The difference between Japan and other countries, in particular the United Kingdom, in views regarding the teaching of geriatrics to undergraduate medical students.

OBJECTIVES: To examine differences in views on geriatrics education at the undergraduate level between Japan and other industrialized countries, including the United Kingdom. DESIGN: We conducted a nationwide survey of professorial staff responsible for undergraduate education in all medical schools in Japan, and an international survey of 37 medical schools and geriatric institutes in other industrialized countries, including 16 medical schools in the United Kingdom. RESULTS: The results indicate that undergraduate education in geriatrics in Japan emphasizes the theoretical aspects of the aging process and the features of diseases in the elderly, and lacks attention to the practical aspects of care. In contrast, geriatrics education in the United Kingdom and other countries places emphasis on practical aspects of the care of the elderly. CONCLUSIONS: The introduction of practical aspects of management and care of the elderly to the undergraduate education programme in geriatrics in each medical school in Japan is strongly recommended. This is especially important to meet the needs of the rapid demographic shift towards an older population in this country.

[University education in geriatrics--present status and future prospects of gerontology and geriatrics education in pathology].

The increase in the number and proportion of the elderly in Japan over the last 30 years has been faster than that in any other country. One of the measures we are compelled to take to deal with this drastic change in medicosocial circumstances is reform of the medical school curriculum. However, the necessary reforms are being implemented slowly and are still insufficient. We surveyed the present status of gerontology and geriatrics education in pathology, and the understanding, interest, and opinions on this matter among professors of pathology. Questionnaires were sent to 148 professors of pathology in 80 medical schools. Responses were received from 84 professors (57%) at 64 medical schools (80%). Of the 11 medical schools with a department of geriatrics 10(90%) included gerontology in the curriculum. In contrast, 43(80%) of the 53 remaining schools did not include gerontology in the curriculum, although education in geriatrics and gerontology has been given as part of pathology lectures in almost all medical schools. Many professors want to establish a department of geriatrics in their school, but feel it will be difficult because of lack of money and higher priority given to other fields. As other hindrances, most of the respondents noted the lack of money and higher priority given to other fields. As other hindrances, most of the respondents noted the lack of a good textbook of gerontology, ambiguity in the concept of the field, and the immaturity of gerontology as a science. Another major problem noted was uncertainty regarding the status of geriatrics as a clinical specialty. One professor mentioned that promotion of aging research would be the best way to solve these problems.

Brain angiotensin II tonically modulates sympathetic baroreflex in rabbit ventrolateral medulla.

The role of endogenous angiotensin II (ANG II) at the level of the rostral (RVLM) and caudal ventrolateral medulla (CVLM) in the control of sympathetic baroreflex function was investigated in urethan-anesthetized rabbits. The baroreflex relationship between mean arterial pressure and integrated renal sympathetic nerve activity (RSNA) was compared before and during microinfusion of saralasin, an ANG II receptor antagonist into RVLM or CVLM. The infusion of saralasin (20 pmol/min) into RVLM reduced the upper plateau, the range, and the range-dependent gain of the baroreflex, as well as the resting level of RSNA. The infusion of saralasin into CVLM augmented the upper plateau, the reflex range, and the range-dependent gain, whereas it did not alter the resting level of RSNA or mean arterial pressure. These results suggest that 1) the ANG II networks in RVLM are tonically active, influencing the resting level of the sympathetic outflow and facilitating the sympathetic baroreflex function, and 2) the ANG II networks in CVLM do not significantly influence the sympathetic activity in the resting state but exert an inhibitory effect on the baroreflex response when arterial pressure falls below the resting level.

[Undergraduate teaching of geriatric medicine in western countries--literature review].

To help plan for the future of undergraduate education in geriatric medicine in Japan, we reviewed the literature concerning undergraduate teaching of geriatric medicine in western countries. Undergraduate teaching in geriatric medicine in the UK is well developed: 22 of 25 universities have a full department of geriatric medicine. Training in geriatric medicine is mandatory in almost all universities. In contrast, geriatric medicine is an elective in most universities in the US. There is a shortage of geriatric medicine faculty in the US, which is similar to the situation in Japan. Clinical and basic research in geriatric medicine and gerontology should be encouraged to attract persons into this field.

[University education in geriatrics: medical students' understandings of gerontology and geriatric medicine].

