For a long while after World War II, travel medicine had sunk ro its lowest ebb in Japan. In the late 1980s, with nation's rapid economic development, national income rose rapidly the number of overseas travelers increased explosively, and many industries began to move their production bases to Asian countries. It was in this socioeconomic context that travel medicine came to be recognized again. In so-called developing, infectious diseases which are rarely seen in Japan and those characteristic in the tropical regions are still prevalent. In addition, new types of infectious disease entities occasionally spread very rapidly by travelers and give a shock to the world. Hence the importance of travel medicine increases. However, Japanese people take it for granted that their country or company protects their health. This is probably because of the universal national health insurance system and vaccination programs for preventing infectious diseases. Unlike Europeans and Americans, they hardly realize that one must protect one's health by oneself. In order to promote travel medicine from now on, a nationwide educational campaign which gives information to people on health risks in traveling abroad and that raises their awareness that one's health must be protected by oneself is necessary. The campaign requiers the collaboration of related medical societies, the travel industry and the administration.

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 Safety management in routine medical practice is one of the important issues that must be addressed by medical staffs, even it is hard to deal with various happenings and problems encountered in medical facilities.
 Here we present some arrangements in a reporting system of incidents and accidents to motivate each staffer to notice the significance of safely, and quantify the urgency and severity of reports using the originally developed management score at the Toride Kyodo General Hospital.
 The reports from all sections of the hospital were previously evaluated by five risk managers. This practice was effective in analyzing reports rapidly and appropriately, but was insufficient to motivate all of staffs to give much more heed to safety in routine medical practice. Instead, these reports are now discussed and analyzed by a group of people consiting of representatives of all sections and the departments in the hospital. This innovation evoked more interest and concerns about the safety management among the whole medical staff.
 We also utilized the management level, which was stratified into three grades from the point of urgency and severity of cases. The first level means the occurrence without urgency or need to change any systems, procedures and organizations. The second level requires some change in systems, but no urgent action. The accident at the third level should be dealt with as soon as possible by any of feasible ways. The total score, obtained by summing up a lisk level multiplied by a management level in each report, decreased between May and August in 2004, despite increases in the total numbers of monthly reports.
 In conclusion, the incident/accident reporting system became more familiar to medical staffs through the use of group-working. The management score and the derived total score may be available for comparing outcomes of safety management activities among different observation periods or facilities.

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 How should the “management of things” be? We carried out a questionnaire survey to find out the facts about the stock control of medical supplies and inventory management system in hospitals affiliated with the National Federation of Agricultural Cooperatives for Health and Welfare. Questionnaires were sent out to 98 hospitals with not less than 100 beds. Fifty-one hospitals responded. The number of effective replies was 49. We made analyses of the data as best we could, especially the data on the operation of the inventory management system and stock control.
 (1) After the adoption of an inventory management system, 41% of the hospitals took more than half a year before the system was put on the right track. (2) The system has turned out to be conductive to the streamlining of such work as placing orders, delivery, storing and stocktaking. (3) Concerning the management of the master file in the system, many respondents gave the accuracy of data, prompt processing and working efficiency as the problems yet to be addressed. (4) In the hospitals using an inventory management system, the in-hospital type SPD took 17.7 days in terms of the holding period in the case where users are supposed to control the consumption of medical materials as against 8.3 days in the case where clerks in charge of warehousing deliver medical materials and take on consumption control. (5) About 80% of the hospitals have introduced their own inventory management system in an effort to promote the standardization of materials, purchase materials in proper quantities, carry out inventory and consumption control, and create an efficient supply system.

