Objectives: This study aimed to investigate what third–year students of the J University School of Medicine had learned in home care practice.
Methods: We analyzed the students’ reports and focused on the description of the learning for the practice. We extracted the category of learning using qualitative content analysis.
Results and Conclusion: The core categories we extracted from the analyses were: 1） characteristics of home healthcare, 2） patients, 3） families, 4） home–visiting nurses, 5） medical treatment teams, 6） frank remarks of medical students and physicians, and 7） necessities as a physician. The frank remarks of medical students and physicians included the distrust of physicians and the hopes of medical students. The students gained valuable experience from this practice. In particular, learning about the distrust of physicians and the hopes of medical students may be difficult without such practice.

Background: Some early clinical exposure programs in the community have been implemented in our medical school from years 1 to 3: community service for the handicapped in year 1, care for severely handicapped children in year 2, and health care at home with district nurses in year 3. The directors of these programs informed us, in feedback reports, of the inappropriate behavior of medical students. We then provided feedback directly to the students. We investigated the changes in student behavior after feedback during the 3 years they participated in these programs.
Methods: We analyzed the feedback reports from these 3 early clinical exposure programs from 2009 to 2011. Inappropriate behavior of medical students and changes in behavior were recorded.
Results: Inappropriate behaviors reported were: 1） lack of essential learning behavior, 2） lack of positive attitude and acceptance of learning in the programs, and 3） lack of communication skills. The numbers of students who received feedback about inappropriate behaviors were 26 in year 1, 11 in year 2, and 2 in year 3. Feedback to students from early clinical exposure programs may lead to changes in their behavior.

We have started to hold regular conferences with patients on walking rounds in order to listen to their problems as much as possible and to make it easy to obtain informed consent from our patients. To sound our patients' opinions about our approach, we distributed questionnaires to a total of 332 patients between August and December 1994. The survey found the 103 patients joined the conferences for more than one week. Ninety-eight patients commented favorably foward the conferences and about 90% said that they have become able to reveal their thoughts and ask the physicians and nurse what they wanted to ask. A lotal of 82 patients said that they understood the purpose of their therapy, while 27 patients said that they had difficulty speaking to us at beside in the presence of other patients in the same room. With these results, we attained our purpose of sharing in their problems and making it easy to obtain informed consent. However, we feel a need to take measures to assure the privacy of the patients.

Objective: In recent years, the Ministry of Health, Labor and Welfare has actively promoted the use of generic drugs.  However, implementation of this policy has not progressed smoothly, as information on generic drugs is poorly organized.  As a result, it is difficult for pharmacists to select the appropriate generic drugs.  Therefore, we attempted to develop a code system to organize information on generic drugs.
Methods: We analyzed the guidelines used for the approval of generic drugs.  We then identified the important aspects for comparison of generic drugs and developed a code system.  Next, we tested this code system using temocapril hydrochloride tablets, which is a generic drug.
Results: We were able to develop a code system for selection of generic drugs.  Furthermore, we confirmed the utility of this code system for selecting generic drugs in the case of temocapril hydrochloride tablets.
Conclusion: We believe that this code system with be useful for pharmacists, but further development is necessary for other generic drugs.

Objective: The purpose of this study is to identify the problems in the adverse drug report (ADR) system in early post-marketing vigilance phase (EPM phase) in Japan.
Methods: The incidence of all ADRs and the ratio of serious ADRs were compared between the new drug application phase (ND phase) and the EPM phase.  The target medicines were Moxifloxacin (Avelox®tablets, 400mg), Gatifloxacin (Gatiflo®tablets, 100mg) and Prulifloxacin (Sword®tablets, 100mg).
Results: The average incidence of all ADRs in the ND phase was 100-fold greater than that in the EPM phase.  There were also 2-fold differences in the ratio of serious ADRs of individual medicines.
Conclusion: There are several problems with the ADR system in the EPM phase in Japan.  It is currently possible that the implementation of EPM will vary between in individual medicines and companies.  This suggests that the present data cannot be applied universally.  Thus, there is an urgent need to standardize the implementation of EPM.

