It is said that medical care is a social application of medicine to the benefit of community or individual. In step with progress in medicine, medical care has been made all the more complicated. Moreover, the system supporting medical care has fallen behind the times when its surroundings have been changing drastically. This situation could be ascribed to the institutional fatigue that the system itself is suffering from after a long period of existence. It also can be pointed out that there have been revolutionary changes in traditional Japanese cultural values together with the awareness of people concering health. However, the primary factor that lies behind need of reform is financial difficulties.
At present, in connection with deregulation of medical care, the introduction of mixed medical care and the entry of joint-stock corporations are taken up for discussion as topics of the day. In the meantime heated debates are being held over the subjects of institutional reform including the setting up of medical care for the aged as part of the fee-for-service system and reconstruction of the network of providers of health care and services. Moreover, the institutions that are engaged in the practice of medicine are expected to tackle a broad range of tasks- -catching up with ever-progressing information technology, disclosure of information, and strengthening of safety measures against medical accients, among many others.
However, these are not the issues which have cropped up in recent years. Many have been brought up and discussed from an angle a little different from what it is today. It is now high time for us to discuss these issues through and through in light of actual situations while looking back on the history of medical care and its system.
In this paper the author shall dwell on the development of the nation's medical system and point out some problems confronting us today with the use of some materials thus far presented by the Japan Medical Association. His view is based on his personal experience in hospital management and with the Japan Medical Association.

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 Older adults tend to lose the opportunities and abilities to pursue hobbies and perform various activities. Club activities provided in the community for old people seem to be beneficial in that the activities prevent them from becoming housebound, and improve overall QOL. In the present study, we conducted a survey by sending out self-answered questionnaire to 424 elder residents in rural areas. We collected information about their life circumstances, the presence or absence of physical pain, activities of Daily Living (ADLs), the degree of enjoyment from activities on the list, the frequency of going out, PGC morale scale and so on. The activities enjoyed frequently by the elderly were bathing, eating and watching TV. The degrees of enjoying eating and bathing showed positive correlations with the PGC morale scale, but the degree of enjoying gambling correlated negatively with the scale. A regression analysis was performed with the PGC morale scale as dependent variables. As a result, a significant model was structured to predict the life sati of the aged by making interpersonal distress, enjoyment derived from gambling, basic ADLs, physical pain and dwelling alone as indepeudent variables. These results will assist us in providing adequate health care to pelple of advanced age.

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 A cluster of insulin resistance, dyslipidemia and hypertension has been labeled as a metabolic syndrome. Asians have a lower rate of obesity than Caucasians, but have recently become increasingly prone to obesity and the metabolic syndrome, especially in rural communities in Japan. Although weight loss has been considered to be effective for improvement of the metabolic syndrome, most data are based on studies in Western countries with only limited information derived from Japanese populations. We conducted a study of 188 subjects who participated in our interventional program for obesity based on health education and self-determination in 2000-2003. The intervention induced significant decreases in caloric intakes and increases in physical activity in the participants, and then resulted in a significant 1.3kg reduction in weight on the average. Weght-loss was significantly associated with indexes of obesity, values of total cholesterol, triglyceide and HDL cholesterol levels, but was not related with blood pressure and LDL cholesterol, which were significantly decreased by our intervention. Furthermore a simple regression analysis was carried out to verify whether weight loss and metabolic syndrome parameters were related. Weight loss was determinantsexplaining less than a total of 10% of the variance in triglyceride and total cholesterol for the participants. Future studies of weight loss for metabolic syndrome should incorporate Asian ethnic factors, such as dietary habits and genetic influences.

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 We experienced a clinical case of a patient with psychotic depression who ingested the residual saponated cresol solution from a 500ml bottle of cresol, a disinfectant, with the intention of committing suicide. Through this experience, we felt it neccessary to investigate the present commercial situation of cresol for domestic use, and to come up with some safty measares.
 All the 128 drugstores and pharmacies in four cities located in the Tohno area of Gifu Pref. (Mizunami, Toki, Tajimi and Ena) were queried by telephone about the sale and stock of cresol.
 Almost 80% of the drugstores in these four cities, excluding pharmacies, were found to deal in saponated cresol solutions. They carried a little more than two 500ml bottles of cresol on average. This volume exceeds an estimated adult lethal dose of 250ml.
 Although it is unlikely that an ordinary household will use the whole of 500ml bottle of the disinfectant at a time, the residual saponated cresol solution could increase the risk of accidental cresol poisoning at home.
 So, it would be desirable not to sell 500ml bottles in ordinary drugstores. Furthermore, before selling a bottle of cresol, the pharmacists, who have a specialized knowledge about it, should kindly explain to the user about its toxicity and usage.

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 In addition to barium swallow, the health screening center of our hospital has started meansuring serum pepsinogen (PG) levels in the stomach cancer screening tests since 1998 if patients wish to receive the PG test. During the past five years, 94 gastric cancer cases were detected by both methods. The average detection ratio worked out at 79.8% for the barium method and 71.3% for the PG method. Of the 94 cases, 51.1% tested positive by both methods. The positivity ratio was 28.7% for the barium method alone and 20.2% for the pepsinogen method alone. In other words, it follows that nearly half of the cancer cases have been picked out by either of the two techniques. Therefore, it could be said that the two methods serve as complementary one to the other. Thus, it was confirmed that using the PG method together with the barium method is worthwhile.
 The hitting ratio of positive reaction was high in patients at level 2 and upward when checked according to PG levels, and in patients whose initial test results were negative and later shifted to level 2 or level 4 with the lapse of time. These findings suggest that it is feasible to presupposed a group of people at higher risk for developing gastric cancer.

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 Based on progress in home visits for rehabilitation and health guidance since 1979, the trend after the Nursing Care Insurance Law was enforced in 2000 was investigated. In home visits for rehabilitation, cooperation with many related organizations is required, and reorganization of the network built before the enforcement of the said Law is needed. The role of each home visiter for rehabilitation is being formed and cooperation with care managers is being strengthened. The tendency that the participation of the local government may decrease can't be denied. Connection with the hospital and the local government should be maintained, and a new community-based network needs to be built.

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 Aichi Koseiren-Aihoku Hospital has implemented a New Glucose Monitoring System,using Precision PCx and its data management application, QC Manager (both Abbott Japan), for outpatient testing. It utilizes the advantages that have come with the introduction of the Ordering System. The new system has automated a great portion of glucose monitoring workflow and reduced the human work, and consequently, the potential risk of malfunction due to human errors. The system has been designed and developed to meet the following criteria; To be able to fully utilize the potential capabilities of the Ordering System (Barcode recognition of test samples); To be capable of transferring test results automatically to the Laboratory Information System without being handled by human; To improve the productivity as a whole system; To possess the precision and accuracy;and To be handled easily for bed-side use.

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 Two years have passed since a patient who started to use the respirator for a tuberculosis sequela and chronic respiratory failure at home. During this period, the patient got several short-term admissions into the hospital. After his first discharge, the patient and his family felt anxiety about recupration at home. It was the first time for us to provide home care services to a respirator wearing patient. However, the shift to recuperation at home was realized as an understanding was reached between physicians who decided upon care home and the patient's wife who wished “to live with the husband together”. The patient is now playing a role as a father and as a husband, and he is leading a full life. In this study, the personal and familial circumstances of the patient, decision-making about home care and community support were analized. We coucluded that there were several important factors for successful recuperation at home:specification of contents of concrete medical support to a patient and a family;an immediate suitable action at the time of change of a patient's condition;taking periodic rests of a patient and a family;and a good family relationship.

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