Introduction : Although recent evidence suggests that regular consumption of soybean is useful for preferable bone health, the optimal amounts of soybean needed are not yet clear. This cross-sectional study attempts to propose the optimal amount for postmenopausal women to prevent osteoporosis in consideration of the upper limitation of daily soy isoflavone intake (74mg, corresponding to 52.7-gram soybean) presented by Food Safety Commission of Japan in 2006.
Methods : The 50-year-old or older women whose bone mineral density (BMD) was measured at our clinic were selected. After exclusion of those who have moved on, those who were dead or demented, those who have long history of corticosteroid administration, ex-smokers, inadequate reporter on soybean consumption and excessive soybean eaters, 50 postmenopausal women were eligible in the study. Under the conditions that the hypothetic thresholds for quantity of soybean intake needed are 20, 25 and 30 grams, the correlation between exposure and the rate of sufficient-bone-mineral-density group was investigated respectively.
Results : The bone was healthier significantly in the groups consuming 30 grams or more soybean (p<0.01). The threshold of 20 or 25 grams didn't show a significant bone-sparing effect in the exposure groups.
Conclusion : The optimal amount of daily soybean needed to support bone health is suggested to be 30 grams or more, not exceeding the upper limitation of 52.7 grams.

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Purpose : The purposes of this study were to survey the current living conditions and to analyze the characteristics of work and leisure, and to clarify the association of their life with health-related QOL in temporary housing, Minamisoma.
Methods : This survey was taken in August 2012. The 115 participants were asked as follows.
1. Basic information included in sex, age, employment and economic condition.
2. Living survey related to life.
a) Activities of typical day and hour of use.
b) The listed activities for four areas (work, self-care, leisure and rest).
3. Self-health status (the use of SF-36).
Results : Valid responses were 90 (38 men and 52 women, age 69.9±11.9). The values of SF-36 were significantly lower than the Japanese standard values in almost all subparts. Both sexes classified eating into work. Women classified the many activities offered by volunteers into leisure. Whereas men classified little activities into leisure. The leisure time spent by women less than 50 years old was negatively correlated with the health-related QOL (r=-0.89), while, that by women more than 70 years old was positively correlated with the health-related QOL (r=0.48). In contrast, no correlation between leisure time and health-related QOL was observed in men.
Conclusion : Volunteer's activities to support women more than 70 years old were suggested to be effective. While, those for men should be altered to match the concerns for man's characteristics.

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Introduction : Intravenous rt-PA therapy for acute ischemic stroke patients within 4.5 hours after onset is approved and effective, but is difficult to implement in depopulated areas because of geographical conditions and lack of medical specialists.
Methods : From February 2013 to February 2014, 75 acute ischemic stroke patients were transferred to our hospital, four (5.3%) of which were subjected to the “drip and ship” method of rt-PA infusion using a telemedicine system for emergency medicine (k-support). We examined the time course after onset and the treatment outcome of these four cases
Results : Four cases had rt-PA infusion started in the depopulated area. ln one case, recanalization of occluded vessels was demonstrated resulting in improved clinical symptoms.
Conclusion : The “drip and ship” method of rt-PA infusion using a telemedicine system for emergency medicine (k-support) may be a safe and ideal treatment in depopulated areas.

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Purpose : The purpose of the present study was to examine the relationship between respiratory function and ADL/QOL among community-dwelling elderly requiring support or care.
Methods : The study included 87 elderly aged ≥65 years who were certified to require support (yousienn)or care (youkaigo)level 1-3 and who used day care at a rehabilitation center. We evaluated their respiratory, mental, physical, and swallowing functions. ADL, IADL, and QOL were estimated using a questionnaire. Spearman's rank correlation test and multiple regression analysis were used to examine correlations of the functions with ADL/QOL.
Results : Respiratory, physical, and swallowing functions showed statistically significant correlations with ADL/IADL/QOL. Multiple regression analysis showed that forced expiratory volume in 1 second and swallowing function were related to ADL, IADL, and QOL (SF8body & mental).
Conclusion : ADL and QOL were associated with respiratory function in elderly subjects requiring support or care. Our data suggested that pulmonary rehabilitation to enhance respiratory and swallowing functions in elderly requiring support or care may improve their ADL and QOL.

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Introduction : Selective admission for medically underserved areas (Chiiki-Waku) has been increasing, but qualifications vary. We investigated the current state of these selective admissions to gain a better sense of their nature and to elucidate problems.
Methods : A web-based cross-sectional survey was conducted among 77 medical schools that accepted applications for selective admission for medically underserved areas in 2013.
Results : There were a total of 1305 applicants for 148 slots at 62 universities. We observed 86 admissions at national universities, and 90 admissions through recommendation/ admissions office-based entrance exams. Thirty programs placed restrictions on employment after graduation, 84 required accepting scholarships, 8 required joining a specific organization as a condition in the pledge and 83 placed limits on place of origin of the applicant. Only 13 programs had special curricula for education in community medicine.
Conclusion : In some Chiiki-Waku, problems such as restriction on employment, the obligation to accept scholarships, and other inappropriate conditions were noted. Definition of students from rural backgrounds in Japan differs from the WHO guideline definition. Few programs offer special curricula covering community medicine.

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[in Japanese]

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Quality assessment in primary care is increasingly important, and quality indicators of primary care principles and primary care physicians' tasks are available for policy making and quality improvement in other countries. Patient centeredness is an especially important concept for evaluation of primary care principles, so patient experience surveys using quality assessment tools have been conducted in Europe and the US. On the other hand, similar effective approaches are lacking in Japan. Previous studies have indicated that important primary care principles in Japan are accessibility, comprehensiveness, coordination, longitudinal continuity, interpersonal continuity, community oriented care, and family oriented care. Quality assessment and assurance from multiple aspects should be promoted in the future to improve the quality of primary care in Japan.

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[in Japanese]

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[in Japanese]

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Introduction : Municipal government scholarships for the purpose of support of rural health & medically underserved areas has increased, but repayment exemption conditions of the scholarships vary. We conducted a survey of scholarships to clarify their impact on physician careers.
Methods : A web-based cross-sectional survey was conducted from November 2013 to January 2014 among municipal governments administering scholarships associated with selective medical school admissions for medically underserved areas in 2013.
Results : There were 59 scholarships administered by 42 municipal governments connected with 53 universities. The mode of the total loan amount was 14.4 million yen. Features of the loan agreements were a high repayment interest rate (over 10%) in 70% of the scholarships and a requirement for lump-sum repayment in 41 scholarships. Three programs allowed free choice of residency training for 3 years or more during the obligatory term, while 48 programs did not allow such choice during the entire obligatory term.
Conclusion : Eighty-percent of the scholarship programs do not allow for the minimum 3 years of basic post-graduate training required by specialty training program guidelines. In order to prevent the anticipated reduction in future applicants to these scholarship programs, appropriate interest rates, repayment rules, and allowance for specialty training are required.

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