantly decreased by Cu(2+), and those in the liver and kidneys were significantly decreased by Cd(2+). Mn(2+) reduced NNMT activity only in the liver. Fe(2+) had no effect on NNMT activity.</p><p><b>CONCLUSIONS</b>No metal increased NNMT activity in this study, contrary to our hypothesis. Further study is needed to clarify the reason why the effects of Mn(2+) and Fe(2+) which have a high relevance to Parkinson's disease on NNMT activity differ from those of Cu(2+) and Cd(2+).</p>

The Effect of Heavy Metals on Nicotinamide \it{N}-methyltransferase Activity \it{In Vitro} Relating to Parkinson\rqs Disease

Objective: The aims of this study were to determine the effects of heavy metals such as manganese on nicotinamide N-methyltransferase (EC 2.1.1.1) (NNMT) activity and to consider the possibility of involvement of NNMT activation in the pathogenesis of heavy metal induced Parkinson’s disease. Methods: NNMT activity in supernatants separated from brain, liver and kidney homogenates of 5 elderly male Wistar rats by centrifugation were measured by high performance liquid chromatography system with fluorescence. NNMT activity under the conditon of 0.5 or 5.0 mM Mn2+, Fe2+, Cu2+ or Cd2+ was compared with control (no metal ion existence). Results: NNMT activities in rat brain, liver and kidneys were significantly decreased by Cu2+, and those in the liver and kidneys were significantly decreased by Cd2+. Mn2+ reduced NNMT activity only in the liver. Fe2+ had no effect on NNMT activity. Conclusions: No metal increased NNMT activity in this study, contrary to our hypothesis. Further study is needed to clarify the reason why the effects of Mn2+ and Fe2+ which have a high relevance to Parkinson’s disease on NNMT activity differ from those of Cu2+ and Cd2+.

Niacin Metabolism and Parkinson\rqs Disease

Epidemiological surveys suggest an important role for niacin in the causes of Parkinson’s disease, in that niacin deficiency, the nutritional condition that causes pellagra, appears to protect against Parkinson’s disease. Absorbed niacin is used in the synthesis of nicotinamide adenine dinucleotide (NAD) in the body, and in the metabolic process NAD releases nicotinamide by poly(ADP-ribosyl)ation, the activation of which has been reported to mediate 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine-induced Parkinson’s disease. Recently nicotinamide N-methyltransferase (EC2.1.1.1) activity has been discovered in the human brain, and the released nicotinamide may be methylated to 1-methylnicotinamide (MNA), via this enzyme, in the brain. A deficiency in mitochondrial NADH:ubiquinone oxidoreductase (complex I) activity is believed to be a critical factor in the development of Parkinson’s disease. MNA has been found to destroy several subunits of cerebral complex I, leading to the suggestion that MNA is concerned in the pathogenesis of Parkinson’s disease. Based on these findings, it is hypothesized that niacin is a causal substance in the development of Parkinson’s disease through the following processes: NAD produced from niacin releases nicotinamide via poly(ADP-ribosyl)ation, activated by the hydroxyl radical. Released excess nicotinamide is methylated to MNA in the cytoplasm, and superoxides formed by MNA via complex I destroy complex I subunits directly, or indirectly via mitochondrial DNA damage. Hereditary or environmental factors may cause acceleration of this cycle, resulting in neuronal death.

Lifestyle-related Health Problems Confronting Japanese-Brazilians Immigrated to Japan / 日本農村医学会雑誌

To clarify the relation between living habitudes in Japan including daily fare and health, the state of health of 21 Japanese-Brazilians living in Japan was investigated. The relation was analyzed based on their views, about the Japanese customs. Only two persons were found to have adapted themselves to the living environment in Japan, 10 persons were not adaptable sufficiently and 9 suffered from maladaptation. Asked why they were not adaptable, they gave personal relations, difficulty in reading and writing, workplace stress, etc. It was also found that at the present their biggest worry concerned the future, followed by personal relations, Japanese language, work and education in that order. Our investigation brought to light the fact that there was much to be done by the local community in terms of receiving immigrants. When it came to foodstuffs, after visiting Japan, the intake of salt, meat and fruit decreased, and fish increased. Like most Japanese, the Japanese-Brazilians regarded salad and rice-baseddiet healthy, but coffee not good. Referring to some foodstuffs which are customarily eaten less, many said they feel eating a lot of fish and shellfish in Japan is good for the health, but little fruit and little bean food are not good. As for the present health condition, more than half of the subjects said they had some problem. In the relation between the change in weight and the change in eating habit, only the increased intake of sugar was related to weight gain. The effect of the Japanese way of life on their health must be continuously followed up on with the common and different points of the customs in eating between Brazil and Japan taken into account.

