We used a new cardiology simulator twice to train lst-year medical residents in physical examination with a specific behavioral objective shortly after they had received their medical licenses. The first training sessions were to teach residents to understand normal heart sounds and to perform physical examinations in the proper order; the second training sessions were to teach recognition of abnormal heart sounds and murmurs. After the first training sessions, all residents could perform physical examinations in the proper order with special attention to the jugular vein, differentiation of systole and diastole by palpating the carotid artery, splitting of S2, and the timing and transmission of heart murmurs. Just after the second training sessions, all residents thought that their physical examination skills and ability to recognize abnormal heart sounds and murmurs had improved. One year later, the residents were accustomed to performing physical examination in the proper order and could recognize gallop rhythms and murmurs of grade 3/6 or higher. Repeated training with specific behavioral objectives could motivate residents to understand both normal and abnormal heat sounds and murmurs.

We have examined the influence labor causing upon health for inhabitants at Yuri district in Akita prefecture. Labor was defined in the light of the following factors ; style of agricultural management, field space, working days, working time a day, etc. Health was defined in the light of the following factors; red blood cell, hemoglobin, cholesterol, triglyceride, HDL-cholesterol, fast blood sugar, choline estelase, GPT, uric acid, alkaline phosphatase, obesity rate and blood pressure. 1) We discovered that in case of male workers the great amount of labor they engaged in, the higher level average index of HDL-ch and GPT reached. As the labor amount increases more numbers of patient appears with abnormality in choline estelase. We have not observed the similar tendency for female.
2) As the labor amount decrease (a) in case of male workers the average index gets higher in cholesterol, triglyceride, FBS and choline estelase, (b) in case of female workers the average index gets higher in triglyceride, FBS, choline estelase, uric acid and albumin. As the labor amount decreases (a) in case of male workers abnormality rate increases in choline estelase, triglyceride and HDL-ch, (b) in case of female Hb, HDL-ch, cholesterol and obesity. 3) For inhabitants over 70 years old male or female those living in plain and open field (Nishime town) are more active and show the lower percentage of getting ill than those in mountains (Higashiyuri town).

The rate of obesity both in man and woman in this district reached the highest (male 18.1%, female 27.8% Minowa Method) in 1978, but has been decreasing since then. It came down to 16.5% in case of male adults and 23.0% in case of female adults. These figures clearly show that the obese rate of female is higher than that of male. Skin-fold thickness meassurement corresponded to direct meassurement performed at the time of gastrectomy (=0.956). Compared with rate of obesity (Minowa Method) skin-fold thickness measurement proved particularly corresponding in navel area of male and in back of female. Regarding relationship between obesity and morbidity, a greater number of thin people suffered from atony or ptosis of the stomach or anemia. On the contrary the following diseases were more common with people as they grew fatter; hyperlipidemia, hypertension, ischemic heart diseases and diabetes mellitus. Patients with diabetes mellitus or hypertension who succeeded in losing weight improved their conditions or completely recovered. Our survey conducted in 1978 proved that residents over the age of forty in our district were not well aware of their obesity. Few of them were concious that their obesity were due to over-feeding. Regarding the effect of weight control conducted at three groups, instituts for the handicapped showed the most effective and successful result, 68.0% succeeded in losing more than 4 kg in a year at the instituts. The rate is incredibly high compared with 33.0% at our obesity clinic or 4.3% at field.

A total of 164 patients who had been admitted into our hospital with cirrhosis of the liver over the past five years were classified according to the origins of this particular disease based on the results of HBs antigen and HBs antibody tests.
Exeessive alcohol consumption was largely responsible for the incidence of the scourge in men, while in women, unknown causes accounted for the majority of the cases.
The cases in which HBs antigen tests were positive represented only 8.3% Although an overwhelming 53.8% of the consecutive HBs antigen positive cases were complicated hepatoma, the percentage of the complications as against the total was as low as 14.1%.
Of those cases which can be blamed on alcoholism, very few developed into cancer. A malignant new growth in cases of NANB liver cirrhosis was a rarity.
The early detection of hepatoma in the cases of HBs antigen positive liver cirrhosis and the early treatment of esophageal varices in the cases of alcohol-induced liver cirrhosis could lead to the improvmment of the prognosis.

During the 18-month period from January 1, 1981 to June 30, 1082, we encountered a total of 11 cases of child peptic ulcer-three gastric ulcer and eight duodenal ulcer casen.
There is every indication that the incidence of child peptic ulcer will increase in a rural area like Yuri, which is situated in Japan's northeastern prefecture of Akita.
To be noted is the fact that 10 cases out of 11 of peptic ulcer were found in three-year lower secondary schoolchildren and the remaining one was found in a sixth grader of six-year elementary school. The incidence as well as the number of visits to our clinics went up as the age advances and reached a peak in third graders of lower secondary school.
The reason why third graders of lower secondary school were attacked most by peptic ulcer is probably that they, at puberty, are under psychic or psychogenic stress with anxiety over high school entrance examinations, mental strain from forced attendance at a cramming school, trouble in getting along with friends, and dissatisfaction with parents.
Therefore, child peptic ulcer should not be treated as a disease of the digestive organ alone but as a disorder in the autonomic nervous system with an aid of psychosomatic medicine and psychiatry. For the prevention of the disease, it would also be necessary to take account of socio-cultural factors.

We have carried out the mass survey for diabetes mellitus by a 50 g GTT as the first screening since 1971. Average incidences of diabetic pattern, IGT pattern, borderline pattern and normal pattern in a Glucose Tolerance Test (GTT) were 2.3±1.8%, 6.6±1.7%, 19.8±6.6% and 71.4 ±7.8%, respectively. 21 males and 6 females were found to be diabetic by this survey for 11 years. Insulinogenic indices (I. Is.) of diabetic, IGT, borderline and normal patterns were 0.13±0.07, 0.70±0.37, 0.58±0.40 and 1.05±0.30, respectively, and the values of I. I. in diabetics and borderline diabetics were significantly lower than that in the normal pattern. A I. I. in the subjects who have revealed the normal glucose tolerance every year for 11 year, 2.62±1.28, was high in the normal range. On the other hand, a I. I. in the subjects who became overtly diabetic from the IGT, borderline or normal pattern, 0.36±0.31, was significantly lower. Therefore, taking into consideration that one of the characteristics of NIDDM is low insulin response to glucose, the mass survey for diabetes mellitus should be carried out by a Glucose Tolerance Test (GTT) as the first screening with the measurement of plasma insulin concentrations. A follow-up study for the low insulin responder is considered to be one of the most preferable investigations for the detection of the early stage of diabetes mellitus.