Medical education in Japan has undergone dramatic changes, but nothing less than a paradigm change is required for the educational model for social medicine. In the 23 years since 1978, we have developed a community-based public health education program. The curriculum consists of a core of family health practice, student lectures, systematic teachers' lectures, participatory research on community health, and health policy-making. The community-based educational model was effective in developing students' active problem-based learning, abilities in health communication, and understanding of community needs as a biologic-psychologic-cultural-geographic complex; the empowerment of students and the community; and a comprehensive approach to the community care management which integrates health promotion and social welfare. We evaluated the community-based curriculum design, which exposes students to a wide variety of medical, social, and psychological problems in a community as a useful public health educational strategy.

We presented here an overview of the international innovation of public health and introduced our community-based educational practice of public health. We also reported it was effective for public health education to let students participate together with teachers in the cooperative movement developing healthy community and let them learn community dynamics, skills of participatory action research and the process of policy making. Today, the under-and post-graduate education of new public health will be effctively performed by participating in the practical healthy community project, which is performed cooperatively by communities, social resources and the university.

Tools to assess problem-solving skills are limited, and comprehensive evaluation is difficult. Concept mapping might be used to evaluate learners' organization of knowledge at various points during training. We used concept mapping to evaluate postgraduate training at the Department of Education Training Technology and Development, National Institute of Public Health. Thirty-five healthcare workers, including physicians, and public health nurses, underwent concept mapping training, drew preinstruction concept maps about public health or community organization, completed an educational course, and then drew postinstruction concept maps. Maps were assessed independently through qualitative comparison of concepts, conceptual links, hierarchy, knowledge domains, cross-links, and examples of preinstruction and postinstitution maps. This study provides preliminary evidence that concept mapping reflects changes and differences in the conceptual framework of individuals and of members of different healthcare specialties. Concept mapping can be used to clarify conceptual frameworks and to develop problem-solving skills. Moreover, concept mapping might be used to evaluate problem-solving skills.

Although great changes have already been made to medical education in Japan, the public health system urgently requires a paradigm change in the educational model. Recently, changes in the concept of public health have been proposed as “New Public Health” based on the World Health Organization's Health Promotion Movement in developed countries. We defined the core concepts and basic theories of New Public Health and have evaluated the validity to New Public Health of the community-based public health education model used since 1978 at Shimane Medical University. We have also established an educational environment that supports the development and dissemination of the model.

The traditional Japanese diet with its high intake of fruits and vegetables that are rich in antioxidants is believed to effectively ward off cardiovascular disease. Oxidative stress, related to reactive oxygen and nitrogen species produced by aerobic organisms, is responsible for the pathogenesis of most chronic diseases. Oxidative low density lipoprotein (LDL) is thought to play a key role in the pathogenesis of early atherosclerosis. There has been increasing interest in antioxidant substances derived from edible plants. It has been suggested that the measurement of LDL antioxidant activity is physiopathologically more important and informative for screening antioxidant activity to prevent atherosclerosis than other methods. We assessed by LDL oxidation assay the antioxidant characteristics of various edible plants from rural areas. The mulberry (Morus alba L.) leaf showed comparatively high antioxidant activity. We identified the antioxidant compounds and investigated compound levels in the mulberry leaf and found the antioxidant activity of mulberry leaves to be mainly attributable to quercetin 3-(6-malonylglucoside) (Q3MG). Dietary consumption of mulberry leaves and/or Q3MG may enhance resistance to oxidative modification of LDL and attenuated atherosclerotic lesion development. However, the outcome of intervention trials suggested that a single antioxidant had little effect on the risk of developing cardiovascular disease. The synergic effect of certain combinations may determine outcome. We need to widen our understanding of the synergic effect of diets and nutrient-gene interactions related to nutrient/disease risk.
Antioxidants ; seconds ; Low density lipoprotein cholesterol measurement ; Pathogenesis ; Oxidative Dietary Supplements

The Japanese government's response to the recent discovery of dairy cows suffering from bovine spongiform encephalopathy (BSE) in this country was analyzed from the viewpoint of policy science with reference to the policy in the United Kingdom and other EU countries. The results of investigation into the causative agent (s) androutes of infection of BSE that affected a total of seven cows were reviewed and the points at issue during the course of the epidemiological survey were given. Despite repeated warnings from the UK, EU and WHO, adequate countermeasures were not taken by the government offices concerned-the Ministry of Agriculture, Forestry and Fishery and the Ministry of Health, Welfare and Labor. They failed to prevent the occurrence of BSE and the resultant panic among consumers. The present review brought to lighta lack of a sense of urgency and risk management system in the government, the moral hazard in the food industry and market, the blunder of the government officials and the absence of an adequate food safety surveillance system. At the same time, we presented some proposals as to what the future food safety policy should be.

