The developmental process of models which Dickert and Grady suggested for the payment to research subjects was analysed, through a critical reading of their paper and a comparison with preceding papers written by Macklin and Ackerman. The wage payment model which Dickert and Grady recommended has developed for non-clinical research and was recognized as a product of compromise between competing interests ; the need to recruit subjects and obligation to offer them certain types of protection. Application of this model to clinical research causesmore ethical problems of payment as compared with its application to non-clinical research. In clinical research, furthermore, payment itself reveals more about commercial relationship between physicians and patients. However, the model has an ethical advantage to prevent therapeutic misconception. Although the reimbursement model is less likely to commercialize the patientphysician relationship, it is difficult to adopt the model as it can not prevent therapeutic misconception. Payment to patients, a symbol of clinical trials which includes tension between the obligation of society to promote research and the obligation to prevent the moral interests of patients, should be used as a tool to conduct informed consent through which both patients and physicians could attain profound realization of clinical trials together.
We conducted two questionnaire surveys targeting vocational college students in Sapporo, We examined how their attendance at nutritional lectures and practicum affects their BMI, mental health, and health habits one year after. The first questionnaire survey was conducted in April 2003 with 182 new students, and the second one in June 2004 with 108 who promoted to the 2nd grade. The categories inquired were health habits (including intake frequency by food groups, dietary behaviors, daily physical activity, sleep), dietary environment (accessibility to food and health information), interests in foodtaking, self rated health, BMI and basic attributes. For the index of mental health, GHQ-28 was used. The response rate was 100%. Compared with the first year, the results of the second one showed improvements in health habits (such as nutritional balance and daily physical activities), dietary environment (such as accessibility to food and health information), interests in food-taking, and mental health (especially in social activities). On the other hand, there was no notable improvement in dietary behaviors or BMI. Some health-related indexes also showed the improvement among the students who have obtained credits in the nutritional lectures and practicum. These findings suggest the importance of introducing nutritional lectures and practicum among vocational college students, since they are expected to be "experts" in the area of health and social welfare in the near future. Follow-up surveys will be needed to see whether and how the habits be sustained in the future.
The importance of the relationship between community health professionals and people has become to be emphasized, because community health promotion is considered closely related with people's daily life and community health practices are required to be conducted in the neighborhood of people. Particularly professionals are expected to take counsel together with people through their daily life. What kind of relationship exits in such circumstances? However, different from services like professional official duties, it is difficult to recognize the existence of such relationship. This difficulty makes professionals hesitate to introduce the construction of such relationship into practices and its importance tends to be a mere idea. The point at this issue was raised in a form of practitioner's dilemma through the experience of practice. It requires us to explain the nature of the relationship between professionals and people under which people begin to take actions towards the health improvement at community level. Experiences in social development activities recommend that professionals assess and share the community problems with people on equal terms, where professionals confirm equality by taking such an attitude like 'learn from people' or 'evaluate the peoples' ability properly'. Findings from community health researches say that such relationship organizes community to meet with health issues close to daily life, which is defined as community empowerment. Summarizing above, community health professionals can promote health at community by means of constructing a relationship with people. Such relationship builds bridges between people's usual world and professional's scientific one, which make community health issues solvable at daily life level to empower people.