Background: The aims of the present study were to reveal the impact of the introduction of social medicine training one year earlier in a new university curriculum on subjective/objective evaluation of medical students, and to discuss the readiness of said students. Methods: In this natural experiment study, subjects comprised 73 third- (n = 31) and fourth-grade (n = 42) medical students who participated in social medicine training, namely “Family Health Practice Tutorial,” in 2017. The data consisted of student’s self-assessment and assessment from clients. The associations between these assessments and student grade were analyzed using the Mann-Whitney U test and ordinal logistic regression. Results: The score for “Language” in the assessment from the clients was significantly lower in the third-grade students than in the fourth-grade students after adjustment for gender (odds ratio = 0.147; 95% confidence interval = [0.027, 0.797]). Discussion: Insufficient readiness for language to residents in the community was found in third-grade medical students. Advanced communication training prior to practice for third-grade students may contribute to sustainable social medicine training in the community.

The Department of Hygiene and Preventive Medicine in Fukushima Medical University has carried out "Family Health Practice Tutorial" as part of social medicine training for undergraduate medical students. In this training, pairs of students, visited the same ordinary homes three times, and studied the Family Health Practices. Further learning was mainly offered in the tutorial, which is regarded as Problem-Based Learning. The visited family evaluated the students and gave feedback to them via their teachers. We herein present the report on the present state, evaluation method and tasks of the training. We also discuss the meaning of this training in medical education as well as future direction.

BACKGROUND: Over the past few decades, the Japanese Ministry of the Environment has been biomonitoring dioxins in the general Japanese population and, in response to public concerns, has taken measures to reduce dioxin exposure. The objectives of this study were to assess the current dioxin dietary intake and corresponding body burden in the Japanese and compare Japanese dioxin data from 2011 to 2016 and 2002-2010 surveys. We also examined the relationship between blood dioxins and health parameters/clinical biomarkers. METHODS: From 2011 to 2016, cross-sectional dioxin surveys were conducted on 490 Japanese (242 males and 248 females, aged 49.9 ± 7.6 years) from 15 Japanese prefectures. Blood (n = 490) and food samples (n = 90) were measured for 29 dioxin congeners including polychlorinated dibenzo-para-dioxins (PCDDs), polychlorinated dibenzofurans (PCDFs), and coplanar polychlorinated biphenyls (Co-PCBs) using gas chromatography coupled with high-resolution mass spectrometry. Using the 2006 World Health Organization toxic equivalence factors, the toxic equivalents (TEQs) were calculated. Clinical biomarkers and anthropometric parameters were also measured and information on lifestyle behaviours collected. Data imputations were applied to account for blood dioxins below the detection limit. RESULTS: The median (95% confidence interval or CI) blood levels and dioxin dietary intake was respectively 9.4 (8.8-9.9) pg TEQ/g lipid and 0.3 (0.2-0.4) pg TEQ/kg body weight/day. The median blood dioxin level in the 2011-2016 survey was found to have decreased by 41.3% compared to the 2002-2010 surveys. Participants who were older were found to be more likely to have higher dioxin levels. Blood dioxins were also significantly associated with body mass index, triglycerides, docosahexaenoic acid, eicosapentaenoic acid, and dihomo-gamma-linoleic acid levels in blood. Furthermore, associations between blood dioxin and dietary dioxin intake were evident in the unadjusted models. However, after adjusting for confounders, blood dioxins were not found to be associated with dietary dioxin intake. CONCLUSIONS Blood dioxin levels declined over the past decade. This study showed that the measures and actions undertaken in Japan have possibly contributed to these reductions in the body burden of dioxins in the Japanese population.
Adult ; Aged ; Analysis of Variance ; Biomarkers ; blood ; Body Mass Index ; Cross-Sectional Studies ; Diet ; Dioxins ; analysis ; Environmental Exposure ; analysis ; Environmental Monitoring ; methods ; Female ; Food ; Food Analysis ; Food Contamination ; analysis ; Gas Chromatography-Mass Spectrometry ; Humans ; Japan ; Male ; Middle Aged ; Surveys and Questionnaires ; Young Adult

