The number of people who participate in our mass screening program for the detection of colorectal neoplasms has been increasing year by year. Regrettably, though, only 60% to 70% of those screened with positive tests have complied with doctors' exhortations about receiving workup.
To improve the low attendance ratio of colon cancer candidates, the first thing we did was to hold classes for public health nurses at city, town and village levels to update their knowledge as professional health supervisors and to perceive the need to enlighten the public.
Following these classes, we sponsored educational lectures directed to the inhabitants in various districts with the cooperation of public health nurses there. Emphasis was placed on the importance of regular physicals and the need of workup in the case of positive screenings. Using slides, lecturers presented eveyday health-related data and explained the procedures and the medical equipment used in the screening and testing processes, using plain language.
As a result of these efforts, the workup attendance ratio is on the rise in every district, with the average ratio now reaching 80%.

In Japan, tuberculosis (TB) control activities are conducted by public health centres (PHCs) and treatment support is provided by public health nurses (PHNs). This study describes the TB situation in the affected areas and assesses the effectiveness of Japan’s TB control efforts after the disaster.

We investigated electroclinical features in patients with symptomatic or cryptogenic generalized epilepsies except for West syndrome. They were divided into a tonic group and a myoclonic group. As a result these groups exhibited different features with some overlap between them. They included Lennox-Gastaut syndrome, severe epilepsy with multiple independent spike foci (SE-MISF), Doose syndrome and other unclassifi ed cases. Thus the boundary between these epilepsy syndromes is sometimes blurred. In patients with SE-MISF, main seizure types were minor generalized seizures though the main EEG fi ndings were multifocal spikes. The role of both cortical and subcortical mechanisms in the occurrence of symptomatic generalized epilepsies should be further clarifi ed.

Recently, supplements for athletes are being increasingly used. To clarify the current status of supplement intake, we conducted a survey in female university long-distance runners.
An anonymous questionnaire survey was conducted in runners who participated in the 18th Japan Inter-University Women's EKIDEN Championship, We investigated 99 respondents.
The survey showed that 86 runners (87%) took supplements. Iron was most frequently taken (68 runners, 69%) . The common purpose was to reduce fatigue (amino acids, vitamin C) and prevent ane mia (iron) . However, some supplements were taken after their effects were realized, while others were taken without an effect. In some cases, the purpose was not consistent with the effects. Most runners (73%) purchased supplements in shops stores. Fifty percent of them took supplements for supplementation of nutrients deficient in diets. More than 50% of the runners obtained information on nutrition from their coaches.
Furthermore, most runners began to take supplements when they were senior (55 runners, 56%) or junior (31 runners, 31%) high school students. About 70% of them have taken iron. In the highest percentage of them, their coaches recommended the use of supplements.
The results of this survey showed that most female university long-distance runners took supplements, and that a high proportion of them began to take them when they were senior or junior high school students, suggesting the widespread use of supplements among young athletes. In addition, their instructors markedly influenced the runner's nutritional outlook, by being the source of information on nutrition.

Objective : The purpose of this clinical research was to create an assessment for patients with muscle disease who wish to continue driving by investigating their motor function and driving experience. Methods : Twenty-four patients with muscle disease who visited our hospital from December 2009 to April 2010 were enrolled in our research. For patients who were still driving, physiatrists evaluated their motor functions, examined simulated driving motions and recorded their driving capabilities and techniques, their ability to get into and out of the vehicle and their ability to store and remove their wheelchairs. Patients no longer driving were asked why they had given up driving. Results : Fifteen patients who continued driving had enough upper limb strength and could simulate driving motions, though the location and degree of their muscle weakness were variable. Five of fifteen drove with the aid of a hand-operated brake and accelerator. Seven needed personal assistance: three to get into and out of the vehicles, six to store and remove wheelchairs. The nine patients who had stopped driving reported that the primary reason for discontinuing driving was that they recognized their muscles were insufficient to control the vehicle. Conclusions : We propose to evaluate muscle strength and to test simulated driving motions when assessing patients with muscle disease. A hand-operated brake and accelerator is efficient for patients with lower limb muscle weakness. However, since no efficient automobile modifications are available for those patients who cannot get into and get out of their vehicles or store and remove their wheelchairs by themselves, we suggest arranging personal assistance for such patients.

