Objectives : To study the impact of a seated posture without back support on the level of alertness, as determined on the basis of autonomic nervous system and cerebral functions, while considering the effects of fingertip pressure, and a lack thereof, during the posture.
Methods : Twenty healthy adult female subjects were studied from October to November 2007, inclusive. Their autonomic nervous system and cerebral functions were measured in a resting supine position and in a seated posture without back support.
Results : The subjects' mean age was 25.8 ± 4.1 years. Compared to the resting supine position, the seated posture without back support yielded higher values for electroencephalographic β-wave content, heart rate, and diastolic blood pressure, but a lower value for parasympathetic nervous activity. Fingertip pressure, and the lack thereof, had no significant effect on the seated posture without back support with respect to any of the indices.
Conclusion : These results suggest that a seated posture without back support is effective in increasing the level of alertness associated with autonomic nervous system and cerebral functions. The comparison of pressure on the fingertips, and the absence thereof, in a seated posture without back support (with the palms facing downward) revealed no difference in the level of alertness associated with cerebral or autonomic nervous system functions, respectively.

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Purpose : The objective of this qualitative study was to clarify rewarding and positive aspects of comprehensive community care practices by clinic nurses.
Methods : Semi-structured interviews were conducted for six nurses who had been working for more than five years at community-based clinics in the surrounding areas of Tokyo. Responses were analyzed using the Modified Grounded Theory Approach proposed by Kinoshita. Concept diagrams were drawn from the themes.
Results : Nurses regarded the integrated care of individual patients, their family and community as meaningful and rewarding because they were able to provide truly holistic care. They were also satisfied with “value of individual experiences of nurses”, “frontier spirit of community nurses providing pathless integrated care”, “appropriate work-life balance”, “independent position in the clinic” and “community-based team approach including medicine, health and welfare”.
Conclusion : Nurses felt easier providing their psychosocial intervention in a community-based clinic as part of a medical system. Nurses obtained rewards by using their holistic care ability. Since nurses and family physicians have similar perspectives with respect to patient-centered care, some nurses felt conflicts with their physicians, because patient-centeredness is not the only strength of such nurses.

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Introduction : While the number of women physicians is increasing in Japan, there is a tendency for these physicians to leave the workforce during their child-rearing years, contributing to an overall physician shortage. In order to create effective policies to ameliorate these shortages, it is important to assess women medical students' views on their careers after marriage and the factors that lead to a low motivation for continuation of their careers..
Methods : From 2010 to 2012, we conducted questionnaire surveys using visual analog scale (VAS) based and multiple choice questions on medical students at the University of Tokushima regarding these issues in women physicians. We analyzed the results of questions included in each of these three-year surveys for women medical students in the first, third and sixth year and men in their sixth year..
Results : VAS results for “intention to continue career after marriage” showed shorter measurements in sixth year women (median 86.5mm, interquartile range (IQR) 64-97mm) compared to sixth year men (median 98mm, IQR 92.5-100mm) (p<0.001). Sixth year women with a VAS of 75mm or under for “intention to continue career” showed less “interest in a medical career” than those with a VAS of 80mm or greater (median 79.5mm (IQR 64.5-88.5) vs. 90.5mm (IQR 82-100)) (p=0.001). All student groups analyzed indicated that a “sense of purpose” was the most important factor in their future careers.
Conclusion : Lower VAS levels for “the intention to continue career after marriage” were related to a lower level for “interest in a medical career” in women medical students, which has implications for education and guidance in the undergraduate years.

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Introduction : The purpose of this study was to clarify the effectiveness of a home exercise (HE) program for hemophilic patients.
Methods : An intervention study was conducted over twelve weeks for patients aged 16 to 60 years, inclusive. Exercise guidance to assist in the improvement of their knee function was provided to the patients. Using questionnaires and assessments of physical function, we measured the physical condition of the patients before and after HE. Guidance about the strengthening of knee extensor muscles, static stretching of knee flexor muscles and standing balance training, as well as advice for the promotion of physical activities, was provided on an individualized basis. Muscle force and range of motion of the knee, modified Functional Reach (mFRT), 10 meter walking time, and 3 minute gait distance were all measured. All patients were surveyed for bleeding frequency, activities of daily living (ADL), and health related quality of life (HRQOL : SF-36), respectively.
Results : Twenty-two patients with an average age of 37.2 years, were included in the analysis, with 86.4% of them having a history of severe of hemophilia (coagulation factor level <0.01 IU mL−1). There were significant improvements in strength of knee extensor and range of extension of the knees, mFRT, 10 meter gait time, 3 minute gait distance, ADL, and physical function of SF 36. There was a significant correlation between Ex for locomotive activities and change of 3 minute gait distance. No increase in bleeding frequency was noted.
Conclusion : HE for hemophilic patients is useful for the improvement of muscle force and range extension of the knees, mFRT, gait speed, and ADL. Individualised guidance for improvement of physical activities and knee function is necessary for improvement of overall physical function.

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Introduction : Indicators were identified concerning the long-term view of support in disaster.
Methods : The author gathered information from two community healthcare nurses and an administrative manager from Shichigahama Town, Miyagi Prefecture, in May 2013
Results : Appropriate information was successfully gathered leading to a greater understanding of the town inhabitants. As a result, this provided the author with sufficient data to understand citizen-based town planning for future administrative services.
Conclusion : The staff of local government offices require added support in addition to the local citizens. The mutual understanding and cooperation with such citizens, can help to prevent confusion during times of disaster.

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