Severe Acute Respiratory Syndrome (SARS) has rapidly spread and caused epidemics in many countries. During these epidemics, the Japanese government contributed to SARS control by dispatching medical teams. In the present article, the author reviews and discusses the process of control of the SARS outbreak based on experiences in activities to support SARS control in Vietnam and China.
Vietnam succeeded in the effective control of SARS for the first time in the world. This was accomplished by complete isolation of patients and implementation of nosocomial infection control from an early stage of epidemic, etc. In China, due to inadequate response in the early stage, nosocomial infection occurred frequently and the disease quickly spread. However, later, effective actions were taken under the strong direction of the government, and the disease was finally put under control. The Japan Medical Team for Disaster Relief dispatched by the government of Japan to Hanoi, Vietnam and Beijing, China offered cooperative activities for the prevention of nosocomial infection and respiratory management. In addition, the Medical Aid Team sent to Guangdong Province in China provided guidance to the local Japanese residents to prevent the infection of SARS and to alleviate anxiety about the disease.
In the control of SARS, it is essential to take adequate actions from an early stage in the development of the disease. For this purpose, rather than starting measures for the control of nosocomial infection after the eruption of the disease, it is important to train medical staff on a routine basis, to establish a nosocomial infection control system, and to consolidate basic preventive practices.

Agriculture has been reported as one of the most dangerous industries, but there are a very few statistical reports about agricultural injuries and accidents in Japan. The authors conducted analyses of agricultural injuries and accidents data from 1992 to 1995 (n=333) in Kochi, in order to discuss issues of agricultural safety and health, and the characteristics of agricultural injuries and accidents among aged farmers.
The average age of 333 patients, including 13 deaths, was 57.1 years old, and 174 patients (52.3%) were over 60 years old. One hundred and thirty seven accidents (41.4%) occurred during the period from July to September. Injuries resulting from falls topped the list with 101 patients (30.3%), followed by pinchs and involvements with 58 (17.4%), cuts and lacerations with 54 (16.2%), and slips with 36 (10.8%). The injury causes were agricultural machinery in 134 patients (40.2%), agricultural facilities in 34 (10.2%), motor vehcles in 27 (8.1%), and farm animals in 18 (5.4%). The rate of fall accidents was significantly higher among people over 60 years old than among those under 60 years old (p<0.001). The rate of serious injuries and accidents was significantly higher among people over the age of 60 than among those under the age of 60 (p<0.01).
Considering these results, effective and feasible preventions for agricultural injuies and accidents must be safety education and training, safety procedure manuals, which should be easy to understand for aged farmers, and improvements of agricultural machinery and eqiupments.

In order to protect farmers from health hazards posed by soil fumigation with methyl bromide in greenhouses, the authors monitored the concentrations of the fumigant inside greenhouses, before and after fumigation and measured occupational exposures. In the meantime, a questionnaire survey was conducted to find out the facts about working conditions, health effects and personal protective equipment in 1996.
As environmental concentrations of methyl bromide decreased from 2200ppm to 1100ppm gradually in three days, two farmers were exposed to 57ppm and 25ppm, in opening up the greenhouses, respectively, which are above ACGIH's TLV-TWA (1ppm) and OSHA's PEL-C (20ppm). The questionnaire survey (n=164) found that about 80% of the respondents have fumigated inside the whole greenhouse without mulch, above 90% have opened up greenhouses within 5 days, and that only 10% have worn effective gas masks and clothes. Regarding subjective symptoms after fumigation, 2%-6% of respondents complained about eye and respiratory tract irritation.
These results suggest that farmers might be exposed to high concentrations of methyl bromide in opening up greenhouses. In order to prevent health hazards of methyl bromide, education programs on toxic information and health effects of methyl bromide, and safety training in soil fumigation should be provided to farmers.

