This paper reports the results of our factfinding survey of annual epidemics of respiratory syncytial virus infection, an important cause of inflammation of the lower respiratory tract in infants and young children, in Honjo City and the neighboring district of Yuri. Diagnosis of RS virus infection was performed with the RSV test pack.
Over the period of three years from January 1993 to December 1995, the number of patients with RS virus infection totaled 127 of whom 107 were hospitalized and 20 were treated as outpatients. The male-female ratio was 69: 58, 60: 47 and 9: 11, respectively. The total number of patients included 9 neonates, 15 one-month-old infants and 17 young children of one year or above.
The infectious disease rages from December through January every year. Of the total 127 people, 64 were infected with RS virus during the winter months.
The pediatric department of our hospital is visited by nearly 20, 000 outpatients annually each from Honjo City and the Yuri district. A check of the number of the outpatients diagnosed with RS virus infection showed that 70 people are from Honjo and 57 from Yuri. During the survey period, 4 boys and 2 girls required endotracheal intubation because of respiratory dysfunction. They consisted of 3 newborn infants and 3 1-month-olds. The occurrence of this infectious disease in the very early period of infancy and signs of pneumonia are considered to be risk factors for respiratory failure.

Many researchers report that cigarette smoking by parents adversely affects their children. We carried out a survey about cigarette puffing by distributing questionnaires to mothers of sucklings and little children. The survey found that mothers and family members were not well aware of the health consequences of passive smoking. It was also found that children frequently exposed to smoking are at high risk of contracting infections of the respiratory tract. The average weight at birth was less in babies borned by smoking mothers than by those who do not smoke. Furthermore, it was revealed that a larger number of smoking mothers had given birth to low birth weight infants than nonsmoking mothers had.
These findings suggested that passive cigarette smoking is linked to low birth weight and respiratory tract infection. We think it is incumbent on us, health-care professionals, to bring home to mothers and the rest of the family members how serious the consequences of passive smoking are.

In order to find an effective way to detect bacteria responsible for respiratory tract infections in children, we first examined as pharyngeal swabs, epi-pharyngeal swabs and nasal aspirates obtained from children hospitalized at our pediatric service during these five months from December 1997 to April 1998. In the rate of bacterial infection, it was found that nasal aspirates came out on top with 92.6%(25/27), followed by epipharyngeal swabs with 71.6%(53/74) and pharyngeal swabs with 26.2%(38/145). Single-species bacteria were found in 78.9%(30/38) of pharyngeal swabs, where as 45.3% of epi-pharyngeal swabs (24/53) and 52.0% of nasal aspirates (13/25) proved mixed infections with two-or three-defferent species. Thus it was suggested that nasal aspirates and epi-pharyngeal swabs would be far more adequate than pharyngeal swabs to detect bacteria with accuracy.
Next, based on the efficiency of bacterial detection, we compared culture media for the specimen obtained from in-patients and out-patients at our pediatric service. The rate of isolation of gram-negative rods was as low as 0.3%(1 of 314 strains) even when BTB agar plate, a selective medium for these bacteria, was employed. The sensitivety was not much different from those observed with nonselective blood agar plate. These results suggest that the conventional blood agar media can substitute for the more expensive type of BTB agar medium for the diagnosis of infections diseases of the airwaysin children.

Cardiac patient simulators are commonly used in Japanese educational institutions; however, most institutions have not established concrete learning objectives or strategies for mastering physical examination of the circulatory system, including cardiac auscultation. In this study, we propose clear learning objectives and strategies for simulator practice for fifth-year medical students who have passed the objective structured clinical examination, and explored their educational effectiveness.
1)The subjects were fifth-year medical students (n=94) at the University of Miyazaki. Learning objectives were the mastery of the sequential physical examination and the ability to distinguish 6 cardiac findings, including normal status. The subjects were evaluated with a checklist before and after lectures and simulator practice.
2)The mean score (maximum score=14) significantly increased from before simulator practice (2.2±0.9) to after simulator practice (11.4±1.5; p<0.001). There was no difference in scores after practice among the cardiac diseases.
3)Before practice more than 50% of subjects could use a stethoscope on only right positions and could indicate only the maximum point of a cardiac murmur; in contrast, after practice more than 90% of the subjects could sequentially describe physical findings and accurately predict cardiac diseases.
4)In a questionnaire administered after practice, 83% of the subjects answered that all physicians should acquire proficiency in cardiac auscultation regardless of their specialty.
Simulator practice with clear learning objectives may help improve clinical examination skills when both time and human resources are limited. The reevaluation of the program's continuing educational effectiveness and the establishment of an iterative learning program will be needed.