In Japan, it is necessary to develop the community medicine (community health care) because of the current of the medical practice. Since 1998, the community-based clinical clerkship (the two weeks' program) has been introduced to the all 5-grade medical students in Jichi Medical School. The aim of this program is to learn not only the knowledge and skill for the community medical practice, but also the attitude included the pleasure, enjoyment and worth to do it. The program contains as many activities of the community medicine as possible other than the out-patient or the in-patient managements. The most of medical students give good evaluation to the program. After the program, many of the medical students became to have the motivation to work in the rural area. In the undergraduate medical education, a community-based clinical clerkship will be more necessary in terms of the development of the community medicine.

Education in community medicine has become increasingly important. At Jichi Medical School, community-based clinicalclerkships began in 1998. This study examined the effects of a standardized program for medical facilities and clerkshipcontents introduced in 2001. A self-administered visual analogue scale questionnaire was given to 308 fifth-yearmedical students to examine their opinions about this program, community medicine, and the future. Results from beforeand after the introduction of the standardized program were compared. After the program had been introduced, significantlymore students agreed that the clerkship program was “meaningful” and should be continued. Furthermore, significantly more students agreed that “physicians enjoy working in the community, ” “talking with people, patients, and public officials is not difficult, ” and “ I will become a general physician or a specialist in the future.” These resultsshow that the standardized program is effective for education in community medicine.

Because of drastic changes in community health care in Japan, increasing emphasis has been placed on medical undergraduate education in community health care.The number of medical school introducing community-based clinical training is increasing.Therefore, effective clinical training in community health care should be developed. This study examined the effects of the location and subjects of training on students' evaluations and impressions of community-based clinical training.
1) Self-administered questionnaires were completed by 499 fifth-year students taking part in community-based clinical training.The main items were the locations and subjects of training and the students' evaluations and impressi ons of training. The associations between these items were analyzed.
2) A total of 96.8% of the questionnaires were analyzed. The students who trained only in clinics were slightly but not significantly more likely to have positive impressions of and to have given higher evaluation scores to training than were other students.
3) Students who participated in health education for healthy persons or patients or both were significantly more likely to answer that“the training program was enjoyable, ”“the preceptors were enthusiastic, ”and“I spent more time with the preceptors.”On the other hand, the students who took part in inpatient care were significantly less likel y to answer that“the training program was enjoyable”or that“the training program is needed.”
4) Students who studied 1 to 4 of the 11 subjects were significantly less likely than were students who studied 8 to 11 subjects to answer that“the preceptors were enthusiastic”and were less likely than were students who studied 5 to 7 subjects to answer that“the training was meaningful.”
5) Students who studied few subjects during training might have negative feelings about community-based clinical training.The experience of health education might have a positive effect on students.On the other hand, the experience of inpatient care probably has a negative effect.

To determine the need of guidelines for judgment of the bathing advisability for the aged in Councils of Social Welfare, we had a cross-sectional study in 1999.
A questionnaire survey by mail for Councils of Social Welfare which were extracted by systematic sampling (n=828, extraction rate was 25%) was conducted. The response rate was 83% and the proportion of respondents who answered the guidelines were necessary was 86% (n=642). Chi-square tests and logistic regressions analyses showed that bathing service in facility, existence of guidelines for judgment of the bathing advisability by body temperature, and respondents judging were independent factors associated with the need of guidelines for judgment on the bathing advisability in aged. Our results suggest the necessity to make guidelines for judgment of the bathing advisability in the aged.

Background: Physician shortage affects mortality at the city level in Japan. The medical administrative district (MAD) covering the area (town, city, etc.) in which the patients live and is the unit responsible for recruiting doctors. The number of physicians or changes in this number in each MAD varies. The relationship between the number, or the change in number, of physicians and the mortality in each MAD has been unclear.
Methods: We designed a descriptive study using publicly-available national statistics. In all 358 MADs in Japan, we analyzed the relationship between the changes in the number of physicians (total, clinic, and hospital) from 2000 to 2005 and the standardized mortality ratio (all causes of death, cancer, heart disease, and stroke).
Results: In MADs, the number of physicians and mortality are not related, nor are changes in number of physicians and mortality. Further investigation including factors associated with mortality is needed.
Conclusion: In MAD, there is no relationship between the number of physician and the mortality, between the change in number of physician and the mortality. Further investigation is needed including factors associated with mortality.

Owing to shortages of primary-care physicians, increasing their numbers has been recognized as an urgent issue in Japan and other countries. However, it is unclear which factors in medical education influence the decision of residents to go into primary care. We investigated the factors associated with residents' choosing to practice primary care.
Of 281 randomly selected medical facilities designated as residency training hospitals, 137 facilities answered. Self-administered questionnaires were completed by 724 residents in the third or fourth postgraduate year. Responses were compared between residents who intended to choose a career in primary care (n=175, 24.2%) and residents who intended to choose a career in other specialties (n=549, 75.8%).
In addition, for residents who had intended during their undergraduate years to enter a non-primary-care specialty (n=442, 61.1%), responses were compared between those who now intended to go into primary care (n=33, 7.5%) and those who did not (n=409, 92.5%).
Residents who had planned during their undergraduate years to choose a career in primary care (adjusted odds ratio [95% confidence interval]: 9.85 [6.24-15.5]), residents who were working as primary-care physicians at the time of the survey (7.58 [4.92-11.7]), and residents who wanted to enter rural practices in the future (2.24 [1.36-3.68]) were significantly more likely to plan to choose a career as a primary-care physician in the future.
Residents who had worked at a rural practice during residency training were significantly more likely to change their career plans from other specialties to primary care (crude odds ratio [95% confidence interval]: 2.18 [1.05-4.49]). Exposure to a rural practice during residency training may affect residents' career plans.
Integrating rural primary-care practice into residency training may help increase the number of primary-care physicians in the future.

To determine the background of aged people who need bathing assistance, we analyzed data of the Survey on Demand for Health and Welfare Services of Japan as of 1997. The survey covered 21, 723 persons aged 65 years or older, and 1, 193 caregivers who provide care to persons 65 years or older throughout Japan. The main parameters were aged people's sex, age, marital status, health condition, degree of bed rest, and needs of care in daily life; relation between caregivers and aged people; life with care giver; job; family composition; use of home care services; demand for home care services; caregivers' sex, age, health condition, and employment status; and demand for home care services. Subjects were divided into three groups, those who need bathing assistance, those who do not need bathing assistance, and those who do not need care in daily life, and the rate was shown for each item. The results indicated that the rate of those who need bathing assistance was higher among (1) aged people who were older, have poor health, and are in bed alweys or almost alweys, (2) aged people who needed care in daily life, used home care service, and required home care service, and (3) aged people whose caregivers required home care services.
Aged people who need bathing assistance are subject to frequent bathing accidents, so we need to pay attention to safe bathing service.

We conducted a nationwide survey to examine the primary care (PC) curricula for undergraduates at Japanese medical schools. The present status of PC curricula and the degree of recognition of the need for improvement were examined. Seventy (88%) of the medical schools in Japan responded. PC education programs have been organized and are carried out by various departments in each school. Of the 69 medical schools, 42% have a PC education program with lectures to teach the role of PC physicians, 65% have a program to provide experience in community medical care, and 80% have programs to provide experience in health care institutions and welfare facilities. Although the number of schools with lectures and experience programs for PC has increased at least three-fold in the past decade, many medical school presidents (more than 60%) recognize PC education should be improved. By comparing medical schools with and without experience programs in clinic more presidents of schools without such programs recognized the need to improve PC education.