High economic growth since the late 1950's has brought about a severe labour shortage in Japan. Japanese industry sought migrant workers as one reliable source of labour. As seasonal and unskilled workers, they were employed in a wide variety of trades ; for example, construction, manufacturing, forestry and transportation. However, some of the migrant work was becoming a principal and nonseasonal occupation, and specialized. Migrant forestry and tunnel-construction work are two examples of such specialized work.
To identify health problems among them, we examined the factors affecting workers' entry into migrant forestry and tunnel-construction work, working conditions, and health care services at the workplace by interviewing 65 migrant wokers identified at Hayama Village in Kochi Prefecture, one of the areas well known for providing migrant wokers. Moreover, we carried out health examinations for vibration disease and pneumoconiosis. In this report, we show the results of analysis on 35 migrant forestry workers.
The main factors affecting their entry into migrant forestry work were unstable and poor socioeconomic conditions in the area and the strong demand for a workforce during the rapid economic growth from the late 1950's in Japan. Most of the wage configuration was for piece and contracted work, which promoted long working hours and above-average consecutive work days. They engaged in cutting down, collecting and transporting trees, using vibrating tools such as chain saws, bush cutters, collecting machines and so on. High levels of vibration-exposure quite exceeded the limit of the Ministry of Labour and lasted continuously over 17 years. A difference in labor conditions and working situations was observed between migrant workers who devoted themselves to migrant forestry work and those who did not. Health care administration including health examinations was inadequate. There had been no case of vibration disease identified at the workplace. However, 68 percent among 25 examinees were diagnosed as suffering from vibration disease. Moreover, 40 percent of the subjects experienced absences of more than 4 days due to occupational accidents.

Since 2000, the authors have been conducting technical cooperation on nosocomial infection control at Bach Mai Hospital (BMH) in Vietnam, which is the first trial in the country. The main contents include: (1) Consolidation of the bases of nosocomial infection control at BMH, which include setting up the appropriate control system and providing training for hospital staff, (2) Cooperation in the SARS outbreak, (3) Fact-finding survey on nosocomial infection, and (4) Preparation against avian influenza at hospitals. As a result of these activities, nosocomial infection control at BMH has been enhanced and the staff is providing technical guidance to other hospitals in recent years with the aim to disseminate skills and knowledge widely in Vietnam. The questionnaire survey on preparedness against SARS, including awareness among staff, training situation, infection control system in hospital, etc., showed comparatively good results in Vietnamese hospitals. The present paper summarizes the collaboration on nosocomial infection control between Vietnam and Japan.
Nosocomial infection control is considered essential to upgrade the quality of medical care. Also, constant efforts to upgrade the skills and knowledge of medical staff and to set up an efficient infection control system will be useful in dealing with the potential risk of resurgence of SARS or human influenza pandemic. Nosocomial infection control is one of the most appropriate subjects for technical cooperation at hospitals in developing countries.

Finger dermatitis among perilla workers have been reported since 1970 in Japan. The agricultural chemicals used for perilla culture and the allergic effects of the perilla itself are discussed as for the causative factors of the dermatitis.
In this report, epidemiological survey and dermatological examination were carried out, with special concern for the prevalence of hazards of each fingers of the workers in relation to their work process, especially picking perilla leaves. Subjects were all of 152 workers who engaged in perilla culture in 2 area in Nankoku, Kochi Prefecture. And the skin patch testing for 32 workers (17 ones with dermatitis and 15 ones without dermatitis) and 20 controls was done using samples of the leaves cultivated without agricultural chemicals for more than 3 weeks and perilla oil extracted from them.
Results were as follows.
1. Skin hazards of the fingers, such as erosion, fissure, desquamation, thickening or bleeding were observed among about half of the workers.
2. The hazards were more frequently observed among the workers whose working hours for perilla culture and picking perilla leaves were longer.
3. The hazards were more frequently observed in the fingers touching the reverse sides of the leaves which had the secreting glands than in those touching the surface sides, on which might be contaminated by agricultural chemicals.
4. The perilla oil acted as the irritating substance for almost all of the examinee, and the skin patch testing demonstrated that both the perilla leaves and their oil caused allergic reactions to the workers with dermatitis.
5. It was considered that the perilla leaves and their oil had played an important role of a cause of the dermatitis among the perilla workers.

Objective: Adequate periconceptional folic acid intake decreases the risk of neural tube defects in infants.  The present study aimed to investigate the awareness of pharmacy students regarding the importance of folic acid intake for the prevention of neural tube defects.
Design: Questionnaire survey.
Methods: A self-administered questionnaire regarding the importance of folic acid intake for the prevention of neural tube defects was distributed to 750 pharmacy students at Tohoku and Ohu Universities.
Results: Among the 685 respondents (response rate; 91.3%), 74 (10.8%) were aware that folic acid intake decreases the risk of neural tube defects.  In multivariate logistic regression analysis, awareness of the importance of folic acid intake was evident among 5th- and 6th-year pharmacy students (odds ratio=3.352, 95% confidence interval=1.797-6.253) and among those who used dietary supplements (2.275, 1.306-3.966).  Among the 74 pharmacy students who recognized the importance of folic acid intake, 17 (23.0%) and 3 (4.1%) were aware that women should begin taking a folic acid supplement before conception and should take about 400 μg per day during pregnancy, respectively.
Conclusion: Only about 10% of the pharmacy students in this study recognized that folic acid intake decreases the risk of neural tube defects, and many were unaware of the recommended intake amount.  Therefore, awareness of the importance of folic acid intake must be more aggressively promoted among pharmacy students.