In the 1990's, a metabolic syndrome associated with obesity, insulin resistance, hyperlipidemia and hypertension began to capture the attention of Japanese investigators as on ominous predictor of myocardial infarction. As there is few information of the metabolic syndrome in rural communities, we conducted a cross-sectional survey of the prevalence of the metabolic syndrome for 1, 084 workers aged 20-59 years in a rural community, Sada Town, and a neighboring local city, Izumo City, Shimane Prefecture. The number of risk factors for atherosclerosis was increased with age and was higher in males than in females. Men in their 50's in the rural community were at higher risk than their counterparts in the city. Most of the workers had one or two risk factors, and those who had three and more risk factors accounted for a little less than 7%. The rate of males aged 40-59 years in the rural community having over two risk factors among obesity, hyperlipidemia, hypertension and diabetes was significantly higher than that of the same age group in the city. The metabolic syndrome among males living in the rural community was related to obesity, hypo-HDL cholesterolemia, and hypertension. Males in the rural community had higher body mass index (BMI), than males in the city, but there was no significant difference in BMI between female groups. The prevalence of obesity in males in the rural community was linked with drinking habit and a decline in physical activities. In order to prevent the metabolic syndrome in the rural communities, a health policy based on a population-based strategy should be implemented to change the healthy lifestyle of workers, to promote health education and establish a health supportive environment.

To arrest the prevalence of obesity in Japanese rural communities, we have conducted to develop an interventional program for the prevention of obesity based on health education and self-dertermination since 2000. We adopted the behavioral program to strengthen self-control of diet and exercise based on learning principles. The objectives of the 3-month program were to lose weight by 3.0kg, to reduce metabolic measurement values by 10% in terms of dietary caloric intake and to keep taking over 7, 000 steps a day. Subjects were 140 residents with Body Mass Index of 24.8±3.0, aged 35-70 years, in Izumo City and Sada Town, Shimane Prefecture, who were interested in the prevention of overweight and obesity-associated diseases, voluntarily participated in the behavioral program conducted in 2000-2002. The rate of dropout from the program was 2.9%(4/140). The behavioral intervention induced significant decreases in intakes of energy, protein and fat, and increases in the number of steps per day taken by the participants. The intervention induced a significant difference in weightloss (-1.0kg in 2001 and -1.8kg in 2002). Significant differences of anthropometric parameters were found in body weight, BMI, waist and hip circumferences, blood pressure and lipid profiles, such as total cholesterol, LDL-cholesterol, and HDL-cholesterol, by the intervention in 2001 and 2002. Since our program is based on the participants' awareness and autonomous improvement of behavior, it would be easier to continue for a long term compared to complying with specialist's complicated prescription of behavioristic modification.

Amid the swell of the tide of globarization and decentralization, the building of healthy cities and communities has become an increasingly important task of Japan’s health and welfare policy makers. In this article the international trends, results and problems of the healthy cities projects were reviewed with attention focused on the 3rd period (1998-2002) of the WHO healthy cities programs. The strategy and methodology, and the theory and practice of the development of healthy cities and communities were also proposed with stress placed on the need of the symbiotic collaboration between rural communities and urban communities from the viewpoint of policy science.
seconds ; Policy ; Science ; Methodology ; Community

In the health and welfare policy of the 21st century, the building of healthy communities in rural areas has become an urgent task. The working out of an effective strategy and supportive activities by the Japanese Association of Rural Medicine have become important. We analyzed the situation, outcome, and problems of the health projects which have been continued for the past 40-50 years in Takasu?cho in Hokkaido, Masuda-cho in Akita, Matsumoto City in Nagano and Izumo City in Shimane Prefectures. The supportive actions by hospitals and universities were assessed as a model of community-academia collaboration.