​ Thanks to the CAMPUS ASIA program, I could have the opportunity to learn and have academic experiences at Osaka University even though the corona pandemic is not completely over yet. I got assigned at the Department of Environmental Medicine and Population sciences, which was a place I had hoped for from the beginning when I applicated for this program. The reason I wanted to learn in Osaka University was firstly I wanted to acquire academic knowledge about cohort researches of cardiovascular diseases and lots of lifestyle related diseases in Japan, and secondly I wanted to gain clinical experiences of managing elderlies in local nursing homes of Japan that I cannot experience in Korea. Looking back after three weeks of practice, I was able to achieve all of this, and also I could listen to a lot of lectures about various researches, and could see what Japanese occupational environment doctors do closely. The schedule of 3 weeks consisted of 2 weeks of common schedule of all 15 students, and 1 week of laboratory practice at each departments that students were assigned.

 Our schedule in the department consisted mainly of listening to lectures of professors or graduate students of this lab who conducted cohort studies on the relationship between lifestyle habits and disease incidence in Japanese population. On Tuesday, we visited a factory where professor Tomotaka Sobue has been conducting health checkups for a long time.

 The research lecture we took on the first day was conducted by Ms. Michico, who works for Janssen Pharmaceutical Company in Tokyo, but she said that it has not been published yet. It was about Renal carcinoma incidence and Fish consumption of Japanese population. The conclusion was that high fish consumption group had higher risk of RCC onset, but it was contrary to the previous studies done in Western countries. It may be because of the high absolute amount of Japanese fish consumption, and the fact that population studies must consider the characteristics of that area was interesting to me.

 I could also learn about the JPHC study, which is a large cohort that was started in 1990 and 1993 in collaboration with 11 health care centers in Japan nationwide. It was conducted to determine what lifestyle habits are relevant to the incidence of diseases, by collecting information about lifestyle habits from approximately 100,000 people living in various parts of Japan, and performing a long-term follow-up of over 10 years regarding the development of their diseases. 

 The study on the second day was also a cohort study of the association between asbestos exposure and mesothelioma development. I had learned this before in 2nd grade of medical school, but the process of actually proving it through a cohort study was interesting. In 2005, residents and workers near a kubota factory that handles asbestos in the city of amagasaki, Japan, suffered a mass outbreak of pleural mesothelioma, so it was emerged as a public issue. Several studies have already been done but because of the long latency of mesothelioma, which is more than 30 years, new research was needed and thats why this study was conducted.

 On the 3rd day, we learned about occupational medicine of Japan from Dr. Sobue. I could learn that Japan, like Korea, regularly conducts health checkups at work and has established a screening system for cancer and metabolic diseases for workers.

 The next day, we visited a real industrial company called DIJET with professor Sobue and observed how the health examination was conducted. This company makes various instruments with carbide, and while touring the factory, we were able to learn and observe the actual manufacturing process in detail, which was also a very interesting experience.

 In particular, the health checkup process was impressive. I had never seen a checkup done at a real workplace even in Korea, and it was interesting that he recorded the values on paper rather than data stored on the Internet. The checkup routinely included height and weight, blood and urine analysis, questionnaires and surveys about symptoms, and a brief physical examination. He said the most important thing was whether he felt the symptoms or not. And if a specific value (ex. aceton in urine) is high, that woker is called separately to check whether there is a history of diabetes or whether the mask was properly worn during worktime.

 On the 5th day, we learned about Japan's cancer control program, and the impressive part to me was that the cancer screening rate of Japan is low compared to other oecd countries, but the survival rate is high. It is true that Japan has a high level of medical care, but this result was a bit questionable to me. Professor said that the HPV vaccination rate in Japan is not as high as in Korea, but the cervical cancer survival rate was also very high. His opinion was that the cancer registry in Japan is not complete enough yet and datas are fragmented.  However in 2016, the Japanese national cancer registry was officially started, though it is still yet challenging to assess the effectiveness of cancer screening.

