Background: Physician shortage affects mortality at the city level in Japan. The medical administrative district (MAD) covering the area (town, city, etc.) in which the patients live and is the unit responsible for recruiting doctors. The number of physicians or changes in this number in each MAD varies. The relationship between the number, or the change in number, of physicians and the mortality in each MAD has been unclear.
Methods: We designed a descriptive study using publicly-available national statistics. In all 358 MADs in Japan, we analyzed the relationship between the changes in the number of physicians (total, clinic, and hospital) from 2000 to 2005 and the standardized mortality ratio (all causes of death, cancer, heart disease, and stroke).
Results: In MADs, the number of physicians and mortality are not related, nor are changes in number of physicians and mortality. Further investigation including factors associated with mortality is needed.
Conclusion: In MAD, there is no relationship between the number of physician and the mortality, between the change in number of physician and the mortality. Further investigation is needed including factors associated with mortality.

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Introduction: This study explored the significance of the treatment of severely disabled stroke patients hospitalized in a convalescent rehabilitation ward, as documented through the narratives of these patients' families.
Methods: The wives of two inpatients who needed assistance in almost all activities of daily living and who were in a convalescent rehabilitation ward, participated in this study. Semi-structured interviews were carried out with two wives about how they viewed their experience during hospitalization and discharge. Interviews were recorded with their permission and transcribed verbatim. Significant expressions in these two transcripts were selected, coded, compared constantly and generate relevant categories.
Results: Narratives fell into three categories: recognition of patient disabilities, hope for recovery, and goal-setting and decision of destination at discharge. These categories are characterized by changing towards discharge influenced by description of the condition from doctors or information gathered from media or acquaintances.
Conclusion: Families of severely disabled patients seek meaning of their experiences through narratives which unfolded deeply and intensively. Assisting these processes is an essential role of convalescent rehabilitation wards. If these assistances are achieved successfully, convalescent rehabilitation wards can contribute to meaning of life of patients and families after discharge.

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Introduction: This study aims to clarify the relationship between the mental condition of elderly persons in residential facilities and their willingness to accept the help of volunteers offering conversation and companionship.This study is intended to help to provide appropriate and effective volunteers in residential facilities.
Methods: A total of 56 elderly persons residing in residential facilities and their care staff were investigated for a year from 2008. The Kruskal-Wallis test was performed, using the GDS-15 score as the independent variable and the “willingness to accept volunteer companions” as the dependent variable. Mann-Whitney’ s U-test was performed, using the evaluation of Karasawa's “Clinical criteria for grading dementia” as the independent variable and “willingness to accept volunteer companions” as the dependent variable.
Results: The association between depression and the willingness to accept volunteers revealed low degrees of willingness in both the normal group and the depression group, but significantly greater willingness in the “predisposed toward depression” group.Meanwhile, a comparison of the normal group and the dementia group showed no significant difference.
Conclusions: This study suggested that the willingness of elderly patients in whom clinical depression has been diagnosed to accept the help of volunteers is markedly low, but those at levels up to “tendency toward depression” respond in conversation and interaction with volunteers.

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Introduction: Epidemiologic evidence on childhood vaccination is scarce in Japan. Our aim was to investigate the vaccination completion rate and risk factors of incomplete vaccination.
Methods:This study was a secondary analysis of the database developed for a childhood infection study of 2368 attendants of 18-month health checkups in one city in Japan. The data of vaccination history included bacillus Calmette-Guérin, diphtheria-pertussis-tetanus, measles-rubella, and polio. A total of 1622 children were included in analyses after 746 were excluded because a large portion of their data was missing, and because their birthweight was <2500 g or their gestational age, <37 weeks.
Results:The overall vaccine completion rate was 79.3%. The factors significantly associated with incomplete vaccination by multivariate logistic analysis were two or more children living together, child care attendance, parents’ smoking habits and absence of exclusive breastfeeding at 4-month health checkups. As the number of risk factors for hospital admission due to infections increased, the vaccine completion rate tended to decrease.
Conclusion:Families with children who attend child care facilities and with two or more other children should be provided with more information regarding vaccination and positive health behaviors in general.

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 The annual suicide rate in the town of Kumakogen (population 100,000), in Ehime Prefecture, is 67.7-very high in a country whose average suicide rate is 24.4, and in a prefecture with a rate of 27.1. Recognizing that it is important to reduce the suicide rate, we decided to initiate suicide prevention measures in 2007. We considered that cooperation with local doctors was the most important approach to take because Kumakogen had no psychiatrists. We obtained the cooperation of the Medical Association of the nearby town of Kamiukena, the Ehime Body and Mental Health Center, and the Matsuyama Public Health Center, and began the primary, secondary, and tertiary prevention procedures. Through this activity, the medical, nursing, welfare, and administration networks for the anti-suicide campaign have been established.

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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