1) In Japan, an integrated curriculum for public health professionals and nurses was enacted in April 1997, as was as integrated curriculum for midwives and nurses. By April 2006, ten schools had been established to provide the former curriculum, but no schools had been established to provide the latter.
2) In the integrated curriculum for midwives and nurses, there are few community health nursing units, and the very concept of the integration is problematic in that midwifery does not tend to involve illness or old age.
3) The integrated curriculum seems to have been enacted without due thought as to its practicability. However, it may be desirable to use the system as a way to address the chronic shortage of midwives in Japan today.

In order to clarify the relationship between acute physical exercise and immunity, the numbers of overall leucocytes, lymphocytes and neutrophils, the concentrations of immunoglo-bulins and complements, the ratios of lymphocyte subsets (OKT 3, 4, 8, Leu 7, OKIa 1) and the levels of lymphocyte transformation response to PHA were measured in nine untrained male subjects (18-22 years old) before, immediately after, along with 24 and 72 hours after acute physical exercise at 50% of VO₂max for 2 hours. Before exercise all components were within normal range. Exercise produced a significant rise in the number of leucocytes and neutrophils overall. The response of lymphocytes to PHA immediately after exercise was significantly lower than before, or 24 hours or 72 hours after exercise.
There was no change in the number of lymphocytes, or in the concentration of immunoglo-bulins and complements before and after exercise. Likewise the ratios of lymphocyte subsets also remained unchanged.
From these results, it can be concluded that acute physical exercise by untrained subjects is one kind of physical stressor and can contribute to T cell dysfunction.

The purpose of this study was to investigate the circulation responses (heart rate (HR), systolic blood pressure (SBP) and second derivative of photoplethysmogram waveform index (|d/a|)) during 90 seconds continuous isometric contraction on trunk muscle. Subjects were 10 healthy male (22±1 years). Subjects performed 90 seconds continuous isometric contraction on Rectus Abdominus. Contraction intensity was 55.4±13.8% maximal voluntary contraction.HR and SBP were a significant increase after contraction beginning, immediately. |d/a| (one of the peripheral blood vessel contraction index) was a significant increase at 60 seconds after contraction beginning. After that, HR was an increase more, |d/a| showed a decline tendency. But, SBP was an increase more.The followings are suggestive by these results. When the contraction beginning, HR was increased immediately by central command, muscle mechano reflex and so on. The other hand, the peripheral blood vessel contraction was late by the accumulation of metabolism product from active muscle was late. When the prolong contraction time, the peripheral blood vessel was extension. But, SBP was increased more by increasing the cardio output, muscle tension and so on.

Objective To observe whether nitric oxide (NO) improves high glucose toxicity induced insulin resistance in streptozotocin (STZ) induced diabetic rats. Methods The changes of metabolic clearance rate for glucose (MCR), as the index of insulin effect, were observed in 24 STZ induced diabetic rats and 24 normal rats in awake condition treated by sodium nitroprusside (SNP), N G monomethyl L arginine (LNMMA), adenosine or saline duringeuglycemichyperinsulinemiaclampprocedure.Results MCR in saline treated diabetic rats 〔(7.2?0.8)ml?kg -1 ?min -1 〕 wassignificantlylowerthanthat in normol control rats 〔(18.0?1.8)ml?kg -1 ?min -1 , P

Physical training has been shown to improve glucose tolerance and insulin action in peripheral tissues. In the present study, regular (R) and high (H) -dose euglycemic clamp procedures were performed to determine the effects of different types of physical training on insulin action (sensitivity/responsiveness) in 10 long-distance runners (LR), 10 weight-lifters (WL) and 12 healthy controls (HC), The amount of infused glucose (glucose metabolism, GM) during euglycemic clamping is a measure of the peripheral tissue sensitivity and/or responsiveness to insulin. For R clamping, when GM was calculated per unit body weight (BW), GM in LR (11.92±1.22 mg/kg BW·min) and WL (9.28±0.63 mg/kg BW·min) was significantly (P<0.05) higher than that in HC (7.44±0.39 mg/kg BW·min) . When calculated per unit lean body mass (LBM), LR (15.07±1.56 mg/kg LBM·min) differed from HC (9, 15±0.59 mg/kg LBM·min, P<0.05), whereas the value in WL (11.50±0.93mg/kg LBM·min) was identical to that in HC. For H clamping, there was no significant change in these three groups when GM was calculated per unit BW or LBM. These results suggest that enhancement of insulin action by physical training is due to an increase in insulin sensitivity, rather than to an increase in insulin responsiveness, and that aerobic exercise, for example long-distance running, is more effective for the improvement of decreased sensitivity to insulin, which is observed in patients with simple obesity and diabetes, than anaerobic exercise such as weight-lifting.

Ghrelin, an endogenous ligand for the growth hormone (GH) secretagogue receptor, has been reported to induce a GH-releasing, orexigenic effect on weight gain, and adipogenic actions. It is, therefore, thought that ghrelin links the regulatory systems for growth and energy balance.We examined 25 obese children undergoing a 3-month inpatient weight reduction program for obese children based on a combination of diet and exercise therapy and evaluated the change in the serum ghrelin levels.The subjects consisted of 25 children with moderate to severe simple obesity [17 boys, 8 girls ; mean age 9.9±1.3 years, percent overweight (% overweight) 52.1±13.6%]. Height, weight, percent body fat (% BF), fat mass, fat-free mass (FFM), and serum ghrelin were measured before and after weight reduction.After therapy, body weight, % BF and fat mass had all significantly decreased (p<0.001), while height and FFM had both significantly increased (p<0.001 ; p<0.05, respectively). There were no correlations between pre-therapy serum ghrelin and any of the following: initial height, weight, % overweight, % BF, fat mass, or FFM. However, after therapy, serum ghrelin levels were negatively correlated with body weight (r_s=-0.544, p<0.01). Serum ghrelin levels increased significantly from pre- to post-therapy (113.9±30.7 to 129.6±42.9 fmol/ml, p<0.05). The rate of changes in ghrelin levels was negatively correlated with the rate of change in the % overweight (r_s=-0.412, p<0.05).These findings suggest that long-term weight reduction based on a combination of diet and exercise therapy lessens the severity of obesity and increases serum ghrelin levels in obese children.

OBJECTIVESThis study investigated the incidence of caries in infants and explored the risk factors related to noteworthy variations between urban and rural areas.

METHODSSubjects were 232 infants (111 males and 121 females) aged 1.6 and 3 years born in "N" town between the fiscal years of 1997 and 2001. Infants aged 1.6 and 3 years had 99.6 and 100% participation in health checkups, respectively. Of the total, 148 and 84 infants were living in the urban and rural areas, respectively, of "N" town.

RESULTSCaries incidence and the average number of carious teeth (decayed/missing/filled teeth, dmft) for infants aged 1.6 years were significantly higher in the rural area than in the urban area, indicating that environmental factors that predispose infants to develop dental caries exist in the rural area. In addition, logistic regression analysis for infants in each of the two areas revealed that risk factors of the child-care environment, for example living with grandparents and brushing by parents, stood in marked contrast with each other. Moreover, the odds ratio of the risk factor dozing off while drinking showed a marked difference between the areas, although this risk factor was common in both areas.

CONCLUSIONSThe results of this study indicated that several factors of the child-care environment, for example the daytime caring person, are related with caries development. Scientific elucidation of the risk factors that give rise to high prevalence of caries in specific regions and access to the whole picture of the disease mechanism may have great potential to lead to the development of effective countermeasures and to contribute to the reduction of dental caries in preschool children.