Background: Globalization urges us to discuss rationale and policy towards establishing a medical education accrediting body in Japan. Experience of General Medical Council （GMC） suggests us some useful lessons.
Method: Based on our visits and investigation into in GMC, we inquire how Quality Assurance （QA） was introduced in UK with what incentives and how QA has brought reforms in the medical schools in UK.
Result: Since 2003, GMC has changed its policy for QA from ‘inspection’ to ‘dialogue’. Dialogical QA asks a medical school to think critically of their education and consider vigorous actions for further improvements.
Discussion: Implications from the experience of GMC are: 1.QA process in GMC makes medical schools take robust steps towards changes, 2. Sharing the rational and policy for QA created the solid base for its effective implementation, 3. There are possible difficulties in establishing structure to do an enormous amount of coordinating work, which is necessary for constructing ‘dialogue with medical schools’.

Risk factors for developing hemolytic uremic syndrome among patients with enterohemorrhagic Escherichia coli O157: H7 (EHEC) infection include age. The young, especially those under the age of five, face an increased risk, as do the elderly. In the present study, we evaluated the protective effects of Hochu-ekki-to (HET) on intraperitoneal infection with EHEC, using immunosuppressant, dexamethasone (Dex)-treated mice.
It was found that HET induced improvement of Dex-induced leukopenia. Similarly, the IgM-plaque forming cell responses to sheep red blood cell (SRBC) were restored by the administration of HET to the normal-mice level in Dex-treated mice. Consequently, HET was administered orally into the Dex-treated mice before infection with EHEC to observe the therapeutic effect. With the oral administration of 500mg/kg/head of HET into the Dex-treated mice, prolonged survival was shown: the 50% survival time in the HET-administered mice was four days, compared with one day in the non-administered controls. In addition, the number of bacteria in the liver was reduced by the administration of HET in the Dex-treated mice.
The results indicate that orally administered-HET protects against EHEC infection in Dex-treated mice, and such protective effects appear to be due to the restorative effects of HET against the Dex-induced immunosuppression.

Europe has a long history with its own traditional medicines. In Germany, the practice of traditional European and Asian medicine along with modern medicine is called Integrative Medicine. The pain clinics at Munich University, TCM Klinik Bad Kotzting, Immanuel Klankenhaus and Zen Haus Klinik are well-known centers of Integrative Medicine in Germany. We visited these hospitals and clinics and report on the state of their treatment.
Four-week programs in chronic pain, traditional Chinese medicine, natural therapy, and traditional Japanese medicine with aromatherapy are given at these facilities. Moreover, Complementary and Alternative medicines are widely covered by public or private insurance. And one reason for the spread of Integrative Medicine may be these social conditions, in addition to historical background.

The Great East Japan earthquake and tsunami disaster that occurred on March 11, 2011 seriously destroyed Japanese social activities the medical system included. We provided medical support to the damaged area, and mainly performed Oriental medicine. Traditional methods using physical diagnoses and the treatments with herbs, acupuncture, and massage were effective, where any infrastructure had suffered or any modern medical facilities had been destroyed. Acute phase infectious disease, common colds, and hypothermia were dominant. Allergies increased two weeks later, and there was much mental distress, and chronic pain symptoms one month later. We prescribed Kampo herbal medicines for common colds, hypothermia, allergies, and mental distress. Moreover, we also performed acupuncture and kneaded patients' body to reduce pain, stiffness, and edema. These treatments were effective for both physical and mental distress. Thus we believe that Oriental medicine is valuable in disaster situations.

Background: As a complementary medicine we have evaluated the efficacy of Benihuuki green tea, which contains methylated form of tea catechin reported stronger anti-allergic activities than ordinary catechin, on Japanese Cedar Pollinosis (JCP) in comparison with Yabukita green tea, contains ordinary catechin. This study was carried out during the pollination season, Feb.–April, in 2005.
Method: Four hundred eighty six patients with JCP, visiting 12 otorhinolaryngology clinics in Fukuoka prefecture were divided into A and B groups and subjected to quasi-single blind clinical trials. Under ordinary conditions, A-group patients took Benihuuki green tea and B-group took Yabukita green tea every day from February 1^st to the end of Japanese cedar and Cupressaceae pollination season. We compared nose and eye symptom scores, medication scores and disturbance of quality of life (QOL).
Result: There were no differences observed between the two groups with respect to their symptom scores and the disturbance of QOL. However, decreasing trend of the medication scores was observed in A-group (p < 0.1).
Conclusion: It has been suggested that Benihuuki green tea is a possible candidate as a complementary medicine for JCP during the pollination season.

