Our school of medicine began a new curriculum for medical students in April of 1999. In their final year medical students are allowed to schedule a 3-month clinical clerkship. This clerkship gives the students three 4-week periods to do rotations in their areas of interest. Our clinics have had a hard time finding the time to teach students evidence-based medicine (EBM) owing to their clinical workloads. Even when the divisions want to teach EBM there are few resources available for the students. Therefore, students are sometimes unable to receive adequate training in EBM. With the introduction of the new curriculum the Department of Hygiene and Public Health thought that the clinical clerkship program offered a good opportunity to teach students EBM with a one-to-one student-teacher relationship. We report here on our preliminary program that uses a scenario approach to EBM education. We determined the students' level of development by studying the detailed progress reports written by their teachers. The students were found to understand EBM when presented with its basic concepts which are then used in multiple discussions. Students will continue to use self-directed learning throughout their careers if they learn to think using EBM early in their training and practice it during their residency. We also show here a worksheet based on the Journal of the American Medical Association User's Guide series to use systematic EBM in daily clinics. Our program is just one of several methods we hope to develop to educate medical students in EBM.

We performed a survey to assess the positions and activities of Japanese women physicians in medical societies. In June 2000, questionnaires were sent to 92 medical societies of the Japanese Association of Medical Science. The response rate was 92.4%. Fifty-four societies (63.5%) failed to provide the number of women physicians. According to the questionnaires that were fully completed and returned, women physicians were more likely to belong to societies of internal medicine, pediatrics, ophthalmology and dermatology. Women physicians were less likely to hold board positions and were underrepresented in leadership positions, even in societies with high percentages of women members. Board positions failed to provide for maternity or child-care leave, and few societies offered childcare facilities at annual meetings. Gender-disaggregated data should be made readily available and additional surveys need to be made to identify obstacles to activities in medical societies.

Objectives: The reliability of surveys on smoking habits based on questionnaires was investigated, using the urinary cotinine content as an objective index. Methods: The subjects tested were 2,849 office workers of middle age, who responded to questions concerning their smoking status, and also their urinary cotinine was measured by the HPLC method. Results: The boundary value between smokers and non-smokers, determined by the histogram independent of the questionnaire, was 63.1 and 79.4 ng/mg of creatinine for males and females, respectively. The rate of misclassification of the non-smokers and former smokers as smokers was 1.3% for males and 1.8% for females, whereas that of current smokers as non-smokers was 6.3% and 2.1%. We also assessed the effect of smoke inhalation on the urinary cotinine value, and found a significant difference for males in the cotinine value by the presence of inhalation and also its depth. Conclusions: The rate of misclassification in this study was considered to be comparatively low. Several studies have also assessed the reliability of the questionnaire on smoking habits, and found different misclassification rates, indicating the dependence on the race and number of subjects tested. To our knowledge, there were only a few surveys on smoking among large groups, particularly in Japan, such as this one, therefore the results obtained in this study are meaningful.
Smoking ; Cotinine ; Indexes ; seconds ; Urine

OBJECTIVESDue to its industrial application and frequent use as a coating material for food containers, bisphenol A (4,4'-isopropylidenediphenol, BPA) is present in abundance in our environment. Data on intake levels of BPA are limited in preadolescent children in Japan. This study was designed to help us better understand the current state of BPA exposure in children in Japan.

METHODSWe followed first graders (n = 104) attending school in a Tokyo suburb from 1998 until the sixth grade (2003), during which time we collected a total of three morning urine samples. Urinary BPA was analyzed using high-performance liquid chromatography isotope-dilution tandem mass spectrometry.

RESULTSNinety-four children were followed for 5 years. Median urinary BPA level was 2.66 ng/mg creatinine (CRE) (range 0.9-38.9) at first grade (1998), 1.52 ng/mg CRE (0.4-11.8) at third grade (2000), and 0.66 ng/mg CRE (0.2-8.5) at sixth grade (2003), showing a significant decrease in urinary BPA levels over a 5-year follow-up study (p < 0.001). No significant difference was seen between boys and girls at each grade.

CONCLUSIONSUrinary levels of BPA were relatively low throughout the study period; however, as the study progressed, we observed a significant decline in levels, the reason behind which is not yet clear.

OBJECTIVESThe reliability of surveys on smoking habits based on questionnaires was investigated, using the urinary cotinine content as an objective index.

METHODSThe subjects tested were 2,849 office workers of middle age, who responded to questions concerning their smoking status, and also their urinary cotinine was measured by the HPLC method.

RESULTSThe boundary value between smokers and non-smokers, determined by the histogram independent of the questionnaire, was 63.1 and 79.4 ng/mg of creatinine for males and females, respectively. The rate of misclassification of the non-smokers and former smokers as smokers was 1.3% for males and 1.8% for females, whereas that of current smokers as non-smokers was 6.3% and 2.1%. We also assessed the effect of smoke inhalation on the urinary cotinine value, and found a significant difference for males in the cotinine value by the presence of inhalation and also its depth.

CONCLUSIONSThe rate of misclassification in this study was considered to be comparatively low. Several studies have also assessed the reliability of the questionnaire on smoking habits, and found different misclassification rates, indicating the dependence on the race and number of subjects tested. To our knowledge, there were only a few surveys on smoking among large groups, particularly in Japan, such as this one, therefore the results obtained in this study are meaningful.