A survey of the relationship between smoking and the academic performance of 5th-year students at Kawasaki Medical School was carried out over a 2-year period (1996 and 1997). Students were asked about their smoking habits when they visited our ward to see patients. To assess their academic performance, students were divided into two groups; students who were promoted to the 5th-year without failures (straight-promotion group) and students who had repeated the same year at least once (repeater group). Among male students, smoking rates in the straight-promotion group were 48.9 % in 1996 and 39.1% in 1997, whereas those in the repeater group were 80.6% and 65.4%. Among female students, smoking rates in the straight-promotion group were 8.7% in 1996 and 9.1% in 1997, whereas those in the repeater group were 25.0% and 37.5%. The smoking rate among male students was significantly higher in the repeater group than in the straight-promotion group, whereas there was no statistical difference between the two groups among female students. Our results suggest that smoking and poor academic performance are related. More aggressive antismoking education is needed to reduce the high smoking rate among male medical students in Japan.

Background: Paraquat has been a matter of grave concern around the world, including Japan, in light of high mortality rates and numerous fatalities.;Method: We undertook a cross-sectional survey of pesticide poisoning by collecting data for 6 years, from 1998 to 2003, from 102 hospitals affiliated with the Japanese Association of Rural Medicine. From these cases, we analyzed those with exposure to paraquat.;Results: There were 79 paraquat poisoning cases, including 71 cases of suicide. Of the suicide cases with 5% paraquat and 7% diquat products, more than 80% resulted in suicide deaths. All people who used 24% paraquat products completed suicide. The outcomes of these cases were related to age and volume of ingestion. The prognosis line proposed by Proudfoot in 1979 continues to explain the final outcome of almost all cases even though more than 25 years have passed since it was first proposed. More than 80% of fatalities died within the first three days of ingestion.;Conclusion: Numerous lifesaving methods have been proposed by physicians around the world. However, almost all of these methods treat pulmonary disorders in the sub-acute and subsequent periods and seem unable to effectively decrease mortality rates. It is necessary to take administrative measures to reduce paraquat concentrations in products and, furthermore, to impose strict restrictions on its distribution.
Paraquat ; Cancer patients and suicide and depression ; Surveys ; Japan ; seconds

We reexamined the cases of renal disease found in urinalyses which had been performed as part of the mass screening, to ascertain its efficacy. During 1990, a total of 94, 913 people underwent physical checkups made by the Naganoken Kouseiren Health Screening Center. The mean positive rates of proteinuria, occult blood in urine and both were 2.4%, 6.2% and 0.5%. Of the total number of examinees, 59, 803 had undergone the previous year's checkup. The mean positive rates of proteinuria, occult blood in urine and both for two consecutive years were 0.8%, 3.4% and 0.1%. The mean positive rates of proteinuria and occult blood increased with age. The mean positive rate of proteinuria was 1.7 times higher in males than in females. On the other hand, the mean positive rate of occult blood was 2.7 times higher in females than in males. However, there was no difference what so ever between men and women in the mean positive rate of both proteinuria and occult blood.
In the mean time, we reviewed the 85 cases in which renal biopsy was performed at the Saku Central Hospital from 1985 through 1990. Among them, 35 (41.2%) were the cases which had been suspected to have kidney disorder in the urinalysis conducted as part of a mass screening, and IgA nephropathy accounted for about 60% of them. The reports from medical institutions which made follow up examinations using the results of the health screening showed that the rate of renal disease was highest in the proteinuria positive cases; that of urological diseases, in the occult blood positive cases; that of chronic glomerulonephritis and urological diseases, in the proteinureal occult blood positive cases. We concluded that urinalysis included in a battery of tests at the time of the mass health screening is an effective procedure for detecting chronic glomerulonephritis and urological diseases.