Mechanism of cytotoxicity of paraquat

Acute paraquat poisoning seems to be very complex because many possible mechanisms of paraquat cytotoxicity have been reported. Some may not be the cause of paraquat poisoning but the result or an accompanying phenomenon of paraquat action. The mechanism critical for cell damage is still unknown. Paraquat poisoning is probably a combination of several paraquat actions. Arguing which mechanism is more critical may not be important, and these clarified mechanisms should be connected and utilized in the development of treatment for paraquat poisoning. Many people still die of pulmonary fibrosis after paraquat exposure. The next target of study will be to verify the mechanism of pulmonary fibrosis by paraquat on the basis of the outcome of studies such as this review.

Mechanism of Cytotoxicity of Paraquat

Acute paraquat poisoning seems to be very complex because many possible mechanisms of paraquat cytotoxicity have been reported. Some may not be the cause of paraquat poisoning but the result or an accompanying phenomenon of paraquat action. The mechanism critical for cell damage is still unknown. Paraquat poisoning is probably a combination of several paraquat actions. Arguing which mechanism is more critical may not be important, and these clarified mechanisms should be connected and utilized in the development of treatment for paraquat poisoning. Many people still die of pulmonary fibrosis after paraquat exposure. The next target of study will be to verify the mechanism of pulmonary fibrosis by paraquat on the basis of the outcome of studies such as this review.

Healthy Town Planning Friendly to Natural Ecosystems. Environmental Network Formation Model in a River-Lake Basin / 日本農村医学会雑誌

The activities of the community based environmental forum over the past 7 years to maintain the Hii River-Shinji Lake ecosystem were reviewed. The network formation model for environmental safeguard developed in local communities in Shimane and the action targets of a healthy city project were evaluated.<BR>1. Interaction between the development of theme and the increased participation of people from all walks of life.<BR>In 1991, the communities launched “The Chironomidae-outbreak counterplan” named “Shinji Lake Forum” with the participation of various classes of inhabitants around Shinji Lake, including fishermen, biologists and environmental health researchers. The participatory action spread from residents around Shinji Lake to other communities along Hii River, resulting in the formation of an enlarged community network and inter disciplinary research network. The action targets developed as follows:<BR>(1) the Chironomidae-outbreak counterplan, (2) water quality preservation of Shinji Lake, (3) community class for ecology, (4) a community network encompassing the river-lake basin, (5) a healthy city project aimed at cultural development.<BR>2. The objective of the healthy city project<BR>Now the participatory action is developing into the movement of “The Harmony of natural ecosystems”. With linkages between development and ecosystem protection, the healthy city project aimed at cultural development could be pursued in harmony with natural environment.<BR>3. “The network formation model that has gone through processes of opposition and sharing” and participatory action research<BR>In this paper we discuss the formation process of environmental safeguard network. At first, opposition structure such as the fishermen and the agriculturalists, the citizens and the administration, the upperstream area residents and the downstream area residents, was made obvious by making clear differences in interest concerning the environment and living well-being. And the common goals to achieve and roles individuals have to play become clear through the process of sharing a thought on the natural ecosystem and the process of recognizing the different standpoints again. The importance of the cooperation of residents, administrations and researchers, together with participatory action research using the network formation model, was emphasized in order to settle variously complicated problems of ecosystems.

Living Conditions of the Solitary Elderly and Their Community Health Problems with Reference to Local Characteristics / 日本農村医学会雑誌

To investigate the problems confronting the present health care system for the elderly in depopulated areas of Japan, we examined the living conditions of solitary aged people in two rural communities, Sada and Koryo, Shimane Prefecture, where the percentage of aged population is the highest among all the prefectures in Japan. Just as community characteristics ofthe two areas are different from each other, so are the features of the elderly's health needs.<BR>Sada is a mountainous agricultural community, where the acreage of cultivated land per household is relatively large. As many families are composed of three generations, only a small number of aged people are living by themselves.<BR>Koryo is a urbanized agricultural community on the outskirts of Izumo City. As the acreage of cultivated land per household is narrower, the average number of family members is smaller, and the percentage of the elderly, especially female, living alone is remarkable.<BR>In Sada as well as Koryo the solitary life of the elderly mostly resulted from the death of their spouse. Their daily contact with their children is scarce, because most childrenlive in big cities far away from their parent's home. The rate of the solitary elderly whose children and their family will return home in future is 27.0% in Sada and 43.4% in Koryo.<BR>Most of the social problems the solitary elderly face are derived from strained household economy. The rate of the elderly whose living expenses are less than 60, 000 yen a month is 41.2% in Sada and 31.6% in Koryo. As the economic resources of the solitary elderly are generally meager, the community should gear up to meet their economic needs.