BACKGROUND: The facial expression of medical staff has been known to greatly affect the psychological state of patients, making them feel uneasy or conversely, cheering them up. By clarifying the characteristics of facial expression recognition ability in patients with Lewy body disease, the aim of this study is to examine points to facilitate smooth communication between caregivers and patients with the disease whose cognitive function has deteriorated. METHODS: During the period from March 2016 to July 2017, we examined the characteristics of recognition of the six facial expressions of "happiness," "sadness," "fear," "anger," "surprise," and "disgust" for 107 people aged 60 years or more, both outpatient and inpatient, who hospital specialists had diagnosed with Lewy body diseases of Parkinson's disease, Parkinson's disease with dementia, and dementia with Lewy bodies. Based on facial expression recognition test results, we classified them by cluster analysis and clarified features of each type. RESULTS: In patients with Lewy body disease, happiness was kept unaffected by aging, age of onset, duration of the disease, cognitive function, and apathy; however, recognizing the facial expression of fear was difficult. In addition, due to aging, cognitive decline, and apathy, the facial expression recognition ability for sadness and anger decreased. In particular, cognitive decline reduced recognition of all of the facial expressions except for happiness. The test accuracy rates were classified into three types using the cluster analysis: "stable type," "mixed type," and "reduced type". In the "reduced type", the overall facial recognition ability declined except happiness, and in the mixed type, recognition ability of anger particularly declined. CONCLUSION There were several facial expressions that the Lewy body disease patients were unable to accurately identify. Caregivers are recommended to make an effort to compensate for such situations with language or body contact, etc., as a way to convey correct feeling to the patients of each type.
Aged ; Aged, 80 and over ; Cluster Analysis ; Cognition ; physiology ; Emotions ; Facial Expression ; Facial Recognition ; physiology ; Female ; Humans ; Lewy Body Disease ; physiopathology ; psychology ; Male ; Middle Aged

To accurately assess the clinical competencies of medical students at Fukushima Medical University, we have developed a novel online self–assessment system, which covers all goals in the "Model Core Curriculum for Medical Education in Japan." We added "Emergency," "Communication skills with staff," and "Simulation–based learning." Following their clinical clerkships, 79 sixth–year medical students assessed themselves and their clinical clerkships.
1)This novel online self–assessment system, consisting of 68 checklists in 15 fields, easily informs us of the actual conditions of clinical clerkships and students' confidence in their clinical competencies.
2)This internet–based self–assessment system revealed the current status and problems of clinical clerkships, prompting feedback to clinical instructors and members of the instruction committee.
3)Students felt "confident" or "confident to a certain degree" in most learning areas; however, simulation–based learning seems to be necessary in several areas, such as clinical skills, where feelings of shame or discomfort may be associated with patient care.
4)Students who had high total self–assessment scores evaluated clinical clerkships favorably. In contrast, students whose self–assessments frequently included "no learning experience" evaluated their clerkships negatively in the educational aspects of "skill" and "attitude."

To investigate the effects of generational factors on the lives of medical students in the first and second years, we surveyed students about the frequency of problems and the seeking of advice.1) A questionnaire was distributed to first- and second-year students in January 2009 asking about problems regarding academic work, mental health, financial concerns, career options, physical wellness, and interpersonal relationships.2) About 70% of the students had sought advice regarding academic work and interpersonal relationships. Also, about 50% had sought advice regarding mental health.3) Students chose potential advisors depending on the type of problem; however, they preferred to consult with their classmates and upperclassmen. In addition, their parents played a role. In contrast, students rarely consulted with teachers.4) High percentages of first- and second-year medical students had various problems. Creating a support system to address these problems is important.

OBJECTIVEThe association between clustering health-promoting components of lifestyle and bone status was examined among middle-aged women.

METHODSA cross-sectional study was conducted in Tadami Town, Fukushima Prefecture, Japan, in 2007. A total of 305 middle-aged women (mean age 55.2 years) participated. The Health-Promoting Lifestyle Profile II was used to assess health-promoting components of lifestyle. Participants' bone status was examined using quantitative ultrasonic calcaneal measurement.

RESULTSA total of 139 participants (45.6%) were defined as having low bone stiffness. In the low bone stiffness group, the mean age was significantly higher, and prevalence of interpersonal relationships score over 3.0 was lower than that in the normal bone stiffness group. There were significant trends in the prevalence of low bone stiffness, each health-promoting component of lifestyle, and presence of hypertension and diabetes mellitus, based on the number of frequently selected health-promoting components of lifestyle. The number of frequently selected health-promoting components of lifestyle correlated negatively with the prevalence of low bone stiffness in both crude and adjusted results.

