To improve doctors' understanding of dietary and nutritional therapy, clinical nutrition must be taught during undergraduate medical education. Using questionnaires given to every medical university in Japan, we examined how clinical nutrition education has been adopted into their curricula. Only 9 (12.9%) of 70 universities have adopted this topic as a cultural or professional subject. Many other universities are performing nonintegrated nutrition education by teaching nutrition-related items in basic and clinical subjects. Although many nutrition-related topics are included in the Essentials for the National Medical Board Examination published by the Ministry of Health and Welfare, only 1% to 5% of the 320 to 330 questions appearing on the national medical board examination are nutritionrelated. The present report suggests that the nutritional knowledge of doctors and medical students is not sufficient. We believe that national guidelines for problem-based nutritional education as part of an integrated curriculum must be established. The present situation of nutrition education in the United States, the United Kingdom, and Europe are also discussed.

Medical interviewing skills were assessed with the objective structured clinical examination using simulated/standardized patients (SP) in 36 5th-year medical students. ultaneously, assessment of cognitive-behavioral characteristics was performed using 7 kinds of scales (locus of control, social skills, self-esteem, general self-efficacy, medical interviewing-specific self-efficacy, person perception of self, and person perception of the patient) on the same students to clarify correlations with medical interviewing skills. Students who had attended a small-group mini-workshop session for medical interviewing skills showed only a significantly better ability to summarize. Personal familiarity with the patient was the only factor among the cognitive-behavioral factors studied which was a significantly correlated with medical interviewing skills. Among the six medical interviewing skills, only summarization and confirmation skills were positively correlated with the students' self-efficacy and the objective assessment with the objective structured clinical examination. We conclude that 1) medical interviewing skills can be taught regardless of the cognitive-behavioral abilities of each student; 2) teaching summarization and confirmation skills are especially valuable and important in teaching medical interviewing to medical students.

A program for teaching basic clinical skills to fifth-year medical students was started at Toyama Medical and Pharmaceutical University in 1999. The five units of basic clinical skills included: 1) medical interviewing, 2) general physical examination, 3) chest examination, 4) abdominal examination, and 5) neurologic examination. The educational strategies and evaluations in each unit consisted of: 1) lectures, 2) videotape demonstrations, 3) role-playing in small groups, 4) practice on patients in small groups, 5) written examinations, and 6) objective structured clinical examinations. The students evaluated each session of the program with a five-grade rating scale and comments. Small-group sessions (role play and practice on patients) and objective structured clinical examinations received the highest scores, followed by videotape demonstrations. Lectures received significantly lower scores than did other parts of the program. In addition, most students recommended standardization of educational content, increased practice time, and fewer lectures. We conclude that evaluation by students is essential for improving programs for teaching basic clinical skills.

Using atomic absorption spectrophotometry, we measured serum mineral (Fe, Cu, Z n, Mg, Ca, K, Na) concentrations in blood of male athletes participating in a triathlon competition held at Nakajima, Ehime in 1989. The athletes were divided into a young group (n=9, 24.2±3.6 yr) and a middle-aged group (n=9, 49.3±4.4 yr) . Blood samples were taken on the day before the competition, at the finish, on the following day and for eight days after.
Immediately after the race, the concentrations of iron, calcium and potassium were increased significantly in sera taken from both groups, and those of copper and zinc were found to be increased only in the young group. In the middle-aged group, serum magnesium and sodium concentrations were decreased significantly. On the day after the race, most of the serum mineral concentrations had returned to values similar to those measured before the race, although the serum sodium concentration in the middle-aged group was still below the previous value, and this low level persisted for eight days after the race in both groups.
Noticeable differences between the young and middle-aged groups were that recovery of increased iron concentration in serum tended to be prolonged in the middle-aged group, and the concentrations of serum copper and zinc were higher than those in the young group throughout the measurement period, with only small changes evident before and after the race. By contrast, serum potassium concentration in the middle-aged group was lower than in the young group throughout the measurement period.

To clarify the core competencies developed through postgraduate clinical training, we analyzed the conditions of our residency program with qualitative research methods. Seven residents (6 first-year residents and 1 second-year resident) answered a questionnaire and underwent semistructured interviews about postgraduate training. We also worked with the residents as “participant observers” of the treatment team. We found that residents often had trouble formulating diagnostic/treatment plans and tended to rely excessively on laboratory data to make decisions. We attribute these problems to a lack of practice in questioning expectations. We hypothesized that mitate-ryoku, the ability to describe the course of a patient's illness, is an extremely important clinical competency. According to the hypothesis, we tried to listen to the residents' description and to discuss it logically as colleagues. The residents described the patients expected condition over the next few days, considering both data and information they obtained from interviews and physical examinations. They adapted their ideas through logical discussion and were thus able to make acceptable decisions by themselves.

