Purpose : The purpose of this study was to examine quantitative activity and determine characteristics using an activity meter in community-dwelling frail elderly people.
Methods : We monitored 25 community-dwelling elderly of support-requiring condition level1 and 2 by attaching activity monitoring evaluation system (A-MES) and measured physical activity (PA) over 24 hours as well as body information, care information, everyday life function.
We examined according to sex / care category using obtained results.
Results : Women's standing position time and walk time were significantly longer, and men's daytime lying position and sitting position time were significantly longer.
Also, in persons of support-required condition level 2 there was a significantly higher number of posture changes from sitting position to daytime lying position.
It was suggested that a quantitative evaluation of the PA could lead to discovery of activity decrease in home life in association with each PA item and low rank criteria of the functional independence measure (FIM).
Securing of enough walk time and shortening of the lying position time in the daytime tend to be important for self-care ability and maintenance of locomotiveness.
Conclusion : It was suggested that the evaluation of shortening the lying position time in the daytime and increasing the amount of position changes will supplement a decrease of the PA, which is related to preventing decrease in activity.

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Introduction : To reveal patients' impressions of physicians working short-term in community clinics, and to explore methods for physicians to work short-term in community clinics.
Methods : We conducted a qualitative analysis of recordings of individual interviews performed on patients in community clinics using a partially revised SCAT (Steps for Coding and Theorization) method.
Results : Patients indicated that they felt reassured by the constant presence of a chief physician at community clinics. They expected care within the scope of primary care, but were not expecting every element within this scope to be met. Patients had the attitude of accepting the current situation and were selecting how to receive medical care from the available options based on their personal priorities.
Conclusion : Physicians working short-term in community clinics were satisfying a portion of the patients' needs. Providing care within the scope of primary care and taking the initiative in getting to know patients are essential elements for physicians working short-term in community clinics.

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Introduction : In recent years, aging of the population and the low birth rate are progressing rapidly in China, resulting in an increase in the number of elderly individuals engaged in the long-term care of an elderly family member (Jap. “Ro-ro kaigo”). We conducted a cross-sectional study to evaluate the current Ro-ro kaigo situation and the factors related to the quality of life of the caregivers in two ethnic groups : Han Chinese and Korean Chinese.
Methods : Fifty-one Korean Chinese households and sixty-one Han Chinese households (≥60 years old) in Changchun or Yanji of Jilin Province, China, participated. The quality of life of the caregivers was measured using the SF-8 health survey questionnaire. We conducted a multiple regression analysis to investigate the factors related to the caregivers' quality of life.
Results : There was no significant difference in gender ratio and caregiver age between the two ethnic groups. In both groups, a spouse was often the cargiver. Factors related to the caregivers' quality of physical life were as follows. For the Korean Chinese : the caregivers' subjective feeling of health, and the number of the caregivers' diseases ; for the Han Chinese : the caregivers' subjective feeling of health, the care period, and the frequency of participation in community activities. Factors related to the caregivers' quality of the mental life were as follows. For the Korean Chinese : the frequency of consultation for nursing-care problems ; for the Han Chinese : the care-recipients' educational history, and having assistance on ceremonial occasions.
Conclusion : The results suggest that good health is important to maintain the quality of physical life of elderly caregivers in both ethnic groups. As factors related to the physical and mental summary scores differed by ethnicity, support for the caregivers that considers their ethnic background is necessary.

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Introduction : Catheter which strays in the ascending lumbar vein during femoral vein catheterization can cause complications such as retroperitoneal hematoma. However, not much is known of this phenomenon.
Methods : We retrospectively studied 107 patients who had indwelling femoral vein catheter in our hospital between March 2013 and April 2011.
Results : The catheter went straying in the ascending lumbar vein 11/110 times (10.0%) , 5/34 times (14.7%) on the left side, and 6/76 times (7.9%) on the right side. The possibility of the catheter straying was maximum when the catheter was displaced laterally or raised sharply towards the caudal side, as seen through abdominal radiographic examination.
Conclusion : Femoral central venous catheter misplacement in the ascending lumbar veins is fairly common. Tests such as additional abdominal CT or radiographs should be conducted if misplacement is suspected.

