We held an interest group session at the 16th Annual Conference of the Japanese Primary Care Association to share best practices for diagnostic excellence in primary care. In addition to physicians, pharmacists and a medical clerk participated in the session. Participants provided examples of good practices for patient engagement and interprofessional collaboration during group discussion, which included themes such as "sharing diagnostic information," "safety netting to address diagnostic uncertainty," and "feedback about diagnostic errors."

OBJECTIVEExposure to polychlorinated biphenyls (PCBs) is considered to have culminated between 1950 and 1970 in Japan, and exposure through diet, the major exposure route, has decreased significantly over the last 10 years. The primary goal of the present study was to investigate the long-term trends and congener profiles of serum and dietary levels of PCBs using historical samples.

METHODSUsing banked samples collected in 1980, 1995, and 2003 surveys, we determined the daily intakes and serum concentrations of 13 PCB congeners (#74, #99, #118, #138, #146, #153, #156, #163, #164, #170, #180, #182, and #187) in women.

RESULTSThe total daily PCB intake [ng/day, geometric mean (geometric standard deviation)] decreased significantly from 523 (2.5) in 1980 to 63 (3.2) in 2003. The serum total PCB level (ng/g lipid) in women <40 years of age decreased significantly from 185 (1.8) in 1980 to 68 (1.8) in 2003. In contrast, the level in women >50 years of age increased significantly from 125 (1.7) in 1980 to 242 (1.7) in 2003. Specifically, the serum concentrations of hexa (#138, #146, #153, #156, #163, and #164) and hepta (#170, #180, #182, and #187) congeners increased significantly. A comparison of the serum PCB levels of women born from 1940 to 1953 revealed that their serum total PCB level was significantly higher in the 2003 survey [242 (1.7), n = 9] than in the 1995 [128 (2.0), n = 17] surveys. This increase in the total PCB level was attributable to increases in the hepta congener groups.

CONCLUSIONPresent results suggest a decreased rate of elimination of hepta congeners with aging in females, rather than a birth-generation phenomenon.

The laxity of shoulder is one of main factors affecting shoulder lesions in athletes.
To measure the anterior-posterior laxity of shoulder, a stress machine was arranged because the ordinary rentogenographic measurement is not suitable. The measurement of the anterior-posterior laxity was done with athletes in several kinds of sports in which shoulder joints are mainly used. The result was compared with those from clinical examinations and stress rentogenography. Conclusions :
1. The anterior-posterior displacements of the affected side in baseball, volleyball and javelin players were significantly larger than that of the control side.
2. For the anterior-posterior displacement of the shoulder joint, baseball, volleyball and javelin players showed significantly larger values than truck runners as the control whereas significantly smaller values were found in water polo players.
3. There was no correlation between the anterior-posterior laxity and the inferior laxity.