There has been a severe criticism that the staff of Japanese medical schools is concerned about only research activity, but little interested in clinical work and education. Fortunately, many young faculties have recently much interest in medical education and are trying to improve their educational quality and technique. However, we can see many defects in the educational system of Japanese medical schools, compared with that of American and Canadian medical schools. The lack of common basic education, too many lectures of all fields of basic and clinical medicine, inspective, not practical bed-side study, and unorganized, over-specialized post-graduate education have been always the target of discussion. It is essentially necessary for us to reorganize the educational system, particularly the medicine department, of our medical schools, to introduce the clinical clerkship by core-curriculum in bed-side training, and to establish the teacher's training system. Now is the time that we should put our plan in action.

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Long term stress causes life-style related diseases by influencing such factors as diet, sleep, exercise and relaxation. Basic Research on the relationships between immune function and life-styles are reviewed. Undernutrition without malnutrition extends life span and prevents the development of diseases. Immune function was decreased by disturbance of sleep, but was, at the same time, increased by moderate exercise. The number of lymphocytes and immune function were decreased by restraint stress.

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Through two cases of diabetes mellitus of childfood origin who could not go to school due to necessary long-term hospitalization, we discussed there backgrounds, especially familial problems, and the kind of medical care which they have been received and that which we should give them. The patients were female sinior high school students. They were admitted to our hospital because of their poor blood sugar control and their problematic attitudes toward medical care. Familial supports have been inadequate in both cases after the onset of diabetes mellitus and they became increasingly lonely as they continued to be under medical theatment. They maintained their defense and poor stress coping behaviors, repeating such problem behaviors as being rebellious to the members of medical care, denying to eat or overeating and so on. Then their blood sugar control became poor. These reactions indicate following problems : too much attention have been paid only to the blood sugar control to build good relationships between therapists and patients, and the people surrounding the patients (i.e., family, doctors, teachers, schoolmates et al.) lacked in the views of growth model of accepting their disease while helping their developments.

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There were several self-reporting questionnaires for assessing alexithymia including Toronto Alexithymia Scale-20 (TAS-20). Although clinical interviews have been recommended to clinicians, there were no uniform methods in Japanese to evaluate alexithymia in clinical setting, Therefore,we decided to develop the Structured Interview by the modified edition of Beth Israel Questionnaire (SIBIQ) in Japanese edition. SIBIQ is constituted by the partially structured interview based on the standard rating scale according to the modified edition of BIQ (Taylor GJ et al.), accompanied with the interview guide-lines composed of the written questions referring to the modified BIQ. Therefore, the aim of this study was to assess the reliability and validity of the newly developed SIBIQ. SIBIQ was carried out by two interviewers to 45 patients (male, n=6 female, n39 ; mean age, 26.3±7.9 yr (SD)), admitting to the department of psychosomatic medicine in Kyushu University Hospital Eating Disorders (n=34), Mood Disorders (n=7), Anxiety Disorders (n=2), Somatoform Disorders (n=1), and Communication Disorders (n=1). Briefly, each patient was interviewed for approximately 20 min by either of the two interviewers, who were randomly selected, and were all familiar with the alexithymia construct ; one interviewer asked questions, while the other only watched beside in the interview room. The patients were rated for alexithymia by the two interviewers independently on the modified version of BIQ according to the interview guidelines. After the interview, the patients answered TAS-20, and consequently the rating scores of SIBIQ and the TAS-20 were compared. When factor analysis was performed on the results of SIBIQ, the following two factors were extracted : alexithymia and fantasy ability. The first factor consisted of both affective awareness and operatory thinking that had been already discriminated in the modified BIQ. As to the reliability, the good internal consistency (α=0.91) and the reliability between raters (ICC=0.82). Significant positive correlation (r=0.49) between SIBIQ and TAS-20 was observed and the convergent validity of SIBIQ was also confirmed. The results indicate that it is valuable to use the SIBIQ for the assessment of alexithymia in daily practice in psychosomatic medicine.

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