CONCLUSIONThis research is particularly important as we suggest health-promotion strategies for the prevention of osteoporosis. A synthetic approach, which includes health responsibility, spiritual growth, interpersonal relations, and stress management, and physical activity and nutrition, may be effective and complement traditional strategies.

OBJECTIVEThe aims of this study were to determine the effects of heavy metals such as manganese on nicotinamideN-methyltransferase (EC 2.1.1.1) (NNMT) activity and to consider the possibility of involvement of NNMT activation in the pathogenesis of heavy metal induced Parkinson's disease.

METHODSNNMT activity in supernatants separated from brain, liver and kidney homogenates of 5 elderly male Wistar rats by centrifugation were measured by high performance liquid chromatography system with fluorescence. NNMT activity under the conditon of 0.5 or 5.0 mM Mn(2+), Fe(2+), Cu(2+) or Cd(2+) was compared with control (no metal ion existence).

RESULTSNNMT activities in rat brain, liver and kidneys were significantly decreased by Cu(2+), and those in the liver and kidneys were significantly decreased by Cd(2+). Mn(2+) reduced NNMT activity only in the liver. Fe(2+) had no effect on NNMT activity.

CONCLUSIONSNo metal increased NNMT activity in this study, contrary to our hypothesis. Further study is needed to clarify the reason why the effects of Mn(2+) and Fe(2+) which have a high relevance to Parkinson's disease on NNMT activity differ from those of Cu(2+) and Cd(2+).

Epidemiological surveys suggest an important role for niacin in the causes of Parkinson's disease, in that niacin deficiency, the nutritional condition that causes pellagra, appears to protect against Parkinson's disease. Absorbed niacin is used in the synthesis of nicotinamide adenine dinucleotide (NAD) in the body, and in the metabolic process NAD releases nicotinamide by poly(ADP-ribosyl)ation, the activation of which has been reported to mediate 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine-induced Parkinson's disease. Recently nicotinamide N-methyltransferase (EC2.1.1.1) activity has been discovered in the human brain, and the released nicotinamide may be methylated to 1-methylnicotinamide (MNA), via this enzyme, in the brain. A deficiency in mitochondrial NADH: ubiquinone oxidoreductase (complex 1) activity is believed to be a critical factor in the development of Parkinson's disease. MNA has been found to destroy several subunits of cerebral complex 1, leading to the suggestion that MNA is concerned in the pathogenesis of Parkinson's disease. Based on these findings, it is hypothesized that niacin is a causal substance in the development of Parkinson's disease through the following processes: NAD produced from niacin releases nicotinamide via poly(ADP-ribosyl)ation, activated by the hydroxyl radical. Released excess nicotinamide is methylated to MNA in the cytoplasm, and superoxides formed by MNA via complex I destroy complex 1 subunits directly, or indirectly via mitochondrial DNA damage. Hereditary or environmental factors may cause acceleration of this cycle, resulting in neuronal death.

To clarify the relation between living habitudes in Japan including daily fare and health, the state of health of 21 Japanese-Brazilians living in Japan was investigated. The relation was analyzed based on their views, about the Japanese customs. Only two persons were found to have adapted themselves to the living environment in Japan, 10 persons were not adaptable sufficiently and 9 suffered from maladaptation. Asked why they were not adaptable, they gave personal relations, difficulty in reading and writing, workplace stress, etc. It was also found that at the present their biggest worry concerned the future, followed by personal relations, Japanese language, work and education in that order. Our investigation brought to light the fact that there was much to be done by the local community in terms of receiving immigrants. When it came to foodstuffs, after visiting Japan, the intake of salt, meat and fruit decreased, and fish increased. Like most Japanese, the Japanese-Brazilians regarded salad and rice-baseddiet healthy, but coffee not good. Referring to some foodstuffs which are customarily eaten less, many said they feel eating a lot of fish and shellfish in Japan is good for the health, but little fruit and little bean food are not good. As for the present health condition, more than half of the subjects said they had some problem. In the relation between the change in weight and the change in eating habit, only the increased intake of sugar was related to weight gain. The effect of the Japanese way of life on their health must be continuously followed up on with the common and different points of the customs in eating between Brazil and Japan taken into account.