Exposure assessment of Organophosphate Pesticide(DDVP) Based on the Aerial Concentration in the Greenhouse / 日本農村医学会雑誌

The exposure to the organophosphate pesticide (DDVP) by sprayers was assessed based on the measurements of concentration in the greenhouse. The serum concentrations of DDVP were examined 1 hour after spraying in two men who worked in the greenhouse with gas masks. Their serum concentration level was 21.2 ng/ml and 15.0 ng/ml, respectively, while serum cholinesterase was within normal level in both men. Changes in aerial DDVP concentrations in the greenhouse were examined. The result showed a higher concentration at the lower point (0.7 m high from the ground) than at the higher point (1.4 m high from the ground). The aerial concentration remained high (0.5ppm-2.0 ppm) for two days after spraying and started to decline thereafter to 0.5 ppm or less. On the seventh day, it was undetectable.<BR>From these results, we suggest that the following precautions should be taken toprevent pesticide exposure in the greenhouse. 1. Wearing only a gas mask but also goggles are recommended when pesticides are being sprayed. 2. The work in the greenhouse should be postponed until the second day after spraying because of the aerial residue of pesticide. 3. The frequent ventilation and gas mask are necessary till the seventh day after spraying. 4. Ventilation of the zone near the ground should be done sufficiently when the workers take the half-sitting posture like “buds gathering, ” because they are exposed to higher aerial concentrations of pesticide than when they are working in a standing posture.

Experience with new community-based curriculum in environmental medicine. (3). Effective trial of co-medical workers' participation in improvement of medical education / 医学教育

The new community-based curriculum in Shimane Medical University, Japan, which are mainly based on family health practice and community health approach, is useful for students to understand the comprehensive medicine and holistic approach to community-based primary health care.<BR>It is important to introduce district health workers in the preventive education for medical students to obtain to humanistic attitude and to change their value and behavior.<BR>The importance of the exposure to the community health activities organized with man power and social resources should be more stressed in the improvement of the medical education curriculum and also of educational methodology to learn the essential physicians' nature such as humanity, responsibility, cooperation, positive attitude, and ability of problem solving.

Two cases of imported amebiasis in a rural district of Shimane prefecture, Japan / 日本農村医学会雑誌

We treated two elderly patients who contracted amebiasis in a foreign country. They ate a watermelon in Peking, the People's Republic of China. From their account, the watermelon was considered the most probable source of infection.<BR>In Case 1, the patient complained of acute nausea, vomiting, diarrhea and unconsciousness following severe dehydration. The trophozoites of <I>Entamoeba histolytica</I> were found by stool examination. The treatment with metronidazole was not so effective in Case 1 patient with fulminating amebic colitis. In Case 2, he had no subjective symptoms, but the cysts of <I>Entamoeba histolytica</I> were found by stool examination.<BR>Recently, traveling abroad has become popular. The number of travelers has been increasing in Japan from not only urban districts but also rural districts. Therefore, it is necessary to exercise strict rigilance over the imported protozoan parasites and possible mass outbreak of amebiasis in tour groups.

Promotion of the health care for farmers working in factories in rural district / 日本農村医学会雑誌

Today's one of the most important problems both in the industrial hygiene and the community health care is the health protection of farmers who are working in factories. There are many such farmers in the San'in rural districts. We surveyed the working conditions of 370 factories in Shimane Prefecture and found that they had many problems to be solved. The problems in the factories, mostly small-scale factories, are summarized as aging of workers, long working hours, insufficient rest, harmful work and night work.<BR>Even in Sada-cho, where the local government is promoting the comprehensive community health care and encouraging the health care activity of inhabitants, the health care for factory workers is performed insufficiently. Some factories do not carry out even a periodical health examination of the workers.<BR>We established the Sada-cho Occupational Health Association in cooperation with the local government, Izumo Health Center, Shimane Labor Standard Inspection Office and the factories in Sada-cho for the purpose of promoting the unified activity of the industrial hygiene and the community health care.