Reform of National Universities in Japan and Mission of the JARM / 日本農村医学会雑誌

Corresponding to the international trend toward a reform of higher educational institutions and a structural reform of universities of Japan, a tota 89 national universities were incorporated in 2004. Each university is making its way in accordance with the 6-year interim plan.Analyses were made of the background and framework of university incorporation, its effect on community medicine, the international trend of agricultural medicine and problems to be addressed by the JARM from the viewpoint of reconstruction of community care in rural areas, especially in out-of-the-way villages and on solitary islands throughout this country.University reform is aimed at separation of education from management, clarification of the responsibility for students, independence from the educational administration, and guarantee of higher education. Behind the incentive of the reform is internationally common recognition that the society in the 21st century will be “knowledge-based society.”The surge of high education reform kicked off in the U.S. and Britain in the 1980s was closely related to their intention to continue economic and cultural development steadily, a market mechanism, intensified competition, and the grouping for the best way to create a new social system.In order to create and maintain healthy rural community, the JAPM has to grapple with various tasks strategically. They include:a comprehensive approach to health care, welfare and higher education; collaboration of rural residents and related governmental agencies with the former acting on their own initiatives; combination of health promotion and other local policies in remote rural areas; participation in agricultural policy making with international cooperation taken into consideration.

Dietary Antioxidants for Prevention of Cardiovascular Disease / Journal of Rural Medicine

The traditional Japanese diet with its high intake of fruits and vegetables that are rich in antioxidants is believed to effectively ward off cardiovascular disease. Oxidative stress, related to reactive oxygen and nitrogen species produced by aerobic organisms, is responsible for the pathogenesis of most chronic diseases. Oxidative low density lipoprotein (LDL) is thought to play a key role in the pathogenesis of early atherosclerosis. There has been increasing interest in antioxidant substances derived from edible plants. It has been suggested that the measurement of LDL antioxidant activity is physiopathologically more important and informative for screening antioxidant activity to prevent atherosclerosis than other methods. We assessed by LDL oxidation assay the antioxidant characteristics of various edible plants from rural areas. The mulberry (Morus alba L.) leaf showed comparatively high antioxidant activity. We identified the antioxidant compounds and investigated compound levels in the mulberry leaf and found the antioxidant activity of mulberry leaves to be mainly attributable to quercetin 3-(6-malonylglucoside) (Q3MG). Dietary consumption of mulberry leaves and/or Q3MG may enhance resistance to oxidative modification of LDL and attenuated atherosclerotic lesion development. However, the outcome of intervention trials suggested that a single antioxidant had little effect on the risk of developing cardiovascular disease. The synergic effect of certain combinations may determine outcome. We need to widen our understanding of the synergic effect of diets and nutrient-gene interactions related to nutrient/disease risk.

Weight Loss and Improvement of Metabolic Syndrome by Interventional Program Based on Health Education / 日本農村医学会雑誌

A cluster of insulin resistance, dyslipidemia and hypertension has been labeled as a metabolic syndrome. Asians have a lower rate of obesity than Caucasians, but have recently become increasingly prone to obesity and the metabolic syndrome, especially in rural communities in Japan. Although weight loss has been considered to be effective for improvement of the metabolic syndrome, most data are based on studies in Western countries with only limited information derived from Japanese populations. We conducted a study of 188 subjects who participated in our interventional program for obesity based on health education and self-determination in 2000-2003. The intervention induced significant decreases in caloric intakes and increases in physical activity in the participants, and then resulted in a significant 1.3kg reduction in weight on the average. Weght-loss was significantly associated with indexes of obesity, values of total cholesterol, triglyceide and HDL cholesterol levels, but was not related with blood pressure and LDL cholesterol, which were significantly decreased by our intervention. Furthermore a simple regression analysis was carried out to verify whether weight loss and metabolic syndrome parameters were related. Weight loss was determinantsexplaining less than a total of 10% of the variance in triglyceride and total cholesterol for the participants. Future studies of weight loss for metabolic syndrome should incorporate Asian ethnic factors, such as dietary habits and genetic influences.

The Evaluation of Community-Based Public Health Education with Reference to Core Concepts in New Public Health / 医学教育

Although great changes have already been made to medical education in Japan, the public health system urgently requires a paradigm change in the educational model. Recently, changes in the concept of public health have been proposed as “New Public Health” based on the World Health Organization's Health Promotion Movement in developed countries. We defined the core concepts and basic theories of New Public Health and have evaluated the validity to New Public Health of the community-based public health education model used since 1978 at Shimane Medical University. We have also established an educational environment that supports the development and dissemination of the model.

