Public health education in the United States has historically been separate from medical education and has emphasized practical training. Public health education is standardized under an accreditation system and is offered by interdisciplinary faculties. Schools have made efforts to provide a variety of programs responding to the vast needs of students with different professional backgrounds. Despite a constant increase in the number of students, the public health workforce remains too small, and schools are reforming their educational systems.

To identify methods for improving reproductive health in developing countries, we reviewed recent family planning issues in Japan. Findings showed that the process of approval for oral contraceptives in Japan has been influenced by sociopolitical discussions without much focus on women's needs for effective contraceptives. We next analyzed recent abortion trends and conducted surveys on unintended pregnancy. Results showed unintended pregnancy to be highly prevalent, which suggested an association with child rearing outcomes when carried out to term. Additional epidemiologic data is needed to document women's health status and to promote evidence-based health services.
Given that Japan and Vietnam share several common characteristics related to reproductive health, we are currently conducting a prospective study of pregnant women in both countries to determine the impact of pregnancy intention on child rearing. Prior to the survey, we started a training program to improve capacity of local health professionals to carry out epidemiologic studies. When assisting developing countries in reaching their health goals, it is important to increase local capacity in collecting scientific evidence and to promote its application in health practice.

1) Obstetrics medical education in Japan, Vietnam, Thailand was compared.The education differed according to the levels of knowledge and the techniques required for first-year doctors.In Japan and Vietnam, the importance of selfdirected learning was stressed in doctors' interviews.
2) The number of deliveries students attended was much higher among Vietnamese students than among Japanese students. Accordingly, Vietnamese students rated their obstetric knowledge and clinical skills more highly than did Japanese students.
3) The major challenges in Japanese medical education are to provide medical students with opportunities to participate in medical care as a member of a treatment team by introducing clinical clerkship training and to enable students to learn in a more self-directed manner.

Objective: This study aimed to clarify outpatient nurses' awareness of their support for the decision-making of newly diagnosed cancer patients undergoing surgical therapy.Methods: Semi-structured interviews were conducted with eight outpatient nurses from two hospitals, and transcribed data were analyzed qualitatively.Results: The following four categories of outpatient nurses' awareness were extracted: "Difficult environment for supporting decision-making", "Identifying a patient in need of support", "Collaborating at the organizational level", and "Supporting the patient until a satisfying decision is made". Although the nurses recognized the need to support cancer patients' decision-making when undergoing surgical therapy, they were obliged to prioritize other duties and found it difficult to adequately provide the support needed. Although it was difficult, nurses tried to identify patients requiring support during their routine work, and to assist them until a satisfying decision was made by collaborating with colleagues at the organizational level.Conclusion: In order for outpatient nurses to more effectively support cancer patients' decision-making, it is necessary to allocate an adequate number of personnel, secure interview spaces, and provide training for nurses to improve their skills in decision-making support, in addition to implementing the necessary organizational changes.

Glycogen is an important source of energy production during endurance exercise, such as marathon. Due to limited storage of glycogen in muscle and liver, augmentation of fat oxidation is known to delay depletion of muscle glycogen, leading to improvement of endurance performance. N-3 polyunsaturated fatty acids (n-3 PUFA) resulting from the form of fish has shown to enhance fat oxidation at rest. However, effect of n-3 PUFA on substrate metabolism during prolonged exercise remains unclear. The present study was designed to investigate whether dietary n-3 PUFA enhances fat oxidation during exercise and endurance performance. Thirteen healthy men were divided into n-3 PUFA group [n=6, 6g/day of fish oil; 1,800mg eicosapentaenoic acid (EPA), 2,700mg docosahexiaenoic acid (DHA)] or CON group [n=7, 6g/day of olive oil]. The subjects ingested each supplement for 4-weeks. Before and after the treatment period, a 60-min pedaling exercise at 65% of maximal oxygen uptake followed by 5 km-time-trial was conducted. Resting concentrations of serum EPA and DHA, EPA/AA were significantly elevated in the n-3 PUFA group only. After supplementation period, the n-3 PUFA group increased significantly exercise-induced elevations of serum free fatty acids and glycerol concentrations, and lowered respiratory exchange ratio during a 60-min pedaling exercise. Similar changes were not observed in the CON group. However, treatment with n-3 PUFA did not affect significantly result of 5km-time-trial. Four-week supplementation of n-3 PUFA increased exercise-induced lipolysis and fat oxidation during prolonged exercise. However, the augmented fat metabolism did not affect endurance performance.

Introduction: Epidemiologic evidence on childhood vaccination is scarce in Japan. Our aim was to investigate the vaccination completion rate and risk factors of incomplete vaccination.
Methods:This study was a secondary analysis of the database developed for a childhood infection study of 2368 attendants of 18-month health checkups in one city in Japan. The data of vaccination history included bacillus Calmette-Guérin, diphtheria-pertussis-tetanus, measles-rubella, and polio. A total of 1622 children were included in analyses after 746 were excluded because a large portion of their data was missing, and because their birthweight was <2500 g or their gestational age, <37 weeks.
Results:The overall vaccine completion rate was 79.3%. The factors significantly associated with incomplete vaccination by multivariate logistic analysis were two or more children living together, child care attendance, parents’ smoking habits and absence of exclusive breastfeeding at 4-month health checkups. As the number of risk factors for hospital admission due to infections increased, the vaccine completion rate tended to decrease.
Conclusion:Families with children who attend child care facilities and with two or more other children should be provided with more information regarding vaccination and positive health behaviors in general.

