Recently, the palliative care team (PCT) at our hospital has included dentists. Among a total of 127 cancer patientsand required PCT intervention from 2009 to 2014, 17 patients (13.3%) had oral symptoms. Therefore, the PCT held discussions in order to determine the optimal way to treat each patient. Various symptoms, including oral pain, dry mouth, taste disturbance, furred tongue, excessive amounts of saliva, appetite loss, and trismus were treated by the dentists. As a result, the oral findings improved in all patients, while the oral symptoms improved in 16 of the 17 patients (94%). Thanks to the fact that dentists have joined the PCT, oral symptoms are effectively relieved, and PCT members now have an increased interest in oral cavity complications. Furthermore, conducting thorough examinations of the oral cavity by the PCT not only results in an improved QOL, but it has also increased the interest in the oral cavity on the part of the PCT. Therefore, more effective palliative care is expected to be achieved by promoting increased cooperation with more clinical departments.

As of 2011, about 12.8 million people in Japan had osteoporosis, which is a social issue in that it increases the number of patients who are bedridden or require residential care and its poor prognosis increases the mortality rate. We delivered a presentation on osteoporosis prevention to residents;the presentation consisted of ultrasound bone densitometry readings followed by a slide show, based on the readings. This report summarizes the presentation and considers whether it was effective in enhancing awareness of osteoporosis. The presentation was given to 39 residents, who were asked to complete a questionnaire before and after it. Of the 31 female respondents, 16.1 percent had bone density in the “low or caution” range;for all eight male respondents, it was “sufficient” or “average.” After the presentation, over 90 percent of respondents selected “agree” or “slightly agree” in response to the statements “I want to have regular exercise and participate in sports,” “I want to eat nutritionally sound meals,” and “understanding one’s bone density is useful for the prevention of osteoporosis.” In addition, 97.4 percent of the residents responded that the lecture was “useful” or “somewhat useful,” and 94.9 percent indicated satisfaction with it. The presentation was considered to be useful in enhancing residents’ awareness of osteoporosis.

The following four possible pathways for itching sensation have been suggested by recent reports. 1) Histaminergic TRPV1-positive pathway: Although histamine-positive nerve fibers cannot strictly be classified as “itch specific” due to their excitation also by pure algogens (making them itch-selective), the existence of a subpopulation of nociceptors responsible for itching is strongly suggested. Moreover, the TRPV1-expressing neurons have been suggested to be the main sensors and mediators of itching. 2) Histaminergic TRPV1-negative pathway: The scratching behavior caused by itching was not different between capsaicin-pre-treated and vehicle-treated (control) mast cell-rich NC mice. This result suggests the existence of a capsaicin-insensitive (TRPV1-negative) histaminergic pathway. 3) Non-histaminergic PAR-2 pathway: Protease-activated receptor 2 (PAR-2) has been shown to play a role in the itching of atopic dermatitis (AD). The itch evoked by cowhage (a non-histaminergic pruritogen that activates PAR-2) is very similar in characteristics to the itch evoked by conditions such as AD. 4) Non-histaminergic serotonin (5-HT) pathway: 5-HT alone applied to the human skin evokes an itching sensation and has been suggested to be involved in the itching associated with pruritic diseases, such as polycythemia vera and cholestasis.
Pruritus ; Histamine

In order to develop the health care system for the elderly we need to analyse fundamentally the phenomenon that the average age of population in each community is rapidly becoming older, as well as we have to grasp life conditions and health needs of old people. We investigated the rate of increase or decrease of population, rate of the elderly living by themselves and the index of the aging of population of each community, classified these communities into several types, and presented the points necessary to develop a community-based comprehensive health care for the elderly as to each type by considering the meanings the indices of health care, medical care and social welfare of the communities disclose.

Recently, while the medical technology developed remarkably on the one hand, the soscial need for preventive medicine largely increased on the other. In Japan, it is an urgent problem of the medical education how to create effective methodology and technology of the preventive medicine that can attract students who generally prefer to become professionals in clinical medicine.
Since 1978 we have practiced an educational programme in which each student looks after one family picked up from the agricultural district for one year, caring for the health of the family members and helping them out of health problems, if there are any. In this way students can learn primary health care and community health of their own will.
Compared with the traditional method, this method is effective in making the students understand with real interest the meanings of comprehensive primary health care through concerning themselves in the health care of a family as “a socio-economical-psycho-complex”.