Investigation of the nurse and co-medical worker ; a basis of writing a scientific paper using the concept mapping / 日本農村医学会雑誌

Methods of writing a scientific paper and forming a working hypothesis were lectured. The concept mapping method has the possibility of evaluating learners' organization of knowledge in research. We tried an application of concept mapping to the research process of nursing. Concept mapping would clarify the conceptual framework, and develop research ability and problem-solving capability.

The International Strategy and Methodology of Healthy Communities with Reference to the Policy Science / 日本農村医学会雑誌

Amid the swell of the tide of globarization and decentralization, the building of healthy cities and communities has become an increasingly important task of Japan’s health and welfare policy makers. In this article the international trends, results and problems of the healthy cities projects were reviewed with attention focused on the 3rd period (1998-2002) of the WHO healthy cities programs. The strategy and methodology, and the theory and practice of the development of healthy cities and communities were also proposed with stress placed on the need of the symbiotic collaboration between rural communities and urban communities from the viewpoint of policy science.

Strategy for Building Healthy Communities in Rural Areas in Japan and Supportive Activities by the Japanese Association of Rural Medicine / 日本農村医学会雑誌

In the health and welfare policy of the 21st century, the building of healthy communities in rural areas has become an urgent task. The working out of an effective strategy and supportive activities by the Japanese Association of Rural Medicine have become important. We analyzed the situation, outcome, and problems of the health projects which have been continued for the past 40-50 years in Takasu?cho in Hokkaido, Masuda-cho in Akita, Matsumoto City in Nagano and Izumo City in Shimane Prefectures. The supportive actions by hospitals and universities were assessed as a model of community-academia collaboration.

Development and Evaluation of Interventional Program for Obesity Based on Health Education and Self-Dertermination / 日本農村医学会雑誌

To arrest the prevalence of obesity in Japanese rural communities, we have conducted to develop an interventional program for the prevention of obesity based on health education and self-dertermination since 2000. We adopted the behavioral program to strengthen self-control of diet and exercise based on learning principles. The objectives of the 3-month program were to lose weight by 3.0kg, to reduce metabolic measurement values by 10% in terms of dietary caloric intake and to keep taking over 7, 000 steps a day. Subjects were 140 residents with Body Mass Index of 24.8±3.0, aged 35-70 years, in Izumo City and Sada Town, Shimane Prefecture, who were interested in the prevention of overweight and obesity-associated diseases, voluntarily participated in the behavioral program conducted in 2000-2002. The rate of dropout from the program was 2.9%(4/140). The behavioral intervention induced significant decreases in intakes of energy, protein and fat, and increases in the number of steps per day taken by the participants. The intervention induced a significant difference in weightloss (-1.0kg in 2001 and -1.8kg in 2002). Significant differences of anthropometric parameters were found in body weight, BMI, waist and hip circumferences, blood pressure and lipid profiles, such as total cholesterol, LDL-cholesterol, and HDL-cholesterol, by the intervention in 2001 and 2002. Since our program is based on the participants' awareness and autonomous improvement of behavior, it would be easier to continue for a long term compared to complying with specialist's complicated prescription of behavioristic modification.

Comprehensive Evaluation of Risk Factors for Atherosclerosis among Workers in a Rural Community and a Local City / 日本農村医学会雑誌

In the 1990's, a metabolic syndrome associated with obesity, insulin resistance, hyperlipidemia and hypertension began to capture the attention of Japanese investigators as on ominous predictor of myocardial infarction. As there is few information of the metabolic syndrome in rural communities, we conducted a cross-sectional survey of the prevalence of the metabolic syndrome for 1, 084 workers aged 20-59 years in a rural community, Sada Town, and a neighboring local city, Izumo City, Shimane Prefecture. The number of risk factors for atherosclerosis was increased with age and was higher in males than in females. Men in their 50's in the rural community were at higher risk than their counterparts in the city. Most of the workers had one or two risk factors, and those who had three and more risk factors accounted for a little less than 7%. The rate of males aged 40-59 years in the rural community having over two risk factors among obesity, hyperlipidemia, hypertension and diabetes was significantly higher than that of the same age group in the city. The metabolic syndrome among males living in the rural community was related to obesity, hypo-HDL cholesterolemia, and hypertension. Males in the rural community had higher body mass index (BMI), than males in the city, but there was no significant difference in BMI between female groups. The prevalence of obesity in males in the rural community was linked with drinking habit and a decline in physical activities. In order to prevent the metabolic syndrome in the rural communities, a health policy based on a population-based strategy should be implemented to change the healthy lifestyle of workers, to promote health education and establish a health supportive environment.

