Recently Health Information Exchange (HIE) has been gradually spreading in Japan. In this study, the effect against the hospital management of the HIE named the Ajisai-net of Nagasaki prefecture in Japan was evaluated through investigations of both the number of the first visit patients and hospitalized patients. The first visit is classified into three types. The first type is the reserved first visit bringing the introduction letters, 2nd type is the non-reserved first visit bringing the introduction letters and 3rd type is non-reserved first visit not bringing the introduction letters. The total number of hospitalized patients was 12,237/32,398 (37.8%) on the first type, 8,764/ 24,549 (35.7%) on the second type and 1,277/7,167 (17.8%) on the third type, and there were significantly differences among 3 types. (p <0.01) The number of hospitalized patients of the reserved new patients bringing the introduction letters who had been registered to the Ajisai-net was 1,008/2,201(45.8%), significantly more than the number of hospitalized patients of any other 3 types of the first visit patients. (p<0.01) The number of the first visit patients registered to the Ajisai-net was also significantly more than that are not registered to the Ajisai-net. (p<0.01) The increase of the number of the new patients and newly hospitalized patients is the most important factor of the high hospital income in Japan. In conclusion, Japanese type of HIE has a positive effect of the Hospital management was showed in this study.

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Purpose: This study examined the factors related to the overall satisfaction level of older people treated at home, regarding medical and welfare services in their area of residence. Method: The survey targeted older people who reported using the services at a day rehabilitation center in Nagasaki Prefecture. The survey investigated the individuals’ backgrounds of, including their age, sex, period of long-term care insurance use, living environment, details and anxiety. It also indicated, through a self-rate system, the extent of information sharing among medical personnel and long-term care workers. The Japanese version of the Client Satisfaction Questionnaire 8-item version (CSQ-8J) was used to measure their level of satisfaction with medical and long-term care services. Results: Data from 205 people were analyzed, which included 73 men (35.6%) and 132 women (64.4%). The mean age was 81.2 ± 7.6(mean±standard deviation) years, the mean period of long-term care insurance was 38.1 ± 38.2 months, and the mean CSQ-8J score was 24.8 ± 5.7 points. The results of the multiple regression analysis (backward stepwise method) showed that only the item “information on illness and treatment is shared among medical personnel and long-term care workers” was significantly associated with the CSQ-8J score (p = 0.007). The results suggest the need to determine the details of the information regarding illness and treatment that should be shared among concerned parties.

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This study aimed to identify associations between daily lifestyle characteristics and latent depressive symptoms in young children by analyzing self-reported questionnaire data. In 2011, in Nagasaki Japan, a cross-sectional survey of 1961 children aged between 10 and 12 years was conducted. Children answered questionnaires that collected demographic information, along with daily lifestyle characteristics, and were administered the Birleson Depression Self-Rating Scale for Children (DSRSC-J). The mean age of the participants was 10.98 years (±0.83 standard deviation [SD]) with a mean DSRSC-J raw score of 11.61 (±6.34 SD). In total, 24.7% of participants reported depressive symptoms. A multiple logistic regression analysis revealed that depressive symptoms were associated with female gender (odds ratio [OR]:1.86; 95% CI: 1.48–2.33), experiencing growth (OR: 1.25; 1.07-1.44), a bedtime later than 11 pm (OR: 1.25; 1.01-1.66), skipping breakfast (OR: 1.55; 1.15-2.10), and not having a set dinner time (OR: 1.65; 1.32–2.07). Conversely, absence of depressive symptoms was associated with involvement in school-related athletic clubs (OR: 0.60, 95% Cl: 0.48–0.76) and at home studying for at least one hour per day (OR: 0.67, 95% Cl: 0.54–0.84). Depressive symptoms in young children were associated with social contact and their parent’s lifestyles. Non-experts in the field of mental health who interact with young children should carefully note the presence of factors associated with depressive symptoms as this would help children with latent depressive symptoms receive prompt and timely care.

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Anastomotic leakage is a severe complication of esophagectomy. Development of an enterocutaneous fistula after anastomotic leakage often occurs after subcutaneous-route reconstruction at esophagectomy. Pectoralis myocutaneous flap (PMCF) repair has recently been performed when an enterocutaneous fistula was refractory to conservative treatment. However, this procedure requires a conspicuous incision and results in deformity of the breast especially in female patient. We performed pectoralis muscle flap (PMF) repair for a 50-year-old woman with a refractory enterocutaneous fistula after salvage esophagectomy. We made an oblique incision along the inframammary crease in order to avoid a conspicuous scar and moved the PMF under the mammary gland to the site of anastomosis. This method was effective for repairing a refractory enterocutaneous fistula, with especially good aesthetic results in a female patient.

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Revascularization surgery is established for both ischemic and hemorrhagic moyamoya disease (MMD), although hemorrhagic complication is a serious problem especially in adult MMD patients showing postoperative hyperperfusion. Herein, we present an extremely rare case with pediatric MMD showing intraventricular hemorrhage the day following direct bypass surgery, possibly due to a breakdown of the terminal branch of well-developed perforators working as moyamoya vessels. Clinicians should consider this rare complication after bypass surgery for MMD regardless of preoperative hemodynamics or patient age.

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