Japan is trying to reform the social system because of aged population and changes in constitution of diseases. According to recent amendment of the law of community health, municipal offices got much more competence to manage health care activities. Primary care physicians need to have knowledge and technique for community health care.
The devision of general practice must take the responsibility not only in compensating for the lack of highly specialized medical education and medical care system, but also in producing physician capable for coping with changes of social systems. Especially, trainees in this division should learn clinical preventive medicine, and join some activities of community health and social services in community during their postgraducate clinical training periods.

Primary care education is extremely important for undergraduate medical students. We evaluated a primary care program with fifth-or sixth-year medical students at the Hokkaido University School of Medicine from October 2002 through July 2003. The aim of this study was to examine differences in the medical situation between a university hospital and primary care clinics and to determine the importance of primary care. We assessed students' opinions about primary care on the basis of student reports. After completing this program, medical students (30.7%) believed primary care medicine was necessary, recognized the importance of the medical techniques, and were motivated to study primary care medicine (93.6%). The problems of this program were the short schedule and the cost of public transportation. We conclude that this primary care program is extremely effective for teaching undergraduate medical students about primary care medicine.

Introduction : The purpose of this study was to review studies on consultation length in Japan.
Methods : We used Ichushi-Web, CiNii, JMEDPlus, Google Scholar, and MEDLINE, and selected and reviewed papers in which researchers have measured consultation length.
Results : We identified 26 studies, 6 of which focused on consultation length in terms of associated factors such as the differences between specialty departments. Seven studies performed in outpatient clinics focused on waiting time as the main topic of investigation and secondarily measured consultation length. In addition, consultation length was used as an indicator for introducing interventions. Three studies discussed appropriate consultation length. Two studies investigated patient satisfaction. The definition of consultation length varied among studies.
Conclusion : Few studies investigated patient outcomes. Further studies are required to monitor consultation length and patient outcomes as well as to clarify the definition of consultation length.

Background and Objective: Since the early 2000s, the incidence of methicillin-resistant Staphylococcus aureus (MRSA) infections among the community of people lacking known healthcare risk factors has increased. This MRSA infection is referred to as community-associated MRSA (CA-MRSA) infection and is distinct from hospital-associated MRSA (HA-MRSA) infection, which occurs among people with known healthcare risk factors. Understanding the epidemiology of CA-MRSA infections is critical; however, this has not been investigated in detail in Japan. Our objective was to investigate the incidence of CA-MRSA infections in a regional hospital. Patients and Methods: We investigated CA-MRSA isolates and infections in a rural regional hospital by reviewing medical records of one year. Infections were classified as CA-MRSA if no established risk factors were identified. Results: During 2008, 31 Staphylococcus aureus (S. aureus) isolates were detected in 29 unique patients, with 1 methicillin-sensitive S. aureus (MSSA) isolates obtained from 19 patients (66%) and MRSA obtained from 10 patients (34%). In the 10 patients with MRSA, the number of HA-MRSA and CA-MRSA cases were nine (32% of patients with S. aureus isolates) and one (3%), respectively. The patient with CA-MRSA was diagnosed with cellulitis due to CA-MRSA. All nine patients with HA-MRSA exhibited colonization. Conclusion: We observed a CA-MRSA case in a regional hospital in Japan, suggesting that incidence trends of CA-MRSA should be considered in future research and treatment.

Infections caused by methicillin-resistant Staphylococcus Aureus (MRSA) have recently occurred in communities in people lacking known healthcare risk factors. This MRSA infection is referred to as community-associated MRSA (CA-MRSA) infection, and is distinct from hospital-associated MRSA infection, which occurs in people with risk factors. We experienced a patient diagnosed with CA-MRSA cellulitis, as culture of pus revealed MRSA and he had not been exposed to healthcare environments for the past year. The patient was a previously healthy 38-year-old man with suppurative cellulitis in his right index finger following injury to the finger at his worksite. The cellulitis was successfully managed with incision and drainage (I&D), followed by cefazolin during a 10-day clinical course, although the patient’s MRSA strain was resistant to cefazolin. There are several reports that suggest that I&D followed by antibiotic treatment for CA-MRSA skin infection produces equivalent clinical outcomes, whether the antibiotic prescribed was effective or not. Given that MRSA emerged in an outpatient setting, CA-MRSA should be considered a possible etiology of skin infection in healthy individuals with no classical risk factors for acquisition of MRSA.

Background and Objective: Since the early 2000s, the incidence of methicillin-resistant Staphylococcus aureus (MRSA) infections among the community of people lacking known healthcare risk factors has increased. This MRSA infection is referred to as community-associated MRSA (CA-MRSA) infection and is distinct from hospital-associated MRSA (HA-MRSA) infection, which occurs among people with known healthcare risk factors. Understanding the epidemiology of CA-MRSA infections is critical; however, this has not been investigated in detail in Japan. Our objective was to investigate the incidence of CA-MRSA infections in a regional hospital.
Patients and Methods: We investigated CA-MRSA isolates and infections in a rural regional hospital by reviewing medical records of one year. Infections were classified as CA-MRSA if no established risk factors were identified.
Results: During 2008, 31 Staphylococcus aureus (S. aureus) isolates were detected in 29 unique patients, with 1 methicillin-sensitive S. aureus (MSSA) isolates obtained from 19 patients (66%) and MRSA obtained from 10 patients (34%). In the 10 patients with MRSA, the number of HA-MRSA and CA-MRSA cases were nine (32% of patients with S. aureus isolates) and one (3%), respectively. The patient with CA-MRSA was diagnosed with cellulitis due to CA-MRSA. All nine patients with HA-MRSA exhibited colonization.
Conclusion: We observed a CA-MRSA case in a regional hospital in Japan, suggesting that incidence trends of CA-MRSA should be considered in future research and treatment.