In January and February 2004, avian influenza assaulted poultry farms in Yamaguchi Prefecture and in Kyoto Prefecture, killing a large number of chickens and sparking a wholesale slaughter of birds near the affected areas. To prevent the spread of the flu, authorities banned the shipment of live chickens, eggs and poultry meat within a radius of 30 kilometers around the infected poultry farms. Even now, you may be able to picture to yourself that masked workers, wearing white work clothes, goggles, boots and gloves, were burying flocks of dead chickens deep in the ground and sanitizing the facilities through and through. Japanese mass media gave prominent coverage to the bird flu outbreaks in terms of food safety, and with good reason. Chicken eggs and meat are in great demand and constitute important items in Japanese dietary culture and habits.
 Vaccines for a human strain of influenza virus are made every year by using chicken eggs to grow a master-seed virus. To ensure a stable supply of human flu vaccines, the epidemic of bird flu must be blocked by all means.
 After all is said and done, the crux of the problem is the ability of the avian flu virus. It can mutate, cross with another flu virus to form a new type of influenza virus that is transmissible from humans to humans, thus causing a global pandemic. As you must have heard, those influenza viruses which caused Spanish flu, Asian flu and Hong Kong flu were derived from an avian flu virus. The virus mutated into new forms of human flu virus and invaded the domain of humans, claiming millions of human lives and triggering crises worldwide. These new forms of human influenza occur in a 27-year cycle. The previous occurrence of a new type of influenza was Hong Kong flu of 1968.
 There is every indication that bird flu, which has the potential to pass easily among humans, is spreading in Asia. Since the spring of 2004, the return of bird flu has become apparent in Thailand and Vietnam where the epidemic was declared to be under control. Even some human cases of avian influenza have been reported. The mortality rate from avian flu is very high. It is estimated that 70% of the patients with bird flu die. The currently prevalent strain of bird flu virus is regarded as a remarkably lethal pathogen. Being so virulent, it attacks chickens systemically and kills them in one or two days. There is general agreement among flu virus experts that the pathogen, known as the H5N1 virus, will sooner or later break the species barrier and begin affecting the human population.
 Such being the circumstances, we shall deal with the incidence of avian influenza in this paper and ponder over what constitutes the core of the problem, how a new strain comes along from the avian influenza virus and what is expected to happen when a new strain of flu virus emerges. By gaining an insight into a new type of influenza and taking lessons from past pandemics that took a heavy toll of human lives, we should make every effort to arrest the spread of the disease and keep the damage to a minimum.

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 To investigate the attitude of personnel at public facilities toward cigarette smoking, a poll was taken at 27 municipal facilities, 14 schools, 15 nursery schools, and 10 post offices in Mizunami City. Questionnaires were distributed to a total of 936 employees, asking them whether they smoke and whether their workplaces are divided into smoking and nonsmoking areas.
 All the questionnaires were collected, with the names of facilities entered. Of the pollees, 20.0% was found smokers. At about 80% of the facilities surveyed, smoking was prohibited at offices and resting rooms for employees. As it turned out, nosmoking zones were limited to only 30% of public space utilized by citizens. At most of the nursery schools surveyed, smoking was banned, but in many schools, smoking was not prohibited in the resting rooms for the teaching and clerical staff. Post offices, compared to the other facilities surveyed, were too lax in regulating smoking. The survey also found that less than half of the facilities have a good knowledge of Article 25 of the Health Promotion Law.
 The findings of the latest survey were such that we deemed it necessary to conduct more positively a campaign against smoking in public facilities open to local residents.

