Emerging ethical issues have prompted Western countries to focus more attention on public health ethics in medical education. To assess the current and future states of public health ethics education in Japan, we analyzed the opinions of public health educators in Japanese medical institutions and explored potential topics for public health ethics curriculums. 1) We mailed self-administered questionnaires to 201 hygiene and public health departments to inquire about their current curriculums and the state of public health ethics education at their institutions. 2) Of the 101 responding institutions, 60.4% were spending 8% of teaching hours on lectures related to ethical issues in public health. 3) Most institutions agreed with a proposal to require the completion of a public health ethics course in medical education programs. 4) Among the major topics chosen to be included in the potential course were ethical issues surrounding public health policy and medical research.

Objective: The aim of this study was to identify the content and methods of ethics education for medical representatives as part of the continuing education program and to suggest a preferable supportive method of ethics education accordingly.
Method: A questionnaire was mailed to the medical representative education managers of all 214 companies, all members of the MR Education & Accreditation Center, Japan.  The questionnaire was carried out from 31st July 2009 to 25th August 2009, and data from this questionnaire survey was analyzed by simple and cross tables.
Results: Out of the 182 (response rate: 85.0%) who responded, we analyzed the 173 institutions for analysis as they responded as having the continuing education program.  In terms of education, “the fair competition code” was the most widely educated (82.6%).  Although “the fair competition code” required most time, “the ethics as a medical representative” was considered as the most important.  The simple kappa coefficient between actual educating item and important item was 0.29.  Answers were affected by whether he/she had experience as a medical representative.  As the method of ethics education, “lecture” style was most common (87.4% of respondents), “group work discussion” was considered the most effective (70.6%) for training a medical representative to think and learn by himself/herself.  The respondents of 82.2% referred to the continuing educations’ guidelines made by MR Education & Accreditation Center, and 81.0% respondents felt “training materials for lectures and/or discussions” necessary in the future.
Conclusion: The ethics education for medical representatives placed a disproportionate emphasis on the importance of “the fair competition code.” Dissociation was seen between the actual education and the education considered as important by the respondents.  Accordingly, there is a need for appropriate materials for training and for a more adequate curriculum, taking time and content of education into consideration, especially for contents which training ways aren’t built up.

Background/Aims: Endoscopic submucosal dissection (ESD) for diverticulum-associated colorectal lesions is generally contraindicated because of the high risk of perforation. Several studies on patients with such lesions treated with ESD have been reported recently. However, the feasibility and safety of ESD for lesions in proximity to a colonic diverticulum (D-ESD) have not been fully clarified. The aim of this study was to evaluate the feasibility and safety of D-ESD. Methods: D-ESD was defined as ESD for lesions within approximately 3 mm of a diverticulum. Twenty-six consecutive patients who underwent D-ESD were included. Two strategic approaches were used depending on whether submucosal dissection of the diverticulum-related part was required (strategy B) or not (strategy A). Treatment outcomes and adverse events associated with each strategy were analyzed. Results: The en bloc resection rate was 96.2%. The rates of R0 and curative resection in strategies A and B were 80.8%, 73.1%, 84.6%, and 70.6%, respectively. Two cases of intraoperative perforation and one case of delayed perforation occurred. The delayed perforation case required emergency surgery, but the other cases were managed conservatively. Conclusions D-ESD may be a feasible treatment option. However, it should be performed in a high-volume center by expert hands because it requires highly skilled endoscopic techniques.