To introduce problem-based learning (PBL) in small groups to medical education in Japan, a questionnaire was sent to 10 foreign medical schools where PBL has been used. Five schools in the United States and one each in the United Kingdom, Canada, and Australia responded to all 15 questions concerning their educational system, faculty training, faculty evaluation, and student evaluation. The faculty is trained in 7 medical schools, retrained in 4, and self-trained in 5. The faculty is objectively evaluated by students and a faculty committee in seven schools and the results are returned to the faculty. The students are evaluated by self-evaluation, written tests, and oral examination in al schools, and also by peer-evaluation in one school. The evaluation of students directly affects their promotion in all schools but one. Such effective evaluation and feedback systems, including evaluations of the students' learning skills and their attitude toward learning, play important roles in effective PBL.

No abstract available.
Air Pollution* ; Fractures, Bone* ; Osteoporosis*

A new educational program for the medical doctor was introduced at Tokyo Women's Medical College in 1990 with a 4-year tutorial education model as its core. To develop the program for educational training more efficiently, current facilities were reviewed on a large scale, and various types of equipment and supplementary materials were made available. We are now investigating utilization and problems of the current program. Supplies and materials of tutorial rooms and mirror rooms have been used effectively. The library has become increasingly useful as a place for independent study and research. However, audiovisual materials have not yet been made fully available. We suggest that further improvements to the system and fostering an environment of open access to information are necessary to increase the accessibility of the support system for tutorial education.

Tutors must understand their role in advance so that tutorial education can be conducted smoothly and effectively. These abilities and attitudes require training. At our school, tutors serve as faculty for basic courses and clinical courses. We assessed their training conditions and future tasks. Of the 1, 077 faculty members who received tutor training between 1988 and 1997, 935 are current faculty members who have completed in-service training (basic course, 115; clinical course, 820). Before 1989, training was on campus, but since 1990 it has been conducted at Shirakawa Seminar House with a 2-day program. The number of working tutors per year is 192, with a basic course to clinical course ratio of 3: 7. About half of the faculty members in the basic course have had four or more experiences as tutors, whereas most clinical course faculty members have had only one experience. Thus, many tutors have had no experience. In a questionnaire survey after undergoing the training program, most participants felt that they were able to understand the theory of tutorial education and the actual role of the tutor and that they were able to concentrate on off-campus training that was removed from their everyday work. To provide added impetus to tutorial education, we suggest that in the future, in addition to the understanding and mutual cooperation of those involved, it will be necessary to provide an advanced program to train tutors who have appropriate abilities and attitudes.

Tokyo Women's Medical University introduced tutorial education in 1990 for 1st-through 4th-year students. To examine the effectiveness of this system in a basic-medicine course, questionnaires were given to all 2nd-year students. Many students felt that they had become accustomed to performing self-learning tasks through collecting information themselves and discussing their findings in a group; in particular, they found that tutorial education markedly improved their communication skills. A few students thought that this method helped them develop the ability of logical/critical thinking and analytic skills from multiple viewpoints. These findings suggest that an assessment system should be established by which students themselves could recognize the extent to which they have developed their abilities, which was the aim of tutorial education.

Personal interviews and group discussions were conducted with all 2nd-year students to examine how they feel about tutorial education used as the core of the basic-medicine course and how they recognize the importance of developing their abilities, which was the aim of this course. Many students showed slight anxiety about the results of their learning with tutorials, felt inadequate in their self-learning ability, and hoped the guidance by instructors would be improved. These findings suggest that students' anxiety will decreased and their willingness to learn will increase if their developed abilities are evaluated appropriately and if they receive adequate feedback. These findings also suggest that a retraining program for experienced instructors is needed to improve their guidance skills and to reinforce the importance of their role.

