Among the Fourth National Comprehensive Development Plan issued in 1988, a Project of Developing Agricultural and Mountainous Communities was proposed for realizing a “Decentralized Country”. Aim of the Project was to vitalize the lives in rural areas. Especially the Act of Developing Resort Areas is thought to have had great influences on the agriculture and community lives in the 1990's. The present report, which is a fruit of cooperation of a study network over the country, surveyed what changes have been seen in rural lives focusing its attention on the issues of health and environment, and also discussed what the agricultural and rural medecine should do corresponding with the changes in agriculture and rural lives.

Corresponding to the international trend toward a reform of higher educational institutions and a structural reform of universities of Japan, a tota 89 national universities were incorporated in 2004. Each university is making its way in accordance with the 6-year interim plan.Analyses were made of the background and framework of university incorporation, its effect on community medicine, the international trend of agricultural medicine and problems to be addressed by the JARM from the viewpoint of reconstruction of community care in rural areas, especially in out-of-the-way villages and on solitary islands throughout this country.University reform is aimed at separation of education from management, clarification of the responsibility for students, independence from the educational administration, and guarantee of higher education. Behind the incentive of the reform is internationally common recognition that the society in the 21st century will be “knowledge-based society.”The surge of high education reform kicked off in the U.S. and Britain in the 1980s was closely related to their intention to continue economic and cultural development steadily, a market mechanism, intensified competition, and the grouping for the best way to create a new social system.In order to create and maintain healthy rural community, the JAPM has to grapple with various tasks strategically. They include:a comprehensive approach to health care, welfare and higher education; collaboration of rural residents and related governmental agencies with the former acting on their own initiatives; combination of health promotion and other local policies in remote rural areas; participation in agricultural policy making with international cooperation taken into consideration.
Universities ; Higher education ; Japan ; educational ; Community

The report of the Canadian Medical Association (CMA) Committee on health care of the elderly was translated, in reference to the teaching of geriatric medicine.
The present state of geriatric medicine teaching, the characteristics of health care for the elderly, the integration of geriatric medicine education, the curriculum of geriatrics, and the particular problems of postgraduate education in Canada were analysed. Some recommendations for improvement were proposed.

We held the 48th meeting of the Japanese Association of Agricultural Medicine and Rural Health in Matsue, Shimane Prefecture in November, 1999. The main theme of this meeting was “Strategies of Agricultural Medicine and Rural Health with a Perspective toward the 21st Century”.
The attendants of the meeting held discussion about four subthemes with the relation to the development of rural communities: environmental crisis and the human existence, medical high technology and humanism, human dignity and the quality of medicine and welfare, and the co-existence of rural and urban communities.
The presidential lecture, which is reported here, treated the international trend of rural medicine and health care, our practice of rural medicine in San' in District, Japan, and some measures against aging society practiced by us in San' in District. The lecture also discussed about problems presented to the rural medicine in the 21st Century, and proposed several objectives to be carried out: integration of health care, medical care, welfare and education in rural districts, promotion of healthy lifestyle in rural districts, corporatism between administrators and researchers in medical care and welfare, policy-making for healthy rural communities and the protection of enviroment and eco-system.

Health condition of the middle- and old-age women living in various agricultural and mountain villeges of Japan was examined and measures for promoting their health were discussed.
The study performed for two years from 1997. The cooperative team was composed of community health specialists who had dedicated their efforts of health promotion for a long time in rural area in Japan.
1. A sheet concerning community profile was made to reveal the present situation of rural communities. The community characteristics was useful to analyse various health problems occuring in rapidly changing rural areas.
2. A health check list of middle- and old-age women in rural communities was made from the aspects of woman health and rights. Also the sheets of community health management were prepared on the basis of each character of community and of age group, which were useful for promotion plan making of woman health.
3. Health examination of middle- and old-age women in rual communities was carried out. Special attention was paid to menopausal disorders. By analysing its relation with life-style, 5% of the disorders were found to be of “the vascular neuromotor type” and each of 1% was “the sleep-disturbance type”, “the neurotic type” and “the sensory-disturbance type”. These results revealed the higher possibility of the influence of sociopsychological factors in women's living conditions rather than that of endocrine environment such as estrogen deficiency.

Methods of writing a scientific paper and forming a working hypothesis were lectured. The concept mapping method has the possibility of evaluating learners' organization of knowledge in research. We tried an application of concept mapping to the research process of nursing. Concept mapping would clarify the conceptual framework, and develop research ability and problem-solving capability.
concept ; Research ; Investigations ; Nurses ; Lower case dee

Recent changes in social needs and the health care system have prompted the development of new teaching strategies and methods in which active learning by students in small groups is emphasized. We created an “early exposure” training program to enable freshman medical students to obtain practical experience at medical and welfare institutions. This program was designed with the following features 1) student-centered and self-directed learning, 2) integrated education for knowledge, skills, attitude and ethics, 3) training in communication skills, and 4) tutor-assisted and small-group discussion. Tutors were recruited from basic medical science departments. In a self-evaluation survey, 92% of students found this early exposure training to be excellent or good. Most students achieved improvement in communication skills, attitude and ethics among the educational objectives. However, a few students did not fulfill any objectives, and thus we should consider further improvements in the tutorial system.

Today, rural communities in Japan are on the brink of a ruin, and the rapidly deteriorating social conditions there have exerted a harmful influence on the health of farmers.
During the work for protecting health of the inhabitants in a village of Ehime Prefecture, it was noticed that a considerably low level of community health has reflected on the high frequency of anemia.
It is noteworthy that most of the anemic cases result from overwork and unbalanced nutrition caused by poverty.
In our last investigation on 1389 inhabitants, anemia was found in 28.0% of the male adults, 25.7% of the female adults, 40% of the old people. The mean hemoglobin level was 14.58±1.63 in the male adults, and 12.57±1.51 in the female adults.
It is urgently necessary to take effective measures to correct the situation.
As causal factors, we can enumerate distorted dietary life, overwork, and physiological phenomena peculiar to women, such as pregnancy and delivery, in the case of women; and overwork, a general decline of bone marrow functions, and the secondary anemia caused by other diseases in the case of old people. The establishment of a system of community health control is needed more than anything else.