[in Japanese]

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In recent years, the number of graduates from medical school who become pediatricians has decreased in Japan. Consequently, there are not enough pediatricians seeing children who visit hospital after office hours. Since pediatricians in ex-national sanatorium like our hospital are required to see these patients, we started a 24 hour-acceptance system for pediatric patients involving four pediatricians and eight non-pediatric doctors (generalists) from December, 2004. In this system, pediatricians are on call when generalists are on night duty. We compared the number of children who visited hospital after office hours before and after the system started. The number was 47.5+/-13.5 (mean+/-SD) per month from January to August in 2004, and it increased significantly to 144.8+/-40.4 per one month from January to August in 2005 (p=0.0117). However, the number of patients who were seen by generalists did not increase significantly (21.3+/-29.5 v. s. 29.5+/-9.15, p=0.1083). The number of patients who were admitted to the hospital did not increase significantly, also. The increase in the number of children on Sundays, Saturdays and holidays was significant. One pharmacist and one nurse were added to support this system. In response to announcing this system to the community, the press reported that the citizens were feeling secure because of the start of the system. Another effect of starting the system has been that the number of children who visit hospital during opening hours has increased, which is profitable to the hospital. In addition, for not only pediatricians but also generalists and nurses, there was an apparent effect to recover medical skills to see pediatric patients, which had been limited in a conventional national sanatorium. One year after we started this system, all pediatricians, including us in Tsugaru community with a population of approximately 400, 000, established a 24-hr medical-care system for children, and we have to be involved in the system for several days a month. Although this was another burden to our pediatricians, they did not oppose working for the system. In conclusion, it was helpful for the reinvigoration of the activity of the hospital to be enthusiastic about meeting regional medical needs such as acceptance of pediatric patients visiting hospital after office hours.

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[in Japanese]

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Based on the report about the factors causing falls of elderly persons, the National Oshima Seisho-en Sanatorium has been working to prevent such falls in daily life settings since 2003. It was expected that compared to elderly persons in the general population, Hansen's disease patients would need some special fall prevention measures due to the multiple disorders peculiar to Hansen's disease. Therefore, the purpose of this research was to clarify the factors causing falls in relation to the aftereffects of Hansen's disease etc. Based on case reports of falls at 13 Hansen's disease sanatoriums throughout Japan between 2003 and 2005, and through the analysis of factors causing falls at the National Oshima Seisho-en Sanatorium, a study was conducted on the factors causing falls of Hansen's disease patients.
As a result, we have found that even though the situation is such that patients in Hansen's disease facilities have more factors causing falls compared to elderly persons in the general population with a disability, the rates of falls of the respective groups in the same generation are about the same. Further, in regard to the bone fracture rate of persons who fell, a lower rate is shown for patients in Hansen's disease facilities compared to stay-home elderly persons and nursing-home residents. This indicates the possibility that living environment improvement such as promoting barrier-free spaces reduces the bone fracture rate of persons who fall.
According to the research on environmental factors, more falls happen mainly in living spaces and surrounding activity areas. Also, more falls are induced by movements such as changing locations, getting on a vehicle, and trying to reach something. In addition, falls happen most frequently during a person's main activity time. This report was consistent with the previous report and no results peculiar to Hansen's disease patients have been shown. Further, as was seen in the previous report, the analysis of physical factors shows that deterioration of physical capability in terms of changing locations and getting on a vehicle contributes to fall incidence and the deterioration of intellectual function may affect a person's ability to avoid the risk of a fall and to ensure safety.
Meanwhile, a significant relation has been shown in the meal activities which are highly related to upper limb functions. This indicates the relation between fall incidence and deterioration of upper limb function of Hansen's disease patients due to deformation, amputation, and paralysis of hands and fingers.

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The methods and results of the recruitment of subjects in the pilot study to elucidate the factors that would influence the cognitive and behavioral development of children in Japan were reported in this manuscript.
The hospital-based recruitment of 160 subjects was accomplished in this sukusuku-cohort in Mie. An introductory explanation of the research contents was given at the time of birth and an informed consent was obtained at the time of the medical examination two or four weeks after birth. Two hundred and three consents were obtained in the recruitment process of this pilot study and there were 14 cancellations that were mainly from the group recruited from outside the hospital. Almost all the subjects resided in the suburbs of the hospital where observation was carried out.
The recruitment rate prior to the start of observation of the pilot study was as low as 30.5%, however, this rate rose to 51.2% after observation was started. The rate of retention of subjects was 98.5%. A full illustration of the observation, an introduction about the medical examination or vaccination which has no influence on the results of research, a regular approach with an invitation letter for observation, the preparation of a homelike atmosphere in the observation room, an appropriate schedule of observation with no waiting time, and a letter of thanks after observation, can positively influence this rate.
On the other hand, prompt public relations, methods and timing of interpretation of research contents, and ways to collect informed consents became the subjects to be investigated in the longitudinal research recruitment from outside the hospital Owase recruitment.
Establishment of a relationship of mutual trust was thought to be the most important factor for the retention of subjects.

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Medical Supply Information Management Office was spun off from the office of the Department of Pharmacy in May 2005. Since then, its restructuring has been promoted through consolidating and organizing large volumes of medical supply information so as to conduct its operation efficiently and smoothly. There were eight items as subjects to be addressed, and we focused our efforts most intensively on construction of a medical supply information provision system. This system utilizes the intranet which was already available at the Department of Pharmacy. In order for pharmacists to further advance their activities as a team medical service member, it was thought that a system for sharing medical supply information collected and stored at the Medical Supply Information Management Office would be necessary. In this light, ways were devised to facilitate information dispatch to pharmacists on a steady basis.
We thought that this system, through centralization of medical supply information management, would enable improvement of pharmacists' work functionality level in their hospital activities and would contribute to medical-examination support which was the biggest aim of this project. Moreover, it appears that by using this system the amount of redundant work operations in the Department of Pharmacy decreased, and thus contributed to rationalization of operations to a certain degree.

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