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Purpose : To seek opinions of medical doctors regarding self-management of assessed personal problems in health information records (SAPPHIRE) by patients themselves.
Methods : Ten-item questionnaires regarding SAPPHIRE were sent to each of two groups of medical doctors, using regular mail for A) doctors of private clinics, and hand-delivered to B) doctors working in a large hospital.
Results : Of the responding 292 medical doctors, 72.9% were in favor of using SAPPHIRE. More medical doctors of private clinics indicated preference for recording and assessment by a medical doctor (47.4%) than doctors working in a large hospital (25.2%). On average, responding medical doctors answered that problem lists could be recorded by co-medical staff (44.1%), but in the end, need to be created with the trustworthy assessment of a medical doctor (79.7%).
Conclusion : More than 70% of medical doctors responded in favor of using SAPPHIRE. Patients' reliable problem lists could be recorded by co-medical staff or a medical doctor, but need to be created with the trustworthy assessment of a medical doctor.

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Introduction : To grasp what kind of problems exists in order to solve the shortage of pathologists, we conducted a survey with special focus on the condition of facilities with single pathologists. We also considered whether the use of virtual slide technology is a viable option in mitigating the shortage of pathologists.
Methods : The survey was conducted at the 58th Autumn Annual Meeting of the Japanese Society of Pathology using questionnaires. Interviews were also obtained with pathologists who use virtual slides
Results : The percentage of facilities with single pathologists was approximately 30%, and these facilities had the highest rates of using virtual slides for remote pathology consultations. Regardless of the number of pathologist at a facility, outside consultation was often obtained with difficult cases. Although pathologists working alone expressed anxiety over diagnosing cancer, consulting other facilities appeared to be difficult.
Conclusion : In order to reduce the anxiety of pathologists working alone and to raise the accuracy of cancer diagnoses, a mechanism by which pathologists can consult each other is required. Developing a network for pathologists for such consultations using virtual slides is felt to be important in primary care.

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Object : Through understanding feelings of residents in the face of the large-scale rationalization of medical resources and their views about the new system of community medicine, we clarify how we should streamline community medicine along the opinion of residents living in local areas.
Methods : We interviewed some residents in the face of the economic collapse in X city. Through the interviews, we qualitatively analyzed their feelings that they had concerning the large-scale rationalization of medical resources and their views about community medicine in the future.
Results : We found three common themes with regard to how to streamline community medicine along the residents' opinions : the way of the rationalization of medical resources, the state of community medicine, and the attitude of the municipal government and medical institutions.
Conclusion : To carry out streamlining community medicine, it is important for the municipal government and medical institutions to take account of residents' opinions more seriously in the process and the content of the rationalization of medical resources, and to understand the social background of the community and residents' feelings more deeply.

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Introduction : Recommendations from healthcare providers are considered by vaccinees and their parents when they decide whether to receive an immunization. However, in Japan, the attitudes of primary care physicians toward vaccination are unknown. We assessed some practices and recommendations of, and barriers to, primary care physicians regarding vaccinations in Japan.
Methods : A self-administered questionnaire was mailed (in 2012) to 3000 randomly selected physician-members of the Japan Primary Care Association. Excluded were physicians within two years after graduation, living abroad or retired. We described respondent practices, recommendations, and barriers to the provision of routine and voluntary vaccinations.
Results : The overall response rate was 25.8%. The rates at which physicians gave routine and voluntary vaccines in their own practices were 29.0-91.4% and 15.2-89.5%, respectively. The vaccine recommendation rates for routine and voluntary vaccines were 58.2-70.2% and 14.1-50.9%, respectively. The physicians reported that their barriers to recommendation of routine vaccines were vaccination schedule complexity (32.9%), opinions of vaccinees and parents (28.9%), and vaccine safety (27.7%). They also reported that perceived vaccine safety (62.1%), lack of understanding of vaccine-preventable diseases (55.7%), and complexity of vaccine schedules (44.4%) were reasons given by vaccinees and parents for noncompliance. Physicians' barriers to recommendation of voluntary vaccines were cost (45.3%), safety (35.1%), and lack of information (30.1%). They reported that vaccinees and parents expressed concern about cost (61.8%), safety (51.8%), and lack of vaccine information (50.7%).
Conclusion : We clarified practices, recommendations, and barriers to primary care physicians regarding routine and voluntary vaccination in Japan.