With the rapid aging of Japan's population, medical professionals who specialize in geriatric medicine are in unprecedented demand. To meet that demand and to improve the curriculum for teaching geriatric medicine and gerontology in Japan, we surveyed medical students' understandings of these specialties. Students at 14 schools with classes in geriatric medicine and gerontology were surveyed. A questionnaire was sent to sixth-year medical students after their classes had ended. Questionnaires were collected from 849 students (60.1%) at ten medical schools (74.1%). One quarter (24.5%) of the students were satisfied with the contents of the classes in geriatric medicine and gerontology taught in their school, whereas 39.4% were not. These specialties encompass many fields of clinical and basic medicine, and many students found the lectures difficult to understand (41.4%). Inter-school comparisons of the results showed that students' strengths and weaknesses in the various areas of geriatric medicine reflected differences in the contents of the classes among the schools. Only 35.4% of students had ever visited hospitals or other health-related facilities for the elderly. Many students (58.8%) had never lived with elderly people. Most students (63.9%) wanted visits to health-care facilities for the elderly to be included in their regular curriculum. Medical students are conscious of the medical implications of the ageing of Japan's population; 13.2% had volunteered to work with the elderly.

[University education in geriatrics: medical student's opinions on gerontology and geriatric medicine].

With the aging of Japan's population, physicians need to be aware of advances in geriatric medicine. To assess the status of geriatric medicine in undergraduate education, we surveyed of medical student's opinions on gerontology and geriatric medicine. A questionnaire was sent to six-year medical students at a total of 20 schools that did not include geriatric medicine in their curriculum. Responses were obtained from 950 students (47.6%) at 16 schools (80%). Almost half of the students (42%) had experiences in health care facilities for the elderly. Ten percent were content with their education in geriatric medicine education and 59% were not. A total of 41.4% felt that geriatric medicine is difficult because it involves many different subjects. Some students had experience as volunteers working with elderly people; they were aware of the aging of Japan's population, and felt that their training in basic geriatrics and in geriatric diseases was insufficient. A total of 56% agreed that all medical schools should have classes in geriatric medicine and 14% did not. Medical students in the schools without classes in geriatric medicine identified dementia (73%), cerebral vascular accidents (51%), cancer (24%) and osteoporosis (19%) as common in elderly people, with no differences between schools. The corresponding data for medical students in schools with classes in geriatric medicine were dementia (77%), cerebral vascular accidents (44%), osteoporosis (29%), and cancer (16%). Undergraduate medical students seem to be exposed to widely differing curricula with regard to geriatric medicine. We found a lack of uniformity in the teaching of gerontology and geriatric medicine to undergraduate medical students in Japan.

[University education in geriatrics. Present status and future plans of universities regarding the development of a program in geriatrics].

Because the number of people who reach an advanced age has been increasing at an unprecedented rate in Japan, geriatricians are expected to play a central role in health care for the elderly. However, only 16 out of 80 medical schools (20 percent) now have departments of geriatrics for undergraduate education. To develop undergraduate education in the field of geriatrics, a survey was sponsored by the Research Projects on Aging and Health (Health Science Research Grant the Ministry of Health and Welfare of Japan). A questionnaire regarding the present status and future plans of the university about a program in geriatrics, was sent to deans of medical faculties or vice-presidents of medical schools. The questionnaire included questions about current status and future plans regarding undergraduate geriatric education, the presence of a department or clinic of geriatrics, educational requirements in the field of geriatrics, opportunities for practice, institutions of practice, research on geriatrics, and other suggestions. The response rate was 93.7 percent (74/79). Departments or clinics of geriatrics had been established in 15 institutions (20.3 percent) and were planned in 18 (24.3 percent). Undergraduate education in geriatrics was considered necessary in 73 schools (98.7 percent) and indispensable as an obligatory subject in 56 (75.7 percent). Clinical practice was considered more important and effective than lectures in 50 schools (63.3 percent). Coordinated lectures on basic biomedical gerontology (such as mechanism of aging) and geriatric medicine for chronic degenerative diseases such as senile dementia were considered essential to the curriculum. In practicing geriatrics, experience in providing medical care to aged patients as well as social support and a welfare system for the aged is emphasized. Institutions, nursing homes, and geriatric hospitals outside medical schools be easily accessible. It was generally agreed that geriatrics should be taught in advanced classes. In conclusion, medical schools in Japan regard undergraduate education in geriatrics as necessary and agree on the optimal curriculum, but it is not universally implemented.

