Objectives : To investigate the prevalence of rubella HI antibody among pregnant women in relation to changes in the recommended age for rubella-containing vaccination.
Methods : A total of 659 primiparous women were included in this study. All subjects were ≥20 years old at the time of delivery in our hospital during the 5-year period from January 2008 to December 2012. Rubella HI antibody titers were measured. Subjects were divided into four groups according to their date of birth and retrospectively analyzed : i) single-dose mass vaccination in junior high school generation ; ii) “interim measures generation” ; iii) single-dose vaccination in infancy generation ; and iv) infancy plus catch-up MR two-dose vaccination generation. HI antibody titers ≤1 : 16 was defined as a low antibody titer.
Results : The percentage of cases with low antibody titers in the total study population was 20.2%. The percentages of cases with low antibody titers in each group were : i) 20.4%, ii) 18.2%, iii) 30.6%, and iv) 31.6%.
Conclusion : The percentage of low antibody titers among all cases was comparable to other reports. The results suggested that rubella seroprevalence was low among those in the generation including and subsequent to the single-dose vaccination in infancy generation.

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Purpose : This study examined the effects of a self-efficacy improvement program (SE improvement PGM) on the care given by family caregivers for behavioral and psychological symptoms of dementia (BPSD).
Methods : A total of 57 caregivers were studied. Twenty five were placed in the control group (CG) and 32 in the intervention group (IG). A program consisting of information on dementia, interaction with other caregivers, and relaxation techniques was provided to both groups. The IG was also provided the SE improvement PGM. The primary outcome studied was degree of self-efficacy, while the appearance of BPSD and sense of burden, depressive moods, and knowledge regarding dementia were assessed as secondary outcomes.. The effects of the program were examined using questionnaires, such as the Japanese version of the revised scale for caregiving self-efficacy (J-RSCSE), Neuropsychiatric Inventory-Brief Questionnaire Form (NPI-Q), Zarit Caregiver Burden Interview (J-ZBI_8Y), Geriatric Depression Scale short version (GDS5), and Alzheimer Disease of Knowledge Scale (J-ADKS), which the subjects answered at pre- and, post-program, and at two-months (2M) post-program.
Results : The SE-Responding to Disruptive Patient Behaviors (SE-RDPB) scores for the J-RSCSE subscale was significantly improved in the IG as compared to the CG at pre- and 2M-post-program (difference of scores ; 9.9±17.8, p<.001). Analysis of covariance using age, gender, and degree of autonomy, as covariates, showed that the SE-RDPB scores of the IG were significantly improved compared with those of the CG (F=6.15, p=.02).
Conclusion : SE improvement PGM significantly improves the self-efficacy of dementia caregivers, especially, in the context of SE-RDPB.

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[in Japanese]

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Family medicine is a relatively new and rapidly growing discipline in Japan. Nevertheless, for family medicine to achieve recognition as a unique medical discipline in Japan, family medicine must develop its own research agenda and appropriate research methods. However, existing literature in Japanese for guiding the design of family medicine research is scarce. This paper introduces strategies for identifying research questions that emerge from clinical “stories” and connects them with appropriate research designs. This paper provides examples of major categories of research designs including those using a single method and mixed-methods designs that take advantage of the strengths of both qualitative and quantitative methods. A solid research foundation in family medicine needs to be established that preserves the unique attributes of this generalist discipline. Family medicine researchers are needed who can lead research teams to address the complex research questions emanating from primary care clinical practice.

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Uncertainty and complexity remains prevalent throughout the practice of medicine. Primary care physicians often experience uncertainty and complexity in their practice because they encounter the wide variety of patients. Coping with uncertainty and complexity is one of the important competence of a physician, and it is one of the attributes of medical professionalism. Tackling uncertainty and complexity is a strong learning chance for physicians and it makes them grow. Using Cynefin framework and good doctor-patient communication with shared decision making are effective strategies for handling medical uncertainty and complexity.

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Introduction : This study examines the feasibility of providing end-of-life care at a residential aged care facility using advance patient directives from the perspective of the non-medical facility staff.
Methods : Efforts were made by the facility staff to obtain advanced patient directives (APD) from 240 residents. Compliance by staff and residents in documentation of APDs for cardiopulmonary arrest (CPA) was examined.
Results : APDs were obtained from 204 residents (85%) and all responded to questions regarding end-of-life care in the facility without resuscitation or emergency transfer, indicating their autonomous wishes. Of the 204 respondents, 196 indicated preferences for both resuscitation and emergency transfer, 62% of which indicated preference for no resuscitation and no emergency transfer. No statistical differences were noted based on age, sex, or diagnoses. Fourteen residents died eight (58%) of whom received end-of-life care in the facility.
Conclusion : Non-medical staff can effectively document resident's wishes using APDs addressing clinical deterioration and CPA.

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Objective : To investigate end-of-life care at the Department of General Medicine of Saku Central Hospital (DGSCH).
Methods : A retrospective survey of medical records of patients who died at DGSCH in 2011.
Results : 101 patients died in that year. The average age was 85.2, and 73% patients lived in Saku city. The main causes of death were pneumonia (30%), cancer (20%) and senility (20%). Cardiopulmonary resuscitation was performed in 4% of patients. Total parenteral nutrition was performed in 8% and tube feeding therapy was performed in 12%.
Conclusion : Patients who died at DGSCH were elderly patients who lived near the hospital, and most died without invasive medical procedures.

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[in Japanese]

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[in Japanese]

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