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Introduction : We investigated the effects of skin stimulation with noninvasive microcones on constipation in university students.
Methods : 17 university students with constipation were studied. Students were randomly assigned to either Group S (n=9) that received skin stimulation of the auricle using microcones, or Group P (n=8) that were given placebo treatment. Both groups received 4 weeks of treatment.
Results : There were no significant differences in the mean baseline CAS-J (Japanese Version of Constipation Assessment Scale) values between the two groups. After 4 weeks, subjects in Group S had significantly lower CAS-J values compared with baseline (P=0.02). No significant changes were noted in the values for Group P.
Conclusion : These results suggested that skin stimulation with noninvasive microcones improved constipation in university students, and may be a viable option for self-care of this condition.

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[in Japanese]

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The mortality rate in Japan due to life-threatening illnesses is predicted to increase rapidly. Delivering appropriate care for people with terminal illness is an important, but largely neglected, role of the health care system in many countries. Recently, the concept of “Primary Palliative Care” has been proposed internationally, and is commonly used as a generic term regarding the activities of primary care physicians and home care nursing services. The tasks of primary palliative care include : 1) caring for people with life-threatening illnesses ; 2) contributing a palliative care approach early in the disease process ; 3) embracing all dimensions of care, including physical, psychological, social, and spiritual ; and 4) providing end-of-life care in the community. By building a system of primary palliative care that is consistent with our nation's medical system and values, care that meets the individual and familys' needs can be provided in the primary care setting which will further enable us to contribute to the community.

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Three questions were provoked by the case of a young female with acute leukemia who died in spite of allogenic stem cell transplantation : 1)What is responsible for the widespread belief that bodies are like machines that can be repaired scientifically? 2)Is there a perspective enabling us to view humans and disease holistically? 3)How can clinicians deal with the question “Why do I have such a disease?” Descartes's mind-body dualism and reductionism is the origin of the biomedical model regarding the human body as a machine. Though the biopsychosocial model advocated by Engel supplanted the biomedical model, this article proposes a more holistic medical model based on the body-mind-spirit trichotomy and four relationships : “self and others,” “self and the natural environment,” “self and oneself,” and “self and transcender.” These four relationships are modeled here in a “trichotomy-triangular pyramidal model.” We postulate that the true cause of disease may be discordance among these relationships. This model is capable of describing all varieties of healthcare professions, and suggests a future form of a team approach that includes chaplains and complementary/alternative medicine specialists, and may give clinicians a guide to healing the grief of patients who ask, “why me?”

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Introduction : To promote influenza prevention activities, we investigated the current status of prevention strategies for influenza among college students.
Methods : We handed out a questionnaire regarding prevention strategies for influenza to all students who visited at Oita University's Health Science Center for a medical checkup.
Results : Of the 2,752 students surveyed, 2,579 (93.7%) responded. Valid responses were obtained from 2,489 students (response rate 96.5%). Analysis of the questionnaire data revealed that the percentage of the students who received influenza vaccine was 21.0%. The proportion of the male students who received vaccine was significantly lower than that of female students (19.1% vs 23.7%). Regarding to the daily prevention habits, 71.7% of the students were able to carry out hand-washing, while less than half of the students carried out gargling, wearing a facemask and avoiding crowds. The proportion of the students who carried out daily prevention habits was significantly lower in non-vaccinated students than in vaccinated groups.
Conclusion : These results suggest that promotion of educational activities about prevention strategies for influenza at university is needed. Among them, promotion of vaccination for male students and daily prevention habits for non-vaccinated students are important.

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[in Japanese]

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