PROBLEM: In the Taro District (population: 4434), the great tsunami of 11 March 2011 destroyed the central region including the clinic, the sole medical facility (one physician, 13 nurses and other staff) in the district, and many citizens were forced to live in evacuation centres.

CONTEXT: The Taro District experienced massive damage during the tsunamis of 1896 and 1933. Since then countermeasures to tsunamis have been implemented. The great tsunami on 11 March 2011 caused catastrophic damage to the lowlying areas where approximately 2500 people lived; 1609 buildings were completely destroyed, and approximately 200 people died or were missing across the district.

ACTION: The Taro National Health Insurance Clinic, the sole medical facility in the Taro District, was required to play a central role in a variety of activities to care for residents in severely affected areas. First of all, evacuees needed to move to neighbouring hospitals or safer evacuation centres because lifeline services were cut off to the first evacuation centre. Then, the clinic staff worked in a temporary clinic; they visited the evacuation centres to assess the public health and medical situation, cared for wounded residents, managed infection control and encouraged a normal lifestyle where possible. Additional medical, pharmaceutical and logistical support was received from outside the district.

OUTCOME: There was no noticeably severe damage to health, although there was manifestation of and deterioration in lifestyle-related diseases (e.g. diabetes, hypertension, obesity). Health care activities gradually returned to their pre-disaster levels. At the end of July 2011, the evacuation centres closed, and all evacuees moved to temporary accommodations.

Discussion: Isolated rural health practitioners were required to be involved in a wide variety of activities related to the disaster in addition to their routine work: e.g. preventive health (public health and safety activities), routine medical care, acute medical care, psychological care, post-mortems and recovery of medical facilities. Although the whole health care system returned to near-normal six months after the disaster, it is important to plan how to develop more resilient medical systems to respond to disasters, especially in rural areas. This article describes my experience and lessons learnt in responding to this disaster.

Influenza is one of most common acute viral infections in humans. It is estimated that seasonal epidemics affect 10–20% of the population, resulting in 250 000 to 500 000 deaths every year. In addition to seasonal influenza epidemics, antigenically distinct viruses originated from animal species tend to emerge in the human population every 10 to 40 years. Since most the human population does not have immunity to such viruses, global epidemics with significant impact, i.e. influenza pandemics, have occurred in the past.

In the present paper, the author reviews acupuncture clinical practice and the research scene in Western countries, and discusses problems in Japanese acupuncture.
The use of acupuncture is increasing in the West, but many more people have received this treatment in Japan. Although regulations on acupuncture depend on the country, many EU countries limit acupuncture practice to medical doctors. Regarding the style and theory of acupuncture, Traditional Chinese Medicine is overwhelmingly dominant in the world.
In recent years, the worldwide prevalence of the concept of evidence-based medicine (EBM) has facilitated randomized controlled trials on acupuncture in the West. However, there is a bigproblem in setting a sham acupuncture group. Pragmatic clinical trials should be considered more in the future.
If the researchers of “Japanese acupuncture” pursue only reductionistic research methodology, they might lose something important that traditional medicine has brought for many years. Although we should employ the concept of EBM, we, at the same time, should discuss what Japanese acupuncture is and how we evaluate the aspect of the “art” of acupuncture medicine more intensely.

A double-blind controlled test was performed to determine the analgesic effect of semiconductor laser irradiation (30mW, Ga-Al-As semiconductor laser) on various types of low back pain.
In the laser irradiated group, the improvement rate (including extremely effective and effective cases) of spontaneous pain was 61%, tenderness 61.8%, and locomotion pain 64% with an overall improvement rate of 73.5%. Significant differences from the control group were thus found in all types of pain (P<0.01).
No significant difference was found in the Lasegue sign and Deep Tendon Reflex (DTR) between the laser irradiated group and the control group and no organic change was found in the laser irradiated tissues.
Also, no significant difference was found between the laser irradiated group and control group blood test items with no side effect or degenerative changes. This confirmed that the laser irradiation was harmless to human tissues. The effectiveness and safety of the semiconductor low energy laser have been established. The authors therefore believe that the laser irradiation will be quite useful in treating low back pain in the future.

Ground water samples were taken from 8 wells at Kitaura area of Gogoshima in Matsuyama City. The sample water was collected every month from June 1978 to January 1979 and some anions contained in them were analyzed in order to examin the characteristics of the ground water.
The concentration of anions in this Island wells were higher 2.5-13 times than that of inland wells. The average concentration of Cl^- is 23 ppm, and this shows that sea water did not permiate into it. The high concentrations of SO₄^2-, NO^-₃-N, and NH⁺₄-N may be caused by chemical manure and compost which are given to the tangerine orchard. 74% of samples analyzed showed the coexistence of NO^-₂-N and NH⁺₄-N. In this area, the flow direction of under groundwater may be 5→1→2, 8→7→2 based on the analysis of concentration correlation matrix and -columner section.

Salithion, an agricultural chemical, was sprayed in persimmon orchards. The exposure of salithion to workers' bodies and the amount of salithion in the blood were measured.
The orchards were situated in the Tataki area of Tanbara-cho, Shuso-gun, Ehime prefecture. Before spraying, the salithion solution was diluted 1, 000 fold.
The amount of salithion exposed to the skin of the sprayers was estimated by the measured amount of salithion on the gloves, socks and filter paper that was put on their underwear. The results were as follows.
1) The mean amount of salithion exposed to the body surface of the sprayers who were protected perfectly was estimated to be 0.54 mg. On the other hand, the exposure to the sprayers protected imperfectly was 8.02 mg. The latter value was 15 times higher than the former, and the difference was statistically significant (p<0.05).
2) The concentration of the salithion in the blood of the sprayers was 11.5±13.8 ppb (M±SD). The correlation coefficient between salithion concentration in the blood and the amount of salithion exposed to the body surface was r = 0.73 (p<0.01).

Inhibitory effect of organophosphorus pesticides on the activity of carboxylesterase (CE), arylarnidase (AAA) and cholinesterase (ChE) in human plasma was investigated. The CE, AAA and ChE activities in human plasma were inhibited by various organophosphorus pesticides. Especially EDDP, BRP, DEP and DDVP showed low I₅₀ values for these enzymes. Generally, the I₅₀ values of CE were lower than those of AAA and ChE for pesticides. The CE activities of DDVP sprayers were significantly reduced after spraying. The mixed pesticides of MEP and IBP increased the inhibitory effect on the CE activity as compared with the individual of the respective pesticides. All of the pesticides investigated in this study showed noncompetitive inhibition to the CE activity in human plasma. The CE and AAA activties were possibly inhibited by -NO₂ radical of MEP stronger than-SCH₃ radical of MPP. The pl₅₀ (-log I₅₀) values of various pesticides on these three enzymes were closely related to each other. The correlation coefficient was over than 0.9.