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 We investigated the incidence of surgical site infection and the number of days required for recuperation in patients who used open drains or closed drains after genitourinary tract surgery. As the method of (statistical) examination, Mann-Whitney's U test was used. Enrolled in this study were 14 patients (mean age:66.3 years) using open drains during the period from May to October 2001 (group A) and another 14 patients (mean age:64.9 years) using closed drains during the period from December 2001 to May 2002 (group B). Using gauze and drains, germ culture was made. From cultures it was found that six out of the 14 group A patients (42.8%) had been infected with Staphylococcus epidermidis, enterococcus and/or MRSA (methicillin-resistant Staphylococcus aureus) but that all of the group B patients had been were negative, thus marking a statistically significant difference between the two groups (p<0/01). A check on the duration of the administration of antibiotics showed 7-42 days (mean:24.5 days) for group A as against 4-11 days (mean:6.1 days) for group B. It was also revealed that there was a significant difference (p<0.01) between the two groups in the number of the days when gauze was exchanged:10-31 days (mean:19.1 days) for group A versus 3-10 days (mean:7.9 days) for group B. In many other respects, the closed drainage group was found to be doing well postoperatively compared with the open drainage group.
 It was also noted that the patients of the open drainage group had run into a lot of difficulties eating, sleeping, excreting and doing daily activities due to bacterial infections.
 By switching from open drainage to closed drainage in postoperative procedures,our department has succeeded in reducing the incidence of surgical site infections, thus making it possible to obtain a remarkably favorable result in terms of recuperation.

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 There are no signs of a drop in the number of deaths in accidents while at farmwork, hovering around 400 a year. Furthermore, the fact remains that accurate data about those farm accidents are not fully grasped.
 This reality gave birth to a Special Study Team on the Prevention of Farmwork Accidents in the Japanese Association of Rural Medicine.
 To cast light on the actuality of farm work accidents, questionnaires on accidents caused by farm machinery and instruments were sent to three medical institutions affiliated with the Association from October 2002 to March 2004. As a result, clinical data were collected on 141 clinical cases. Moreover, studies were performed on five cases in which rescue squads were dispatched to give aid to the injured.
 The data thus collected on the clinical cases revealed that grass cutters, harvesters, riding and push-on-foot types of tractors, and straw cutters were responsible for many accidents. Some individuals were involved in the accidents as operators of grass cutters were unaware of their existence nearby because of noise from the machines, some dragged in by the harvesters or straw cutters, and some pinned under the tractors.
 Case studies on death-induced accidents suggested the indispensability of fitting a safety frame and a seat belt to the tractor and installing a cabin on the speed sprayer.
 For the prevention of accidents by farm machinery, it is important to hold lecture meetings more frequently both on the basic method of their use and on first aid.

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 Our hospital has a nutrition support team (NST) serving inpatients of all department. Two years ago, the team started activities with the motto “Apt nutritional management for inpatients”. It is an interdepartmental unit consisting of physicians, nurses, dietitians, pharmacists and speech therapists. Initially we found it difficult to make time to join forces, but now it has become possible to screen patients for undernourishment on a weekly basis while making nutritional assessment and planning, and holding consultations. The main purpose of the consultations is to improve the nutritional status of patients according to plans formulated after nutritional assessment made at the request of physicians and nurses in charge of the patients. To achieve the objective, we are expected to concentrate all our efforts and brains. This paper presents some consultation cases we have handled. In addition, the nutritional assessment and nutritional intervention activities of our hospital are described.

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 Today, the patient's needs for medical care and services have become diversified and medical information spreads widely and swiftly at that. In these circumstances, nurses are strongly expected to further develop their faculties of nursing and appropriately responding to the patient's emotional state. To nurture capable nurses, it is neccessary to establish an adequate training and performance evaluation system.
 In 2002, we had a chance to participate in the planning of “the Mie prefectural enterprise for continuous nurse education and appropriate nursing staff arrangement”. Based on this experience, we made a guideline for continuous nurse education, practice manual and an appraisal table for each rank.
 Meanwhile, The Mie Prefectural Federation of Agricultural Cooperatives for Health and Welfare, was studying a faculty appraisal system for all staffs. We started our nurse education program incorporating this system.
 Our nurse education program is made up of five ability-areas, that is, (1) nursing practice, (2) education to the lower class nurse and research, (3) human-relationship achievement, (4) nursing team management and (5) risk management.
 The outcome of this program was examined by the appraisal committee according to the improvement level in nursing abilities (including both skills and sensibility).

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