[University education in geriatrics. Opinions of teaching staff on undergraduate education in gerontology and geriatric medicine].

Undergraduate education in gerontology and geriatric medicine has become more important because of a progressive increase in the aged population. To assess curricula in geriatric medicine and to survey the opinions of teaching staffs as to the ideal curriculum, a questionnaire was sent to professors of gerontology and geriatric medicine at 14 medical schools. Responses were obtained from all 14 professors. In all medical schools, students are given lectures in the fifth or sixth year, or both. The total number of hours for the lectures varied from a few hours to 40 hours, and contents of the lectures varied between schools. Medical staffs pointed out that little time is allocated to geriatric medicine. They also emphasized the importance of bedside teaching.

Procaine microinjection into the lower midbrain increases brown fat and body temperatures in anesthetized rats.

A tonic inhibitory mechanism on heat production was studied by microinjecting procaine into various regions of the brain while recording temperature changes of the interscapular brown adipose tissue (IBAT) and rectum in urethane-anesthetized rats at room temperature of 23-25 degrees C. Procaine microinjected bilaterally (10%, 1.0 mu l/site, 1.5 mm to midline) into the midbrain and the upper- to mid-pontine area of the reticular formation increased temperatures of the IBAT and rectum. The highest temperature rise (1.02 +/- 0.11 degrees C for IBAT, 0.64 +/- 0.06 degrees C for rectum) with the shortest onset latency (1.5 +/- 0.3 min for IBAT, 4.6 +/- 1.1 min for rectum) was observed when procaine was injected into the lower midbrain (the area between 6 and 7 mm posterior to the bregma, and 6.5 to 8.5 mm deep from the cortical surface). These regions include the retrorubral field, pedunculopontine tegmental nucleus, and rubrospinal tract. Procaine-induced IBAT and rectal temperature increases were dose-dependent, and reproduced reliably from the same injection site of the same animal. Intravenous indomethacin, a prostaglandin H synthase inhibitor, did not affect procaine-induced temperature rise, and propranolol, a beta-blocker, completely blocked it. These results suggest that microinjected procaine exerts its local anesthetic effect and release a tonic inhibition resulting in a disinhibition-induced temperature increase through the enhanced central sympathetic outflow. They support the hypothesis that a bilateral tonic inhibitory mechanism on heat production exists in the lower midbrain.

Usefulness of R-R interval and its variability in evaluation of thermal comfort.

The use of R-R interval and the coefficient of variation in R-R intervals (CVR-R) for the evaluation of thermal comfort was investigated. The experiments were carried out with ten male subjects but data from one were excluded from the analysis. Thermal sensation, comfort, and tolerance of environmental conditions were reported and mean skin temperature, R-R interval and CVR-R were monitored during a 3 h period in a climatic chamber with the operative temperature set at 26, 20, or 30 degrees C. Relative humidity was maintained at ca. 50% in each case. At the operative temperature of 20 degrees C, the mean skin temperature was significantly lower, the cold sensation was significantly more intense, and discomfort was significantly greater than at 26 degrees C and R-R interval was increased significantly. Seven of the nine subjects were unable to tolerate this thermal environment. The R-R interval and CVR-R were increased in five and four of those seven subjects, respectively. At the operative temperature of 30 degrees C, the mean skin temperature was significantly higher, and the sensation of warmth was significantly more intense than at 26 degrees C. Seven of the nine subjects felt discomfort, and four of the seven reported an inability to tolerate this thermal environment. The R-R interval and CVR-R were decreased in four and three of these four subjects, respectively. At the operative temperature of 20 degrees C CVR-R was significantly greater than that at 30 degrees C.(ABSTRACT TRUNCATED AT 250 WORDS)

What roles does the organum vasculosum laminae terminalis play in fever in rabbits?