Water exercise has various health benefits. However, effects of low-intensity water exercise program, frequently conducted as a health promotion activity, on high frequency component of heart rate variability (HF, an index of cardiovagal activity and a predictor of future cardiovascular disease) has been unexplored. To investigate acute effects of a low-intensity water exercise program on cardiovagal activity, 35 young healthy men participated in this study as a part of the water exercise group (15 min of walking, 10 min of jogging, and 10 min of supine floating) or the control group (35 min of sitting at rest on land). Heart rate during walking, jogging, and floating in water were 88±13, 104±19, and 73±14 bpm, respectively. Ratings of perceived exertion (Borg’s 6—20 scale) were 9±2, 10±2, and 7±2, respectively. Before the low-intensity water exercise program or 35-min sitting rest, there were no intergroup differences in natural logarithm of HF (lnHF), the ratio of low to high frequency component of heart rate variability (LF/HF), heart rate, blood pressure, sublingual temperature, and salivary amylase activity. An interaction between time and group was found in lnHF (P = 0.01); lnHF was greater 15 min and 30 min after versus before the program in the water exercise group, whereas there were no differences in the control group. There were no interactions in LF/HF, heart rate, blood pressure, sublingual temperature, and salivary amylase activity. These results suggest that the low-intensity water exercise program consists of walking, jogging, and supine floating acutely enhances cardiovagal activity.

This study sought to demonstrate the benefits of conducting cervical cytology and human papillomavirus (HPV) testing in our cervical cancer screening program and was conducted between April 2012 and March 2017 in the Yuri-Honjo district of Akita Prefecture. A total of 3581 women aged 20-49 years underwent this combined screening for 5 years. Of these, 10.3% (369/3581) tested positive for HPV, and 433 women were initially diagnosed as positive for atypical squamous cells of undetermined significance and/or positive for HPV. Of those, 342 women (79.0%) underwent cervical biopsy, among whom 62 (18.1%) were diagnosed as positive for cervical intraepithelial neoplasia (CIN)2+. Of 204 women who were positive for HPV but showed no abnormalities in cytology, 24 women (11.8%) were positive for CIN2+ and 6 women were positive for CIN3+. Conventional cytology (Pap test) detected only 0.58% of the examinees positive for CIN2+ in Akita Prefecture, whereas our combined screening involving a Pap test and HPV testing detected 1.73% of the examinees (P<0.0001). We recommend HPV testing be used in combination with the Pap test to improve cervical cancer screening and accurately identify CIN2/3 disease.

Objective: Human papillomavirus (HPV) vaccination was introduced in Japan in April 2013, as a national immunization program for girls aged 12–16 years, after an initial introduction in 2010 as a public-aid program for girls aged 13–16 years. The Yuri-Honjo district had the highest vaccine coverage among women aged 17–51 years in 2017, due to the original public-aid program. The aim of this study was to evaluate the differences in the vaccine types of HPV16/18 infections between 2008–2012 (pre-vaccine era) and 2013–2017 (vaccine era).Materials and Methods: We evaluated whether HPV vaccination was associated with a decrease in the prevalence of HPV16/18 and high-risk HPV and the incidence of HPV-associated cervical lesions. A total of 1,342 women aged 18–49 years, covering both the pre-vaccine and vaccine eras, who visited Yuri Kumiai General Hospital and underwent HPV genotype tests from June 2008 to December 2017 were compared.Results: Among women aged 18–24 years with higher vaccine coverage (68.2%), the prevalence of HPV16/18 and high-risk HPV decreased from 36.7% and 69.4%, respectively, in the pre-vaccine era to 5.8% and 50.0%, respectively, in the vaccine era (p=0.00013 and p=0.047, respectively). Among those with cervical intraepithelial neoplasia grade 2− and grade 2+, HPV16/18 prevalence decreased from 30.0% to 2.7% (p=0.0018) and from 81.8% to 36.4% (p=0.030), respectively. In this age group, the rate of HPV16/18 positivity decreased significantly. Among age groups with lower vaccine coverage, HPV prevalence did not significantly differ between the two eras.Conclusion: The prevalence of HPV16/18 and high-risk HPV significantly decreased in women aged 18–24 years, most of whom were vaccinated. HPV vaccination effectively reduced the prevalence of HPV16/18 infections in the Yuri-Honjo district.