OBJECTIVES: Air pollution is a growing concern in Korea because of transboundary air pollution from mainland China. A panel study was conducted to clarify the effects of air pollution on respiratory symptoms and health-related quality of life (HR-QoL) in outpatients with and without chronic obstructive pulmonary disease (COPD) in Korea. METHODS: Patients filled out a questionnaire including self-reported HR-QoL in February and were followed up in May and July. The study was conducted from 2013 to 2015, with different participants each year. Air quality parameters were applied in a generalized estimating equation as independent variables to predict factors affecting HR-QoL. RESULTS: Lower physical fitness scores were associated with Asian sand dust events. Daily activity scores were worse when there were high concentrations of particulate matter (PM) less than 10 μm in diameter (PM10). Lower social functioning scores were associated with high PM less than 2.5 μm in diameter and nitrogen dioxide (NO2) concentrations. High NO2 concentrations also showed a significant association with mental health scores. Weather-related cough was prevalent when PM10, NO2, or ozone (O3) concentrations were high, regardless of COPD severity. High PM10 concentrations were associated with worsened wheezing, particularly in COPD patients. CONCLUSIONS: The results suggest that PM, NO2, and O3 cause respiratory symptoms leading to HR-QoL deterioration. While some adverse effects of air pollution appeared to occur regardless of COPD, others occurred more often and more intensely in COPD patients. The public sector, therefore, needs to consider tailoring air pollution countermeasures to people with different conditions to minimize adverse health effects.
Air Pollution* ; Asian Continental Ancestry Group* ; China ; Cough ; Dust* ; Humans ; Korea* ; Mental Health ; Nitrogen Dioxide ; Outpatients* ; Ozone ; Particulate Matter ; Physical Fitness ; Public Sector ; Pulmonary Disease, Chronic Obstructive ; Quality of Life* ; Respiratory Sounds

OBJECTIVES: In recent years, transboundary air pollution from mainland East Asia has led to growing concerns about air pollution in Japan. Air pollution is reportedly associated with the exacerbation of respiratory diseases. In this study, we assessed the effects of air pollution on respiratory symptoms and the health status of participants with and without chronic respiratory diseases. METHODS: Participants (n=2753) with and without chronic respiratory diseases who visited healthcare facilities in Japan during February from 2010 to 2015 filled out a self-report questionnaire regarding their symptoms and perceived health status. Participants were followed up during April-May and June-July. RESULTS: Oxidant concentrations were associated with respiratory symptoms, overall health, and quality of life (QoL). Suspended particulate matter (SPM) and particulate matter <2.5 μm levels were associated with physical fitness; SPM was also associated with QoL. Recent experience of an Asian sand dust event had a significant effect on allergic symptoms, change in health, and QoL. CONCLUSIONS Respiratory symptoms were more strongly affected by oxidants than by other pollutants. Significant associations of air pollutants were found with a comprehensive range of items related to perceived health status, including overall health and QoL. Although the effects of air pollutants on respiratory symptoms and health status were more apparent among patients with respiratory diseases, the adverse effects of air pollutants were significant even among participants without such conditions.

School lunches serve to improve nutritional status and to promote the health of children. The purpose of this study was to investigate the portion sizes of school lunches served and consumed in Japanese elementary schools. In addition, gender difference in servings and consumption were also studied. A cross-sectional study was undertaken between October 2007 and February 2008 in schools located in Tokyo and Okayama, Japan. A total of 192 fifth-grade children attending four elementary schools participated in this study. Weighed plate waste methods and observation were used to collect dietary data for two non-consecutive days. The proportion of children who chose staple foods along with main dishes and/or side dishes for at least one day was higher in boys than in girls (respectively, for staple food: 42.1% vs. 9.3%, for main dish and/or side dish: 68.4% vs. 44.3%, P < 0.001). The ratio of initial amount served to amount offered was 0.88 +/- 0.11 for boys and 0.84 +/- 0.10 for girls (P < 0.05). The ratio of amount consumed to amount offered was 1.04 +/- 0.19 for boys and 0.88 +/- 0.12 for girls (P < 0.001). Weight was related to amount consumed both in boys (r = 0.222, P < 0.05) and in girls (r = 0.201, P < 0.05). These findings suggest that the nutritional standards of school lunch programs should take into account gender differences. Clearly, boys were more likely to consume more than the initial amounts served due to their higher propensity to take second helpings. Boys feel few reservations about taking second helpings to adjust their total intake. However, school lunch plans should take into consideration girls' reluctance to do so, by serving appropriate initial portion sizes.
Asian Continental Ancestry Group ; Child ; Cross-Sectional Studies ; Humans ; Japan ; Lunch ; Nutritional Status ; Tokyo