OBJECTIVESSleep disorders and psychological stress have become major concerns as health risks in modern Japanese society. Chronic sleep deprivation could lead to physical and mental exhaustion, which could affect the circulatory condition. In this study, we have investigated the effects of long-term sleep problems and mental health conditions on abnormal ECG findings from the standpoint of community health.

METHODSData were obtained from the records of community physical checkups conducted in a town in Okinawa from 1993 to 2001. Data regarding average sleep duration and the 12-item version of the general health questionnaire (GHQ) were also collected at the community physical checkups. In order to compute the odds ratio of electrocardiographic (ECG) findings according to mental health condition and sleep duration, we conducted multivariate analysis using logistic regression maneuvers.

RESULTSThere was a significant difference of average GHQ scores according to sleep duration, with shorter sleep duration (< or =6 h) correlating with poorer GHQ and longer sleep duration (> or =8 h) correlating with healthier GHQ (p < 0.05). In the multivariate logistic regression analysis among subjects with poorer GHQ, shorter sleep duration showed significantly high odds ratio (OR = 7.14) for abnormal ECG findings.

CONCLUSIONSThe present study suggested that the mental health condition appears to impact ECG results indirectly through its strong association with sleep duration and provided ground for suggestion that mental health items to be included in community physical checkup examination items.

OBJECTIVESChanges in B-type natriuretic peptide (BNP) and electrocardiographic (ECG) findings in an adult Japanese population were measured over a 5-year period, and the statistical relationships between these were evaluated.

METHODSThis was a longitudinal analysis in which data were collected on 353 subjects (135 men and 218 women) who had undergone general health checks in 1998 and 2003.

RESULTSData were examined by correlation coefficient and one-way analysis of covariance using repeated measurements. The correlation coefficient for BNP between 1998 and 2003 was 0.622 (P < 0.0001) for the men and 0.557 (P < 0.0001) for women. The changes in BNP over the same period were 13.71 +/- 26.06 (P < 0.0001) pg/ml in the men and 20.17 +/- 32.01 (P < 0.0001) pg/ml in the women. In 99 men and 145 women who had undergone ECG tests, with both normal and abnormal findings, visual inspections of changes in the ECG findings with respect to BNP changes were performed over the 5-year period. In men, both age and BNP significantly correlated with changes in ECG findings; however, in women, no significant correlation between BNP and changes in ECG findings was observed.

CONCLUSIONSThis regional longitudinal study revealed a gender difference in the relationship between long-term changes in BNP and ECG findings, suggesting that a 10 pg/ml or more increase in BNP in men over a 5-year period may a indicate worsening of cardiac function and the need for intervention.

In Japan, Nordic walking (NW) has two style walking method. For one thing, the poles are used to push against the ground towards the back of the body (diagonal style: DIA). The other one, the poles put on forward and using like a cane (defensive style: DEF). This study aims to clarify differences between the two Nordic walking (NW) styles. The subjects were 12 community-dwelling middle-aged and older adults (mean age: 62.4 ± 7.8 years). All of subjects were tested to perform NW in both style for 12 minutes walking around the park. Walking distance, speed, heart rate (HR), energy expenditure (EE) and electromyogram (EMG) amplitude of the upper and lower limbs using surface EMG were assessed. A pole with a built-in load cell measured force used to push the pole into the ground (pole force), pole contact time, and pole impulse. Distances and speed in DIA was significantly higher than DEF. Significant difference in muscle activity was observed between DIA and DEF in the triceps brachii only. EE of DEF was significantly higher than DIA. Poling force and pole impulse in DIA was significantly higher than DEF. These results indicate that when prescribing NW for health promotion, it should be done according to each characteristic in DIA or DEF.