 The study lecture on the last day was about comparing lung cancer survival rates in Korea, Japan, Taiwan and the United States. The reason why Japan’s survival rate is high is thought to be due to the high CT scan rate of Japan, and the reason of low rate of USA, other factors were expected to contribute such as eating habits or genetic factors. The second lecture on the last day was about JPHC gastric cancer and vitamin consumptions by Ms. Paramita from Indonesia. The reason why she started to conduct studies of gastric cancer was interesting. She said that Indonesian people also have high H.pylori rate like Korea, but the incidence of gastric cancer in Indonesia is very low. She told us that she saw only one case of gastric cancer during her residence training in Indonesian hospital, so she came to Eastasian countries to learn more about gastric cancer.

 This is what I learned throughout Campus Asia program, especially by the labworks on the second week. I learned how JPHC based cohort researches are conducted, and since there are no unified personal codes in Japan unlike Korea, it was little bit harder to conduct cohort studies in Japan compared to Korea. Also, I could learn what medical doctors can do other than making clinical treatment inside the hospital, and that there are many opportunities open to study at foreign hospitals. Moreover, I could see that occupational medicine is an essential part in industrial companies by looking up close and visiting a real factory.

 And on the 3rd week when the common schedule was held, it was really fun and I was able to build a lot of precious memories with my classmates and the assistants of CAMPUS Asia program. The most fun memory is when we all gathered at local park in the morning and did some gymnastics with elderlies and doctors. I could see that as Japan is an aging society, doctors and the society is paying a lot of attention to the quality of life and health exercises of the elderlies. We also visited the Suita Tsugumodai local nursing home, and had the experience of digging seeds with the elderlies who were undergoing rehabilitation for their own reasons, such as after suffering from stroke or Alzheimer Diseases. After that we could cook and eat them with cookies and cream cheese, which had a really good taste. 

 ​After 3 weeks of precious experience, I thought of what I would like to research more in the future. Since I have learned a lot about disease and related lifestyle factors, I also want to conduct cohort researches based on Korean population. I have written a case report about SLE patient last year, so I had interest in SLE, which is a chronic, systemic autoimmune disease with a broad spectrum of clinical manifestations. The etiology of SLE is not precisely verified yet, but these factors: environmental, genetic, epigenetic, and hormonal factors, are thought to contribute to SLE onset and generating autoantibodies against nuclear antigens and accumulating immune complex in multiple organs and tissues of human body. 

 I had taken part in the study of SLE pathogenesis and microRNA dysregulation a few years ago, which is about the epigenetic effects on SLE. But after this week experiencing in our department, I wanted to conduct study about SLE development in the aspect of environment factors, which are mostly Lifestyle factors. So I searched studies about Dietary habits, or lifestyle factors related to SLE. Tehere was a study held in Japan many years ago, which was also based on JPHC. 20 yrs ago, Japanese people’s vitamin C consumption was inversely associated with SLE disease activity. Also, there were many researches recently held in European countries about dietary factors, and fatty acids, calloric restriction, vitamin D were possible risk factors of SLE. Since Asians are known to have low prevalence and high severity of SLE compared to Caucasians, I thought if this cohort study is held in Korea or only Asian countries limitedly, it would be more helpful information to us. Moreover, it would be worthwhile to add datas about relationship with alcohol consumption since Korean people have high alcohol consumption.

 The experience I gained at Osaka University through the 3-week Campus Asia program was so invaluable and precious. I enjoyed so lot and I will never forget this time. In addition to the academic goals I achieved, I was also able to experience Japanese culture by traveling to many famous places nearby Osaka during weekends and after lectures, and also improve my Japanese language skills. I have always enjoyed traveling to Japan in the past, but through this experience, I could get to like Japan even more and I think I will seriously think about becoming a doctor in Japan in the future. ​

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