Background: Rapid and accurate diagnosis is essential for containing the novel influenza A/H1N1 pandemic. Polymerase chain reaction (PCR) testing is an accurate diagnostic method, but it is not routinely available worldwide. We herein evaluated the usefulness of pharyngeal “influenza follicles” in diagnosing seasonal influenza and influenza A/2009 (H1N1) pdm.
Methods: Between August 3 and October 29, 2009, we evaluated 87 patients with influenza-like symptoms. Twenty-three had influenza follicles (22 on initial evaluation; 1 on follow-up) while 64 did not. Considering these two groups, we then compared the positive cases using rapid diagnostic testing (confirmed by PCR). In addition, 419 cases of seasonal influenza diagnosed between 2003 and 2009 were examined for the presence of influenza follicles based on Miyamoto's 2007 definition⁹, and new exclusion criteria were developed.
Results: Among the 23 patients with influenza follicles, 21 were diagnosed with novel influenza. Of these, follicles were present on initial evaluation in 20 and on follow-up in 1. None of the 64 patients without influenza follicles were diagnosed with influenza (sensitivity 100%, specificity 97%). Among the 419 patients diagnosed with seasonal influenza between 2003 and 2009, influenza follicles occurred in all type A/H3N2, A/H1N1, and B cases (sensitivity 95.46%, specificity 98.42%). Thus, follicles were considered a specific sign of influenza.
Conclusion: Influenza follicles occur in both seasonal and novel influenza. This identification method has higher diagnostic sensitivity and specificity than rapid diagnostic testing and is a promising clinical tool for diagnosing influenza when PCR is unavailable, or in pandemic situations.

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BACKGROUND: Home-visit guidance has the advantage of assisting child-raising while respecting an individual's lifestyle; however, there are many people who refuse it at present due to individual and family privacy concerns. In addition, such medical services involve individual and financial constraints; thus, the beneficial effects of the service should be clearly presented.
METHODS: During postnatal weeks 16-20, questionnaires were sent by researchers to a group that received home-visit services during postnatal weeks 2-12 to investigate their levels of satisfaction with the services. A different questionnaire was sent to those that did not receive home visits to investigate the reasons for their rejection of the services.
RESULTS: Home-visit services were highly evaluated by those mothers who received them, especially for primiparas to reduce anxiety about and improve confidence in child-raising. Also, a significant difference was observed between the “home-visit” and the “no home-visit” groups when asked, “How much are you willing to pay for home-visit guidance?” Among the “no-home visit” group, mothers who stated less than 1,000 yen and “free of charge” (59.7%) accounted for 75.8% and among the home-visit group, mothers who stated less than 1,000 yen and “free of charge” (26.0%) accounted for 50.9%, and 35.5% of mothers stated from 1,000 to 3,000 yen.
CONCLUSIONS: The level of satisfaction of mothers who received home-visits and the reasons for not receiving visits were investigated. Two problems identified were that information about this program is not provided to all mothers and the timing of home-visits does not meet the needs of mothers.

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Background: To determine whether nutrition is associated with rehabilitation outcome in the disuse syndrome.
Methods: A retrospective cohort study was performed in 223 inpatients admitted to a university hospital who were diagnosed by physicians in the rehabilitation department as having the disuse syndrome, and subsequently prescribed physical therapy. Malnutrition was defined as a body mass index<18.5 kg/m², hemoglobin level<10.0 g/dl, serum albumin level<3.0 g/dl, or total lymphocyte count<1200 cells/mm³. Rehabilitation outcome was defined as whether or not the ADL score improved during rehabilitation. Nutritional status was assessed at referral using the Onodera's prognostic nutritional index (PNI).
Results: The study cohort included 136 men and 87 women (mean age 67.5 years; median duration between admission and referral 17 days; median rehabilitation duration 32 days). A total of 202 patients (91%) were defined as being malnourished. Mean PNI was 32.9, with the ADL score improving in 135 patients (61%) during rehabilitation. Rehabilitation outcome was better in patients with normal nutrition compared to malnourished patients (relative risk: 0.72, p=0.04). Patients with a hemoglobin level>10.0 g/dl (relative risk: 0.69, p=0.001), total lymphocyte count>1200 cells/mm³ (relative risk: 0.78, p=0.03), or PNI>35.0 (relative risk: 0.74, p=0.01) had a better rehabilitation outcome. Logistic regression analysis showed that hemoglobin level was associated independently with rehabilitation outcome (odds ratio 2.34, p=0.005).
Conclusions: Malnutrition is common in patients with the disuse syndrome. Patients with low hemoglobin level and PNI at referral are more likely to have a poor rehabilitation outcome.

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Objective: The present study examined the status of the provision of drug information to hypertensive patients at community-based pharmacies by evaluating patients' satisfaction, understanding, and wishes.
Design: A cross-sectional study was conducted by surveying patients using a self-administered questionnaire.
Methods: Three items were evaluated: 1) the level of patient satisfaction with provision of drug information; 2) the level of patient understanding of information provided on antihypertensive drugs; and, 3) patient wishes regarding provision of drug information.
Results: The level of satisfaction with provision of drug information was high (86.6%). Although patients were found to understand the precautions for use of antihypertensive drugs, their understanding of drug efficacy was insufficient. Also, patients wished to receive more explanation from pharmacists regarding the efficacy of drugs in addition to explanations of associated adverse reactions or precautions for use of the drugs.
Conclusions: Hypertensive patients were highly satisfied with the provision of drug information at community-based pharmacies, but did not show sufficient understanding of the efficacy of antihypertensive drugs, an issue to be addressed in the future by pharmacists in their instructions to patients on the use of drugs.

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Acute food impaction of the esophagus is a medical emergency caused by an ingested foreign body. Since the most common obstructing bolus is poorly chewed meat (often following beer drinking), it is often called “steakhouse syndrome” or “backyard barbecue syndrome.” ¹ In this article we present a typical case of this relatively unknown syndrome. Written permission was obtained from the patient for publication.

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Delayed hemothorax following blunt chest trauma is classified as a late presentation of hemothorax after a nearly normal chest X-ray on admission. Here, we present a case of delayed hemothorax 5 days after blunt chest trauma with ribs and sternal fracture.

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