To accurately assess the clinical competencies of medical students at Fukushima Medical University, we have developed a novel online self–assessment system, which covers all goals in the "Model Core Curriculum for Medical Education in Japan." We added "Emergency," "Communication skills with staff," and "Simulation–based learning." Following their clinical clerkships, 79 sixth–year medical students assessed themselves and their clinical clerkships.
1)This novel online self–assessment system, consisting of 68 checklists in 15 fields, easily informs us of the actual conditions of clinical clerkships and students' confidence in their clinical competencies.
2)This internet–based self–assessment system revealed the current status and problems of clinical clerkships, prompting feedback to clinical instructors and members of the instruction committee.
3)Students felt "confident" or "confident to a certain degree" in most learning areas; however, simulation–based learning seems to be necessary in several areas, such as clinical skills, where feelings of shame or discomfort may be associated with patient care.
4)Students who had high total self–assessment scores evaluated clinical clerkships favorably. In contrast, students whose self–assessments frequently included "no learning experience" evaluated their clerkships negatively in the educational aspects of "skill" and "attitude."

Today, well over 160, 000 patients undergo dialysis throughout Japan. The number of patients who are newly required to receive it is increasing year by year. Given that situation, our hospital has annually held a seminar since October 1994 for patients with renal diseases. The purpose is to slow the deterioration of renal function and to delay the introduction of dialysis by encouraging the patients to acquire a habit of taking high calory, low protein food.
This seminar must have help the patients get more knowledgeable about morbidity and learn the benefit of low protein rice-based diet. Now that three years have passed since the opening of the course, we reviewed the outcome, comparing the effects of old and new restrict diets.
A difference began to appear 9-2 months after the lst seminar between the seminar participants and the non-participants (control group) who received guidance only at the outpatient ward. The average rate of decrease in the serum creatine level of those participants who eated lowprotein rice was 0.029 and that of those participants who did not eat the restricted food was 0.166 (p<0.05), compared with 0.262 in the control group. We concluded that the difference is ascribable to the effect of the seminar. We would like to contribute to the well-being of the patients by enriching the content of the seminar and continuing to hold it.

　　Placental abruption occurs suddenly and may cause maternal and fetal mortality. Forced delivery is the only way to improve perinatal outcome, but the aftereffects could be severe despite a high survival rate.　　Our hospital manages approximately 170 cases of maternal transport annually, including cases of severe placental abruption. Longer transport time can lead to undesirable maternal and fetal outcome. Hence this study, we compared the perinatal backgrounds and outcome of placental abruption retrospectively between the cases managed by maternal transport and by the local hospital (our hospital). The study included 54 cases of placental abruption during the period from January 2008 to December 2012, of which 27 cases were managed by our hospital, the other halves were managed by maternal transport. There were 6 intrauterine fetal deaths but not a single maternal death. There were no significant differences in the amount of blood lost and obstetric DIC (disseminated intravascular coagulopathy) score between two groups (p＝0.342, p＝0.649), and the number of cases that needed anti-DIC therapy and blood transfusion in each group was statistically similar (p＝0.807, p＝0.115). The time taken from the on-set of placental abruption to delivery was significantly shorter for the cases managed by our hospital (in-hospital management 143±133 minutes, maternal transport management 265±176 minutes, p‹0.05), while obstetric DIC score and Apgar score showed no significant differences (p＝0.336, p＝0.780) between the two groups. Thus, it could be said there were no correlations between the time taken from onset to delivery and perinatal outcome. It should be noted, however, maternal and fetal outcome of placental abruption could be fatal even with the rapid intervention, so quick diagnosis and management at the first contact are crucial. Thus, we concluded that forced delivery managed by the local hospitals is necessary for the potential better perinatal outcome, and an ideal system to manage maternal and/or neonate transport after the delivery should be established immediately.

　　Catamenial pneumothorax (CP) is defined as a form of thoracic endometriosis syndrome (TES) and the clinical manifestations and management of this disease are not consensual. Successful treatment depends on how closely pulmonary specialists and gynecologists work together. Such being the circumstances, we reviewed our experience with CP in terms of treatment and follow-up. We treated surgically many patients with pneumothorax during the period from 1989 to 2014, of which eight cases had endometriosis on the diaphragm, lung or pleura histologically. The median age at the time of operation was 37 (range, 17 to 41). CP was right-sided in seven of the eight patients (87.5%). Six patients underwent an examination with diagnostic laparoscopy and five had positive findings. The median period of follow-up after surgery was 33.5 months (range, 4 to 129 months). Two patients had no recurrence without hormonal therapy. Six other patients experienced a recurrence of pneumothorax, although two patients received dienogest after surgery. The use of only dienogest or both GnRHa and dienogest prevented recurrence in all patients. CP is a critical condition that requires prompt action, so after surgical treatment, the choice of hormonal therapy with a high rate of patient compliance are needed. No recurrence occurred in young patients who had only surgical treatment, suggesting that there were some associations between age and recurrence. Since we succeeded in preventing recurrence after using GnRHa in all cases, we recommend GnRHa or dienogest following GnRHa for the first choice of hormonal therapy after surgery. However, treatment with only dienogest could achieve successful results with no recurrence, so more case studies need to be done to make the best treatment choice for each case.