The Occurrence of Bovine Spongiform Encephalopathy (BSE) in Japan from the Viewpoint of Political Science / 日本農村医学会雑誌

The Japanese government's response to the recent discovery of dairy cows suffering from bovine spongiform encephalopathy (BSE) in this country was analyzed from the viewpoint of policy science with reference to the policy in the United Kingdom and other EU countries. The results of investigation into the causative agent (s) androutes of infection of BSE that affected a total of seven cows were reviewed and the points at issue during the course of the epidemiological survey were given. Despite repeated warnings from the UK, EU and WHO, adequate countermeasures were not taken by the government offices concerned-the Ministry of Agriculture, Forestry and Fishery and the Ministry of Health, Welfare and Labor. They failed to prevent the occurrence of BSE and the resultant panic among consumers. The present review brought to lighta lack of a sense of urgency and risk management system in the government, the moral hazard in the food industry and market, the blunder of the government officials and the absence of an adequate food safety surveillance system. At the same time, we presented some proposals as to what the future food safety policy should be.

Educational Evaluation of Problem-solving Skills by Means of Concept Mapping / 医学教育

Tools to assess problem-solving skills are limited, and comprehensive evaluation is difficult. Concept mapping might be used to evaluate learners' organization of knowledge at various points during training. We used concept mapping to evaluate postgraduate training at the Department of Education Training Technology and Development, National Institute of Public Health. Thirty-five healthcare workers, including physicians, and public health nurses, underwent concept mapping training, drew preinstruction concept maps about public health or community organization, completed an educational course, and then drew postinstruction concept maps. Maps were assessed independently through qualitative comparison of concepts, conceptual links, hierarchy, knowledge domains, cross-links, and examples of preinstruction and postinstitution maps. This study provides preliminary evidence that concept mapping reflects changes and differences in the conceptual framework of individuals and of members of different healthcare specialties. Concept mapping can be used to clarify conceptual frameworks and to develop problem-solving skills. Moreover, concept mapping might be used to evaluate problem-solving skills.

Healthy Cities and Communities Projects as the Undergraduate Medical Education / 医学教育

We presented here an overview of the international innovation of public health and introduced our community-based educational practice of public health. We also reported it was effective for public health education to let students participate together with teachers in the cooperative movement developing healthy community and let them learn community dynamics, skills of participatory action research and the process of policy making. Today, the under-and post-graduate education of new public health will be effctively performed by participating in the practical healthy community project, which is performed cooperatively by communities, social resources and the university.

The Development of a Community-Based Educational Model in Public Health / 医学教育

Medical education in Japan has undergone dramatic changes, but nothing less than a paradigm change is required for the educational model for social medicine. In the 23 years since 1978, we have developed a community-based public health education program. The curriculum consists of a core of family health practice, student lectures, systematic teachers' lectures, participatory research on community health, and health policy-making. The community-based educational model was effective in developing students' active problem-based learning, abilities in health communication, and understanding of community needs as a biologic-psychologic-cultural-geographic complex; the empowerment of students and the community; and a comprehensive approach to the community care management which integrates health promotion and social welfare. We evaluated the community-based curriculum design, which exposes students to a wide variety of medical, social, and psychological problems in a community as a useful public health educational strategy.

Health Promotion of the Middle- and Old-age Women in Rural Areas in Japan / 日本農村医学会雑誌

Health condition of the middle- and old-age women living in various agricultural and mountain villeges of Japan was examined and measures for promoting their health were discussed.<BR>The study performed for two years from 1997. The cooperative team was composed of community health specialists who had dedicated their efforts of health promotion for a long time in rural area in Japan.<BR>1. A sheet concerning community profile was made to reveal the present situation of rural communities. The community characteristics was useful to analyse various health problems occuring in rapidly changing rural areas.<BR>2. A health check list of middle- and old-age women in rural communities was made from the aspects of woman health and rights. Also the sheets of community health management were prepared on the basis of each character of community and of age group, which were useful for promotion plan making of woman health.<BR>3. Health examination of middle- and old-age women in rual communities was carried out. Special attention was paid to menopausal disorders. By analysing its relation with life-style, 5% of the disorders were found to be of “the vascular neuromotor type” and each of 1% was “the sleep-disturbance type”, “the neurotic type” and “the sensory-disturbance type”. These results revealed the higher possibility of the influence of sociopsychological factors in women's living conditions rather than that of endocrine environment such as estrogen deficiency.