Experiments were designed to clarify the role of the brain's organum vasculosum laminae terminalis (OVLT) in the development of fever in rabbits. Rectal and ear skin temperatures were recorded in conscious animals in which the OVLT had been electrolytically destroyed or in which the preoptic anterior hypothalamus (PO/AH) had been transected bilaterally. When the OVLT had been ablated the febrile responses to intravenous injection of interleukin-1 beta (IL-1 beta) or tumour necrosis factor alpha were significantly attenuated, while those to intracerebroventricular injection of IL-1 beta were not affected. Fever induced by intracerebroventricular injection of prostaglandin E2 (PGE2) was prolonged significantly. The febrile responses to intravenous injection of IL-1 beta and to intracerebroventricular injection of PGE2 were attenuated when the transection was located caudally to the anterior wall of the third ventricle and extended laterally more than about 3 mm in the ventricular wall. The results show that the OVLT region is a site through which signals to increase body temperature are transferred from the blood to the brain in rabbits.

Does interleukin-1 mediate tumour necrosis factor alpha-induced fever in rabbits?

We investigated the humoral mechanisms involved in tumour necrosis factor alpha (TNF alpha)-induced fever in rabbits. No change in lymphocyte-activating factor activity was detected in serum drawn during TNF alpha-induced fever. The pyrogenic activity of recombinant rabbit interleukin-1 beta (IL-1 beta) was entirely abolished by pre-incubation with anti-IL-1 beta antiserum from the goat. Fever induced by intravenous (i.v.) injection of IL-1 beta was significantly diminished by i.v. infusion of the antiserum. However, i.v. infusion of the antiserum for 1 h did not affect fever induced by i.v. injection of TNF alpha, when the antiserum infusion began either simultaneously with, or 2 h after, the injection of TNF alpha. Furthermore, intracerebroventricular injection of the anti-serum did not affect TNF alpha-induced fever. The intracerebroventricular administration of naloxone (an opioid receptor antagonist) significantly diminished TNF alpha-induced fever. The results suggest that IL-1, both in the blood circulation and in the brain, may not be involved in TNF alpha-induced fever. Similar to the contribution of eicosanoids, the opioid system in the brain seems somehow to contribute to the mechanism of the development of fever induced by TNF alpha in rabbits.

Intraperitoneal injection of 1-oleoyl-2-docosahexaenoyl phosphatidylcholine enhances discriminatory shock avoidance learning in rats.

Effects of injection of 1-oleoyl-2-docosahexaenoyl-sn-glycero-3-phosphorylcholine (ODHPC) on learning ability were investigated in rats using discriminatory shock avoidance learning task. When ODHPC (2 mumol) was intraperitonealy administered 5 min before the beginning of the first trial of learning task from the second to fifth sessions, avoiding rates of the ODHPC-injected group were significantly higher than those of the control group. However, any injection of ODHPC derivatives, such as 1-oleoyl-2-docosahexaenoyl-diacylglycerol, 1,2-dioleoyl-sn-glycero-3-phosphorylcholine, glycerophosphorylcholine, docosahexaenoate, oleate and choline chloride, did not affect learning. These results suggest that intraperitoneal ODHPC injection enhances learning ability by its specific conformation.

Effects of halothane and enflurane on the peripheral vasoconstriction and shivering induced by internal body cooling in rabbits.

General anesthetic agents have central and peripheral effects on body temperature regulation, and its alterations are related to the depth of anesthesia. To evaluate the effect of halothane and enflurane on thermoregulation, we investigated the threshold of body core temperatures to induce peripheral vasoconstriction and shivering in spontaneously breathing rabbits. Rabbits were anesthetized with halothane or enflurane at 0.0 (control), 0.2, and 0.4 MAC (minimum alveolar concentration). Internal whole body cooling was performed by perfusion with cold water (10°C) through a U-shaped intestinal thermode placed in the colon. Core (esophageal) and peripheral (ear skin)_temperatures were measured with thermistor probes. The esophageal temperatures at the beginning of peripheral vasoconstriction and shivering induced by internal whole body cooling were determined. Core temperature threshold values for peripheral vasoconstriction were significantly higher than those for shivering in both groups. The incidence of peripheral vasoconstriction was not significantly affected by halothane or enflurane. However, the incidence of shivering decreased in a dose-dependent fashion with both anesthetic agents. At 0.2 MAC, the incidence of shivering in the enflurane group was significantly higher than that in the halothane group, suggesting that suppression of shivering by halothane is stronger than enflurane.

1-Oleoyl-2-docosahexaenoyl phosphatidylcholine increased paradoxical sleep in F344 rats.