Introduction

  The Direction Office of Healthcare Activities (DOHA) started around 1998 in Vietnam offers training provision for all lower- and higher-ranked hospitals. An understanding of the factors responsible for the success of this unique training provision system can be useful in implementing appropriate human resource development strategies in the health sector. Furthermore, the reviews about the changes in the training provision styles can offer us clues on how to connect training provision with visible clinical improvement.

Method

  We reviewed the policy papers from the ministry of health in Vietnam, the activity reports of DOHA in the training center of Bach Mai hospital, which is a high-ranking hospital, JICA (Japan International Cooperation Agency) reports, and NCGM (National Center For Global Health and Medicine) reports from 1997 to 2015.

Results

  DOHA was founded as a government-led health provision system in Vietnam with strong policy guidelines. However, to expand their activities, strengthen the capacity of training in hospitals, and establish a financial mechanism for training, there was a need to empower lower-ranked hospitals.

  To enhance the training impact of the clinical field in lower-ranked hospitals after training provision, staff of higher-ranked hospitals were dispatched to lower-ranked hospitals to provide on-the-job training (1816 project) and training provision with equipment preparation in lower-level hospitals to overcome environmental difficulties in implementing techniques that they had learned (Satellite hospital project).

Conclusion

  “Strong policy commitments”, “a viable financial system”, and “bottom-up empowerment” were needed to establish nation-wide continuous medical education system in Vietnam. To connect training provision with improvement in the clinical field, “integrated approaches for multiple factors in clinical fields like clinical environment changes and extended follow-ups“ by providing training are needed.

It is not uncommon for edema in the end stage of advanced cancer to be caused by nephrotic syndrome (NS) as well as by cachexia, hypo-proteinemia due to malnutrition, or lymphedema. Such edema not only causes patients' quality of life (QOL) to be deteriorate, but may also result in earlier death in the absence of accurate diagnosis and treatment. We report a case of nephrotic syndrome with advanced uterine cancer, in which the patient's QOL was greatly improved by the accurate and timely diagnosis and treatment of NS. A 65-year old woman suffering from recurrent uterine cancer (lung and brain metastases) was admitted as an emergency due to deterioration of her general condition. Edema of both legs was severe, and laboratory findings (TP 5.0 g/dl, ALB 1.3 g/dl, T-Chol 369 mg/dl, proteinuria 3+) at the time of admission met the diagnosis criteria for NS rather than cachexia. We first administered albumin to stabilize circulation, and started treatment with prednisolone and cyclosporine, which greatly improved her general condition and edema of her legs. Subsequently, NS repeatedly improved and worsened and the tumors gradually progressed. The patient died of multiple organ failure induced by disseminated intravascular coagulation (DIC) at 81 days after admission. NS caused by malignancy is not uncommon. In general, however, such cases of NS are associated with solid tumors, such as gastrointestinal and lung cancer. NS caused by uterine cancer is very rare. We suggest that NS should be borne in mind in addition to cachexia, hypo-proteinemia or lymphedema as a possible cause of edema in the end stage of advanced cancer. Palliat Care Res 2011; 6(1): 316-323

Depression and pain are common and often early non-motor symptoms of Parkinson disease (PD). The relationship between pain and depression in PD has been unsettled, with conflicting findings. The PD patients followed up at the general neurology outpatient clinics were requested to complete Beck Depression Inventory (BDI) and McGill pain questionnaire. The patients were categorized in three groups according to the Hoehn-Yahr (H-Y) stage of PD; mild (stage I&II), moderate (stage III) and advanced stage (stage IV&V), and group comparisons were performed in each group between those with and without pain. A total of 186 patients completed the questionnaires. Their mean age was 74±9.3 years, and the mean H-Y stage was 2.8±0.8.Sixty-nine percent of the patients reported pain symptoms of various natures. The BDI scores were significantly higher in the pain group (P< 0.0001) despite the absence of statistically significant differences in the mean age, H-Y stage, and duration of illness. Only PD patients of mild stage revealed significant difference of BDI scores between those with pain and without pain (P <0.001). Our results showed that pain is a common symptom in patients with PD and suggest that it may be related to depression in the early stage of the disease.