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 Clostridium difficile (C. difficile) is one of the important pathogens which cause antibiotic-associated diarrhea (AAD) -diarrhea following antibiotic therapy. There are some reports of nosocomial outbreak of AAD caused by C. difficile.
 We analyzed risk factors and epidemiology of C. difficile-associated diarrhea (CAD) in Kumiai Hospital. From March 2003 to February 2004, 53 in patients developed AAD, of whom 35 patients (66%) were diagnosed as having CAD. Advanced age, bed-rest, tube-feeding, and prolonged administration of antibiotics were regarded as risk factors.
 In initial two months, seven cases developed CAD in one ward and five in another ward. After hand-washing and use of gloves were enforced in treating CAD patients, the incidence of CAD decreased. Epidemiological analysis was performed using PCR ribotyping of C. difficile strains recovered from 20 among 35 CAD cases in the different wards. Nineteen of 20 strains were identical, typed as the ribotype. These results may suggest nosocomial diarrhea but we cannot conclude that is a hospital infection as yet.
 Although all C. difficile strains recovered in this study were toxin A-positive, the result of the test using a toxin A detecting kit was negative in three cases. It is necessary toculture C. difficile in addition to detecting toxin A to diagnose CAD.

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 A clinico-epidemiological analysis was performed of 2,414 consecutive stroke patients who were treated in our hospital during the 6-year period from 1997 through 2003. All the patients were neurologically examined and diagnostic studies were made by use of computed tomography. Cerebral infarction, cerebral hemorrhage, and subarachnoid hemorrhage accounted for 68%, 22%, and 10% of the stroke cases, respectively. The incidence of these subtypes of stroke in this region during the past 20 years was characterized by a singnificant decrease in cerebral hemorrhage, and an increased proportion of cerebral infarction. Men exceeded women in the incidences of both cerebral infarction and hemorrhage, whereas characteristically women far exceeded men in subarachnoid hemorrhage. The incidence reached a peak in the 70-79 age group regardless of the subtypes of stroke, and 64% of the entire stroke patients were those 70 and older. Women were found to suffer from stroke at much older age than men. As to the site of hemorrhage, putaminal hemorrhage was the most frequent, experienced by 36% of the patients, followed by thalamic hemorrhage in 34% of the patients. Putaminal and pontine hemorrhages predominated in the age groups younger than 60;thalamic, cerebellar and subcortical hemorrhages were predominant in the age groups older than 70. The incidence of these subtypes of hemorrhage during the past 20 years was characterized by a dramatic decrease in putaminal hemorrhage in a younger population, and a significant increase in thalamic, cerebellar, and subcortical hemorrhages in an older population.

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 This is the second report of the findings of the clinical and epidemiological studies on pathogen-carrying madani tick bites (ixodiasis) and the vector-borne diseases conducted by a study group of researchers specially organized by the Japanese Association of Rural Medicine. The report covers the period from January 1 through December 31, 2004.
 The same questionnaires that had been prepared in the previous survey were sentto 80 JARM-affiliated medical facilities and 11 non-member medical institutions to collect information about tick bites and resultant infections.
 It was found that during 2004 there were 134 cases (67 for men and 67 for women) of skin lesions caused by ixodid tick bites, 14 cases of Lyme disease (7 for men and the same for women), and none for Japanese spotted fever. These ixodiasis cases did not show any speciffic difference from those reported previously. All the Lyme disease patients developed erythema migrans which characterize stage 1 infection.
 As there is still plenty of catching up to do in terms of coping with the tick bite problems in Japan, we referred to some literature on the control of ixodid ticks, serologic testing techniques for Lyme disease, administration of prophylactic antibiotics and therapeutic methods.

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 A 75-year-old man, who was under treatment for bronchial asthma and hypertension in our hospital, complained about his snoring and daytime sleepiness. Polysomnography (PSG) was indicated. He was diagnosed as having a serious obstructive sleep apnea-hypopnea syndrome in April, 2003. Continuous positive airway pressure (CPAP) treatment was effective, and his symptoms waned. The CPAP treatment was discontinued at the end of October, because the patient, chief priest of a temple Buddhist, had to serve for 100 days as acting chief priest of another temple. He ate only meals prepared at the temple, and drinking and eating out were not done at all, and the eating habits were managed. He was told he is a trrible snorer, but was not aware of daytime sleepiness. In April 2004, PSG showed his condition turned a little better with AHI being 9.9/hour. After he returned to the original temple, a diet was continued. However, the AHI rose to 12.8 in November 2004-nine months after reinstatement. It was thought that differences in everyday life were responsible for the exacerbation of OSAHS despite the fact tha the showed an improvement just after he came back to his temple.

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