The effects of administration of 1-oleoyl-2-docosahexaenoyl-sn-glycero-3-phosphorylcholine (O-DH-PC), a kind of lecithin, and of glycerophosphorylcholine (GPC) on sleep were investigated in male F344 rats. Intracerebroventricular administration of O-DH-PC at a dose of 10 micrograms/rat induced significant increase in paradoxical sleep time and total sleep time in the following 24 h, while administration of GPC did not. Results suggest that O-DH-PC affects on neuronal mechanism relating to paradoxical sleep, and that the effect of O-DH-PC might be caused by fatty acid residues, rather than choline residue.

A new infrared tympanic thermometer in surgery and anesthesia.

We have evaluated a new infrared tympanic thermometer, IT-10, as an intraoperative temperature monitor in patients with or without open abdominal surgery. It determines temperature by measuring infrared radiation given off by a warm object. Temperatures measured with this device were closely correlated with those measured with rectal and bladder thermometries. We conclude that this new tympanic thermometer is safe, convenient, accurate, and easily usable in the clinical situation.

Comparison of TRH and its analog (NS-3) in thermoregulatory and cardiovascular effects.

The effects of TRH and its metabolically stable analog NS-3 [(3R,6R)-6-methyl-5-oxo-3-thiomorpholinylcarbonyl-L-histidyl-L-pro linamide tetrahydrate] on thermoregulation and circulatory control have been investigated. Both NS-3 (1-100 ng/kg ICV) and TRH (0.1-10 micrograms/kg ICV) increased rectal temperature and metabolic rate with a transient cutaneous vasoconstriction in conscious rabbits. They also increased arterial blood pressure, heart rate, respiratory rate, and renal sympathetic nerve activity (RSNA) in urethane-anesthetized rabbits. Ten ng/kg of NS-3 and 10 micrograms/kg of TRH had comparable hyperthermic, pressor, and tachycardic activities, while the relative potency of NS-3 to increase RSNA was greater and that to increase metabolic rate was smaller than the other effects. In conclusion, NS-3 was more potent than TRH in all of the effects measured, but there was a dissociation in the relative potency of NS-3 in the different autonomic effects.

[Effect of halothane on the peripheral cutaneous vasoconstriction and shivering induced by internal body cooling in rabbits].

Although suppression of thermoregulatory mechanisms by anesthetics is generally assumed, the extent to which thermoregulatory responses are active during general anesthesia is not known. To evaluate the effect of anesthetics on thermoregulation, we investigated the threshold body core temperatures to induce peripheral cutaneous vasoconstriction and shivering in spontaneously breathing rabbits. Rabbits are anesthetized with halothane at 0.05, 0.2 and 0.4 MAC (minimum alveolar concentration). Internal whole body cooling was performed by perfusing the cool water through an intestinal U-shaped thermode placed in the colon. Core (esophagus) and peripheral (ear) temperatures were measured with thermistors. The esophageal temperatures at the beginning of peripheral cutaneous vasoconstriction and shivering induced by internal whole body cooling were determined. Peripheral cutaneous vasoconstriction was not significantly affected by halothane. However, the incidence of shivering was significantly decreased by halothane dose-dependently. Threshold of shivering (37.3 +/- 0.8 degrees C) was significantly lower than that of peripheral cutaneous vasoconstriction (38.9 +/- 1.1 degrees C). We conclude that the halothane can exert an influence on shivering.

Hypothermia enhances contractile responses of the guinea pig taenia caeci to acetylcholine, 5-hydroxytryptamine, caffeine and calcium.

Isometric contraction of isolated guinea-pig taenia caeci was induced with acetylcholine (ACh) and 5-hydroxytryptamine (5-HT) at 37 and 30 degrees C to investigate the effect of hypothermia on the response of smooth muscle to neurotransmitters. Lowering the temperature increased the amplitude of contraction in response to 10(-6) M ACh. Contraction in response to 10(-6) M 5-HT was also greater at 30 degrees C. 5-HT-contraction was not inhibited by atropine, but was inhibited by ketanserin. Calcium-contraction was also induced in an isosmotic high potassium solution. The amplitude of the contraction elicited by 5 x 10(-3) M Ca was significantly greater at 30 degrees C, and was inhibited by verapamil. The amplitude of the contractile response to 5 x 10(-3) M caffeine was also greater at 30 degrees C than at 37 degrees C. The finding that both calcium- and caffeine-contraction were enhanced at low temperature raises the possibility that intracellular calcium participate in cold-induced enhancement of contraction.