Data concerning clinical cases of pesticide poisoning/disorders were collected from members of the Japanese Association of Rural Medicine during 2001-2003, and were analyzed statistically.A total of 194 cases of poisoning/disorders by pesticide exposure were reported from 36 hospitals and other medical institutions. Suicide cases accounted for 74% of the total number of cases, which was followed by the cases caused by exposure during spraying (17%) and drinking/eating by mistake (7%).In 144 suicide cases, those of males accounted for 52%, the middle-aged and older people constituted the majority. By types of clinical manifestations, almost all of the cases were acute or subacute pesticide poisoning (98%). Organophosphate insecticides were the most frequent inducers of the cases (39%), which was followed by bipyridylium herbicides (23%). When it comes to the outcome, more than 80% of suicide cases with paraquat products resulted in death.There were 39 cases of pesticide poisoning/disorders resulting from exposure during spraying, preparation or settling, and working in sprayed area. In these cases, males accounted for 70% the middle-aged and older people made up the majority. By types of clinical manifestations, the cases of acute or subacute pesticide poisoning accounted for 39%, which was followed by acute dermatitis (33%), chemical burn (14%), and ocular disorders (11%). The pesticides that induced clinical cases varied greatly. Main factors contributing to the onset of pesticide poisoning/disorders were insufficient protective clothing (44%), self conceit (19%), insufficient information (14%), and carelessness (12%).
Pesticides ; Clinical ; Poisoning aspects ; Acute ; Cases

A dermatitis of unknown etiology has occurred among the farmers working in paddyfields in some districts of Tokushima Prefecture, such as Anan, Kainan and Komatsujima.
The dermatitis occurs from March to May when rice-planting and weeding are on and is characterized by erythemato-papulo-vesicular eruptions accompanied with severe itching. The chief symptoms are observed on the parts exposed to water, especially on forearms and lower legs. The results of the epidemiologicaland clinical observations indicated that the dermatitis was due to the invasion of cercariae of an avian schistosome.
The investigation for snail intermediate hosts was carried out in the paddy fields where the dermatitis occurred.
Cercariae of apharyngeal furcocercous type were detected from the fresh water snails (Austropeplea ollula) which were collected most abundantly from the paddy fields during the season of occurence of the dermatitis.
The cercaria wasidentified as species belonging to the genus Trichobilharzia and was regarded as the same species as so far described in Saitama Prefecture by Suzuki et al (1973).
An experimental infection with the cercaria was performed. A few drops of watercontaining cercariae was placed on the fore-arm of. a voluntor. The cercariae invaded into the skin and produced a dermatitis quite similar to that prevailing in the endemic areas.
Therefore, it was concluded that theetiological agent was the cercaria of a species of an avian schistosome.

Data concerning clinical cases of pesticide-induced disorders were collected from members of the Japanese Association of Rural Medicine during 1998-2000 FY throughout the nation, and were analyzed statistically.
1) A total of 209 cases of poisoning by agricultural chemicals were reported from 49 hospitals and other medical institutions.
2) By types of clinical manifestations, the majority of the cases were acute or subacute pesticide poisoning (91%), which was followed by acute dermatitis (5%) and chemical burn (3%).
3) Suicide accounted for 67% of the pesticide poisoning cases, which was followed by accidental exposure on the job during spraying (17%), and so forth.
4) Organophosphate insecticides were the most frequent inducers of the clinical cases (34%), which was followed by bipyridylium herbicides (21%) and a carbamate insecticides (9%), and so forth.
5) There were 43 cases of intoxication during spraying, during preparation or settling, and working in sprayed areas By types of clinical manifestations, the majority of the cases were acute or subacute pesticide poisoning (56%), which was followed by acute dermatitis (23%) and chemical burn (16%).
6) Agricultural chemical compounds responsible for the clinical cases varied greatly. They induced organophosphate insecticides (19%), and bipyridylium herbicides (12%).
7) Main factors contributing to the onset of pesticide-related disorders were insufficient protective clothing (32%), carelessness (22%), and inevitable consequences of pesticide use (10%).