 This cross-sectional study examined cigarette smoking knowledge, attitudes, and practices among medical students in a southwestern region of China. The subjects included 557 and 223 first and fourth year Chinese medical students, respectively. Comparison data were collected from 74 Japanese and 90 Vietnamese fourth year medical students. The smoking rate among the fourth year medical students in China (7.0%) was significantly higher than among the first year medical students (2.8%), and higher than among the medical students from Vietnam, but lower than the medical students from Japan. The fourth year Chinese students had a more permissive attitude toward cigarette smoking by physicians compared with the first year students, and the lowest knowledge base on cigarette smoking-related diseases among the students from all three countries. Based on a multivariate analysis, the factors associated with cigarette smoking were male gender, having friends who smoked, and exhibiting a permissive attitude toward smoking. Implementations aimed at improving tobacco education and addressing the gender differences and peer influences related to cigarette smoking are needed to improve Chinese medical students’ knowledge and attitudes about cigarette smoking, and to prevent students from starting to smoke cigarettes.

Objective: We have developed an automatic vigilance system (AVS) that automatically reports adverse drug reactions (ADR) based on laboratory finding abnormalities and symptom keywords in electronic medical records.　In this study, we aimed to evaluate the impact of detecting ADR using AVS on medical treatment.Methods: In AVS, drugs and their ADR signals, which would be detected and reported by AVS to pharmacists, were defined.　Pharmacists evaluated the severity of these signals to identify whether these signals should be discussed with the doctor, continued to be followed up, or ignored.　We investigated detection of ADR at University of Fukui Hospital between April 2016 and March 2017 along with whether prescriptions were modified because of ADR and the contribution of AVS.　Assuming that ADR had worsened without appropriate treatment, medical expenses needed for treating severe ADR were calculated.Results: In total, 325 signals were defined for 146 drugs.　There were 9,103 ADR signals confirmed by pharmacists for 8,531 subjects.　Of these, 12 and 164 signals were discussed with the doctor and continuously observed, respectively.　The pharmacist's suggestions based on AVS led to prescription modifications in 10 cases, corresponding to a reduction of 2.56 million yen in medical expenses in the event that these cases become severe.Conclusion: AVS assisted prescription revisions because of ADR and is thought to contribute to the prevention of worsening of ADR and reduction of medical expenses.

Objectives: Approximately 17% of Japanese women have hemoglobin concentrations less than 12 g/dL. Therefore, anemia prevention and early intervention are crucial public health issues in Japan. This study aimed to identify the symptoms and characteristics of anemic individuals in the general adult population by comparing survey responses of individuals with anemia and without anemia visiting blood donation centers.Materials and Methods: This cross-sectional study used self-administered questionnaires. Individuals who visited two Japanese Red Cross Society blood donation centers in Fukushima Prefecture, Japan were included. Hemoglobin levels were measured at blood donation, and the levels of 13 g/dL for men and 12 g/dL for women were defined as anemia.Results: Of the 857 individuals analyzed, 530 were men and 327 were women, of whom 19 (3.6%) and 12 (3.7%) had low hemoglobin levels, respectively. Logistic regression analysis was performed in men, and the results showed that “lightheadedness” (odds ratio [OR]=8.4) and “depressive symptoms” (OR=3.6) were significantly associated with hemoglobin levels. None of the evaluated items were significantly associated with hemoglobin levels in women.Conclusion: Among healthy Japanese men, those who exhibit lightheadedness and depressive symptoms have an increased risk of anemia. Lightheadedness and depressive symptoms may be indicative of undiagnosed anemia in men, which necessitates greater clinical attention.

Objective: This study sought to estimate the prevalence of erectile dysfunction (ED) and to ascertain risk factors among Vietnamese men with diabetes. Methodology: One hundred and fifty one diabetic patients were recruited from the People’s Hospital 115 between August 2011 and March 2012. They were asked to complete a self-administered questionnaire that included the International Index for Erectile Function Questionnaire (IIEF-5) and the World Health Organization (WHO) - Five Well-being Index. Medical history, anthropometric measures, and laboratory test results were recorded. ED was classified based on the IIEF-5 total score. Results: Of the 151 diabetic men, 135 (89%) completed the IIEF-5. The overall prevalence of ED was 84%; majority (65%) were classified as mild to moderate, while 10% were considered severe. The prevalence of ED was higher among those with peripheral neuropathy [adjusted odds ratio (OR) 5.22, 95% confidence interval (CI) 1.14-21.89] and longer duration of diabetes (OR 1.11, 95% CI 1.00-1.24). Conclusion ED represents a prevalent major complication among men with type 2 diabetes. The presence of peripheral neuropathy and long duration of diabetes may be useful indicators of ED.
Diabetes Mellitus ; Erectile Dysfunction ; Vietnam ; Peripheral Nervous System Diseases ; Surveys and Questionnaires