Introduction: Epidemiologic evidence on childhood vaccination is scarce in Japan. Our aim was to investigate the vaccination completion rate and risk factors of incomplete vaccination.
Methods:This study was a secondary analysis of the database developed for a childhood infection study of 2368 attendants of 18-month health checkups in one city in Japan. The data of vaccination history included bacillus Calmette-Guérin, diphtheria-pertussis-tetanus, measles-rubella, and polio. A total of 1622 children were included in analyses after 746 were excluded because a large portion of their data was missing, and because their birthweight was <2500 g or their gestational age, <37 weeks.
Results:The overall vaccine completion rate was 79.3%. The factors significantly associated with incomplete vaccination by multivariate logistic analysis were two or more children living together, child care attendance, parents’ smoking habits and absence of exclusive breastfeeding at 4-month health checkups. As the number of risk factors for hospital admission due to infections increased, the vaccine completion rate tended to decrease.
Conclusion:Families with children who attend child care facilities and with two or more other children should be provided with more information regarding vaccination and positive health behaviors in general.

Background: Urosepsis is a potentially fatal syndrome that is sometimes difficult to diagnose. Thus, the aim of the present study was to clarify the clinical and laboratory characteristics and pitfalls in the diagnosis of urosepsis.
Methods: We enrolled the study participants based on clinical records of patients with urosepsis treated between January 2009 and April 2012 inclusive, in the Department of General Internal Medicine, Toyama University Hospital and retrospectively surveyed underlying diseases, clinical symptoms, physical findings, and laboratory data, respectively.
Results: Ten definitive patients were selected (nine females and one male; age, 55–86 years). Fever was the most frequent symptom followed by nausea. Lower back pain was the chief complaint in only two patients. One patient complained of dysuria, and on examination half of the patients lacked costovertebral angle (CVA) tenderness. Five patients showed elevated liver enzymes without evidence of hyperbilirubinemia.
Conclusions: There were no specific clinical characteristics of urosepsis, and symptoms in some patients resembled digestive diseases such as cholangitis. Our results demonstrate that use of dipstick urinalysis and microscopic urinalysis are essential for the diagnosis in patients with sepsis. Abdominal ultrasonography and/or computed tomography should also be considered to rule out false negative results of urinalysis related to urinary tract obstruction, and to detect other focal infections when appropriate.

Introduction : This study aimed to clarify the relationship between the presence of someone to care for and the subjective QOL (quality of life) of local elderly people.
Methods : Data for 7,728 residents aged 65 and above was obtained from the everyday life sphere needs survey implemented by the government of Nanto City, Toyama Prefecture, between May to July, 2014. Multiple logistic regression analysis was conducted to evaluate the relationship between two sets of variables : first, the presence (or absence) of “something to live for”, “sense of fulfillment”, and “self-esteem” as indicators of the respondents'subjective QOL ; and second, a set of explanatory variables (common to all models) including the presence of someone to care for, indicators of the personal attributes, health, and life style of the respondents.
Results : The presence of someone to care for was positively related to the presence of “something to live for,” “sense of fulfillment,” and “self-esteem,” which were indicators of subjective QOL, even after several indicators of personal attributes, health, and life style were accounted for.
Conclusion : Promoting mutual help in local areas has a positive significance for those elderly who take care of others, as well as for those who accept care. The results also suggest the social importance of being the recipient of care in the elderly.

The usefulness of individual care of patients in the attitude education of undergraduates was evaluated with questionnaires completed by 4th-year medical students and patients. Ninety-eight percent of students finished performing patient care during a 2-week period. Seventy percent of patients completed questionnaires. The appearance, manner of greeting, and language of the students were considered good by 87% or more of the patients, and the students' consideration for the patients' safety, privacy, and communication was considered good by 86% or more of the patients. The practice was approved by 77% of the patients and was objected to by none. Ninety-nine percent of students completed questionnaires, and 79% of the respondents approved of the practice. Fourteen percent of the student respondents, many of whom had been treated as outpatients, objected to the practice. These results suggest that individual care of patients by medical students is useful for both patients and students.