Strategies of Agricultural Medicine and Rural Health with a Perspective toward the 21st Century - What are the objectives to be carried out? / 日本農村医学会雑誌

We held the 48th meeting of the Japanese Association of Agricultural Medicine and Rural Health in Matsue, Shimane Prefecture in November, 1999. The main theme of this meeting was “Strategies of Agricultural Medicine and Rural Health with a Perspective toward the 21st Century”.<BR>The attendants of the meeting held discussion about four subthemes with the relation to the development of rural communities: environmental crisis and the human existence, medical high technology and humanism, human dignity and the quality of medicine and welfare, and the co-existence of rural and urban communities.<BR>The presidential lecture, which is reported here, treated the international trend of rural medicine and health care, our practice of rural medicine in San' in District, Japan, and some measures against aging society practiced by us in San' in District. The lecture also discussed about problems presented to the rural medicine in the 21st Century, and proposed several objectives to be carried out: integration of health care, medical care, welfare and education in rural districts, promotion of healthy lifestyle in rural districts, corporatism between administrators and researchers in medical care and welfare, policy-making for healthy rural communities and the protection of enviroment and eco-system.

Urination Trouble in Middle Aged and Elderly People and Need of Medical or Health Care / 日本農村医学会雑誌

Loss of bladder control has a significant psychological and social impact on the well-being of affected individuals. In the present study, a questionnaire survey regarding the incidence of urination trouble was conducted on individuals aged 40-86 years from a selected community.<BR>A total of 281 individuals (137 males and 144 females) responded to our survey. In this study, urination trouble was categorized into: painful urination, retension and a decreased daily activity due to loss of bladder control. Of the 281 respondents, 122 (43.4%) said they had one or more symptoms of dysuria, 89 (31.7%) had irritative symtoms, 67 (23.8%) had obstructive symtoms, and 53 (18.9%) experienced a decrease in daily activities due to loss of bladder control.<BR>The cases of abnormal urination showed no relationship to age, disease, or exercise. However, urinary abnormalities appeared to be related to frequent nocturnal and diurncl urination.<BR>Loss of bladder control showed a positive correlation with the individual's perception concerning the quality of life. Thus, it was made clear that urinary trouble should be grappled with in earnest in the field of community health care.

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.

Learning Satisfaction in Public Health Education with Student Participation / 医学教育

Social needs have prompted the development of new teaching methods in which active learning by students is emphasized. Public health education with student participation was introduced in a nursing school. A self-evaluation survey found that students considered these public health lectures good or excellent and were interested in public health and community health nursing. We conducted an analysis with covariance analysis of linear structural equations procedure using SAS statistical software to clarify a relationships among readiness of students, their learning types, and learning satisfaction in public health. A multiple indicator multiple cause model showed that learning satisfaction was associated with readiness for interest in public health, and learning type for self-directed learning. Students satisfied with student-centered public health education felt discouraged about nursing education. Our results suggest that teachers should develop the ability to communicate with students about dissatisfaction in nursing school and to support self-directed learning and tutor-assisted learning in small groups.

Development and Evaluation of an Early Exposure Training Program for Freshman Medical Students / 医学教育

Recent changes in social needs and the health care system have prompted the development of new teaching strategies and methods in which active learning by students in small groups is emphasized. We created an “early exposure” training program to enable freshman medical students to obtain practical experience at medical and welfare institutions. This program was designed with the following features 1) student-centered and self-directed learning, 2) integrated education for knowledge, skills, attitude and ethics, 3) training in communication skills, and 4) tutor-assisted and small-group discussion. Tutors were recruited from basic medical science departments. In a self-evaluation survey, 92% of students found this early exposure training to be excellent or good. Most students achieved improvement in communication skills, attitude and ethics among the educational objectives. However, a few students did not fulfill any objectives, and thus we should consider further improvements in the tutorial system.

Health Care for the Elderly. Today's Challenges, Tomorrow's Options. Canadian Medical Association; The CMA Committee on the Health Care of the Elderly / 医学教育

The report of the Canadian Medical Association (CMA) Committee on health care of the elderly was translated, in reference to the teaching of geriatric medicine.<BR>The present state of geriatric medicine teaching, the characteristics of health care for the elderly, the integration of geriatric medicine education, the curriculum of geriatrics, and the particular problems of postgraduate education in Canada were analysed. Some recommendations for improvement were proposed.