In a farm village of Shimane Prefecture we conducted an investigation on the difference of nutrition between young, middle-aged and old generations. The result showed that nutrition was below the necessary level in the old generation, with many foods being scantily taken. Irrespective of generation the diet was of Japanese style. It will be necessary to guide people to the improvement of dietary life according to generations.
The dietary life of bedridden people and of those who attend to them was the worst of all. Some social measures to improve the situation, as well as the repletion of primary health care for old people are urgently required.
Women in rural communities generally have concrete demands for improvement of the dietary life. It is important to carry out the improvement in harmony with the actual condition of life in the community and the demand of inhabitants.

Today's one of the most important problems both in the industrial hygiene and the community health care is the health protection of farmers who are working in factories. There are many such farmers in the San'in rural districts. We surveyed the working conditions of 370 factories in Shimane Prefecture and found that they had many problems to be solved. The problems in the factories, mostly small-scale factories, are summarized as aging of workers, long working hours, insufficient rest, harmful work and night work.
Even in Sada-cho, where the local government is promoting the comprehensive community health care and encouraging the health care activity of inhabitants, the health care for factory workers is performed insufficiently. Some factories do not carry out even a periodical health examination of the workers.
We established the Sada-cho Occupational Health Association in cooperation with the local government, Izumo Health Center, Shimane Labor Standard Inspection Office and the factories in Sada-cho for the purpose of promoting the unified activity of the industrial hygiene and the community health care.

We treated two elderly patients who contracted amebiasis in a foreign country. They ate a watermelon in Peking, the People's Republic of China. From their account, the watermelon was considered the most probable source of infection.
In Case 1, the patient complained of acute nausea, vomiting, diarrhea and unconsciousness following severe dehydration. The trophozoites of Entamoeba histolytica were found by stool examination. The treatment with metronidazole was not so effective in Case 1 patient with fulminating amebic colitis. In Case 2, he had no subjective symptoms, but the cysts of Entamoeba histolytica were found by stool examination.
Recently, traveling abroad has become popular. The number of travelers has been increasing in Japan from not only urban districts but also rural districts. Therefore, it is necessary to exercise strict rigilance over the imported protozoan parasites and possible mass outbreak of amebiasis in tour groups.

The recent urbanization of rural communities and the associated changes of the living environments influenced the health conditions of children in rural districts of Shimane Prefecture, Japan. It obliged therefore to review the usual school health approach and to evaluate the care system to new trends of critical health problems of children.
A questionnaire was sent to school nurses asking their worries and problems about each step of the scientific school health procedure to recognize the health needs, to analyse the health problems, to plan the appropriate counterplans, to practice and to evaluate.
As a result of our investigations, the following remedies were necessary for the development of rural school health activities.
Firstly, the specialization of school nurses should be established without delay, and their working conditions should be more improved.
Secondary, school nurses should strengthen the contacts with teachers, parents and other school staffs to organize the developed school health system.
Finally, school nurses should make their efforts to delop the community-based school health care which connected the comprehensive community health care.

The rise of the average age of the population in Shimane Prefecture has become more and more conspicuous in these years. According to the estimation of the future population the aging phenome-non in Shimane Prefecture is going about fifteen years ahead of the average of Japan. Therefore it is significant to perform a community experiment of the comprehensive health care for the elderly in this prefecture, in the sense that its results will offer many useful experiences to other districts of Japan, where the aging of the population is proceeding a little more slowly.
We carried out an experiment called “the Service Package System for the Bedridden Elderly”, in Sada-cho, Shimane Prefecture in cooperation with Sada-cho, Izumo Health Center and Izumo Medical Association. It is an improvement on the health care system for the bedridden elderly and their family, which has been performed in Scandinavian countries.
The results of our experiment obviously showed the existence of many problems stemming from the lack of integration among different fields such as health care, medical care, social welfare, working and cultural life. To establish the comprehensivehealth service system for the elderly and their family the integration of these fields is most urgently demanded.