Pesticide poisoning is one of the most inportant health issues associated with rural medicine, and chronic nervous and mental disorders are its importnat sequelae. We investigated suquela cases nationwide, and reviewed chronic nervous and mental disorders from a clinical and epidemiological point of view.
Our nationwide survey found one reported case of delayed neuropathy. The patient ingested organophosphorus insecticides, and showed delayed neuropathy dozens days after.
Cases of delayed neuropathy attributable to Mipafox was reported in1951.This disease is mainly caused by organophosphorus insecticides. Carbamate insecticides are also known as the agents to induce delayed neuropathy. Herbicide Glufosinate (Basta^TM) was put on the market in 1984. The case reports published during the 1990's pointed out that some Glufosinate poisonings cause amnesia and disorientation. Thesecases were reviewed according to the types of pesticides or their groups.
An epidemiological investigation of neurological and psychiatric desorders among such workers exposed to several types of pesticides as plantation workers and sheep dippers was made. These exposed workers were at high risk of mild cognitive dysfunction, tremor, weakness, and so on to a significant extent. Those children who were exposed to organochlorine insecticide and pollutant via placenta or milk were also surveyed whether they had impairments of nervous and mental development. Highly exposed children were significantly slow in development relative to their peers. The results of these investigations were also reviewed.

Nephroblastomatosis (NBM) is a precursor of Wilms tumor. We herein report a case in which Wilms tumor was initially suspected and the affected kidney was removed.The tumor was subsequently diagnosed as intralobar NBM and a favorable outcome was achieved with postoperative chemotherapy. A 2-year-old boy who presented with gross hematuria was found to have an enlarged left kidney with hydronephrosis.Needle biopsy of the left kidney suggested Wilms tumor and left nephrectomy was performed. The tumor was histopathologically diagnosed as intralobar NBM.Although NBM is regarded as a precancerous lesion, a definite treatment plan has not yet been established. In the present case, we used a similar chemotherapy regimen to that for Wilms tumor. Eight years after the completion of chemotherapy, Wilms tumor has not developed or recurred. Appropriate management plans need to be developed by accumulating similar cases.

Objective: In the instructions for package inserts (PI) of prescription drugs revised in June 2017, the section “persons with reproductive potential” was established under “precautions concerning patients with specific backgrounds.” The description rules associated with contraceptive duration were modified in these. In this study, we investigated descriptions of contraceptive duration in PI that were prepared based on the revised instructions, interview forms (IF), and other proper use materials (PM).Methods: We collected PI, IF, and PM of prescription drugs containing a new active ingredient approved from April 2017 to March 2022 for which the PI were prepared based on the revised instructions and investigated descriptions of PI, contraceptive duration, and its evidence in each information material.Results: Of the 181 drugs studied, 43.1 and 12.7% required females and males to use contraception during the period of drug consumption, respectively. Among these, the ratio of drugs that had descriptions of contraceptive duration were 15.4 and 0% for females and males at PI, respectively; 51.3 and 39.1% for female sand males at IF, respectively. Anticancer drugstended to describe contraceptive duration in the PM rather than PI or IF. For some drugs, there was no description of contraceptive duration in any of the materials. Contraceptive durations ranged from the period of administration of that drug to over a year for females and approximately one week to six months for males. The reasons for these contraceptive durations were diverse.Conclusion: Contraceptive information in the PI based on revised instructions were not sufficient for use by healthcare workers, even when the IF and PM were confirmed. These results suggest that there is a need for standardizing the descriptions, types of materials to be described, and choice of evidence for contraceptive duration.

In the 2022 revision of the Model Core Curriculum, a new "Educational Strategies and Assessment" section was added as a further development in outcome-based education. By adding a chapter on strategies and evaluation, which is an important element of the curriculum, and linking it to qualities and abilities, we have devised a way for learners and instructors to make use of the Core Curriculum more easily. In addition, 11 example of strategy and assessment cases are included as Good Practice to encourage practical application. However, since these are only examples, we hope this chapter will be further developed as universities create strategies and evaluations that make the most of their unique characteristics.