It is important to improve not only patients' lifestyle but also psychosocial factors for the reduction of their stress and for the treatment of metabolic syndrome and lifestyle-related diseases such as hypertension, diabetes mellitus, cerebrovascular diseases, and ischemic heart diseases caused by eating habits and exercise habits. Moreover, the psychosomatic approach does not limit itself to the lifestyle-related diseases, and is effective for the prevention and treatment of many other diseases. In clinical practice, it is important that early diagnosis and early treatment is to be made for unexpected illnesses of patients admitted with mild symptoms. In addition, if the disease will not recover completely, we are required to delay exacerbation or slow down the progression of the disease. Preventive medicine is actually related to various phases of diseases though it is thought to be different from the treatment of diseases in clinical practice. Preventive medicine is generally divided into three stages: the first stage is prevention of diseases and health promotion, the second stage is early detection and early treatment of diseases and the third stage is prevention of the worsening of diseases. Preventive medicine in a broad sense is also essential in the clinical practice of psycho-somatic medicine.

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The author presented the utility of the psychosomatic approach for treating musculoskeletal disorders and locomotive syndromes, such as osteoarthritis, degenerative spondylosis, osteoporosis, neck-shoulder-arm syndrome, rheumatoid arthritis, and many other disorders of the locomotive organs. The author investigated the patient-physician relationship in the examination room of an orthopedic surgery clinic and coined the term "painful depression" to express the pain and depressive state characterized by agitation and helplessness. The patient had functional somatic syndromes that included fibromyalgia, chronic fatigue syndrome, and irritable bowel, which resulted in the painful depression. The majority of orthopedic surgeons who use only a physical approach can establish a good relationship with their psychosomatic patients, without any suspicion of the psychosomatic factors. This is because the orthopedic surgeon treats the psychosomatic patients for the organic disease, and the psychosomatic patients only intent to undergo physical treatment. Physical examination and treatment by a general practitioner, such as an orthopedist who examines only the body, can become a very good psychosomatic approach for patients with painful depression. When the painful depression persists, a physical symptom such as pain and mental symptom such as depression coexist, and the patient is said to be in a state known as "pain-depression deflation spiral" in which both pain and depression make the patient exhausted. In this state, the patient's mental and physical health deteriorates, and the patient falls into a bad circulation. The prevention of locomotive syndrome is an extremely important health promotion activity. The locomotive syndrome results in deterioration of the exercise function and loss of mental and physical health. Including the psychosomatic approach in the treatment framework of medical departments is very important. This approach will lead to the development of "psychosomatic orthopedics".

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It has been one of the most pressing long-term issues in Japan that prevalence of stress is as high as 60 per cent in both men and women. Moreover, up to 20 per cent of people can hardly take an adequate rest or enough sleep. In addition, the number of people suffering from depression and the other mood disorders in 2008 sharply increased 2.4 times from 1999 to exceed a million. This paper aims to discuss mental ailment prevention, particularly primary and secondary prevention against depression. First of all, to raise an issue of it, I am going to describe some examples and study results such as: (1) primary prevention against depression in the local communities of Akita and Aomori prefecture, which Naoki Watanabe et al. have conducted; (2) 'Mental Health Week (Kokoro no Anzen Shukan)', which Takashi Hosaka et al. have proposed; (3) relation between stressful life events and depression; (4) relation between depression and life-style related diseases such as heart disease, diabetes, hypertension, cerebrovascular disorder etc.; (5) relation between depression and sleep; (6) relation between overwork and suicide, which Nobuo Kuroki et al. have reported; (7) the provision for mental ailments in 'Health 21 (Kenkou Nippon 21)'. Overall, I am going to give an account of the current state and future prospects on mental ailments prevention in Japan.

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This paper examines a mental health care program that has been implemented at a company in the manufacturing industry, from the viewpoint of its effectiveness and practicability as a workplace-based preventive measure. It presents a report on the program conducted with 3882 employees in the fiscal year 2006. For the purpose of screening, two procedures were incorporated into periodic health checkups: a mental health questionnaire and a history-taking by a public health nurse. For case identification, interviews were given by a counselor and examinations by an occupational physician. As a result, 22 employees (0.6%) were newly identified as having mental health disturbances. Preventive interventions such as counseling and environmental control were also conducted for some of those employees who were not identified as suffering from mental health disturbances. An examination of the numbers of clients between 2003 and 2007 shows that, in the two years when screening was conducted at the time of periodic health checkups (i.e., in 2003 and 2006), the company clinic received many more clients than in other years, while the number of clients from routes other than periodic health checkups decreased. This result suggests that a mental health care program utilizing periodic health checkups can be effective for both secondary and primary prevention. Further-more, the program reported in this study was conducted by a small number of occupational health staff members. This practicability should be of importance to many companies that attempt to promote mental health care for their employees.

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The purpose of this study is to clarify the relationship between mobile phone addiction and psycho-behavioral factors among high school students. Six hundred and fifty seven high school students replied to scales about the mobile phone addiction and stress response. Results indicate that a high degree of mobile phone addiction is related to high stress responses in high school students. It was disclosed that these stress responses were aggravated by the high degree of mobile phone addiction evoked high dependence against mobile phone use. Furthermore, it was suggested that a high degree of mobile phone addiction caused some kinds of maladjusted behaviors. Mobile phone is a useful tool for high school students. However, it is possible that a high degree of mobile phone addiction evokes various psycho-behavioral aberrations.

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Objectives: To determine the efficacy and safety of low-dose tacrolimus (TAC), a calcinulin inhibitor, in combination with biologics agent to control the signs and symptom of rheumatoid arthritis (RA) in patients with an insufficient clinical response to biologics agent alone. Methods: Nine patients with active RA (mean±SD DAS 28; 5.3±1.3, despite treatment with biologics treatment for more than 3 months, were enrolled and given TAC at a starting dosage of 1mg/day and continued for 30 weeks while administration of biologics agent was continued at the existing stable dosage. All other disease-modifying antirheumatic drugs were discontinued; stable dosage of nonsteroidal anti-inflammatory drugs and oral corticosteroids (<10mg/day prednisone or its equivalent) were allowed. The primary endpoint was the assessment of clinical improvements using the EULAR criteria, and secondary endpoints were assessments of the changes in the modified health assessment questionnaire (mHAQ), depression scale (use the self-rating depression scale; SDS) and adverse events. Results: Administering TAC to biologics agent-refractory RA patients produced significant improvements in the DAS28 after both 14 (DAS28; 5.3 to 3.9) and 30 weeks (to 3.6). In addition, after 30 weeks all patients had respectively achieved moderate (5 of 9 patients; 55.6%) and good responses (4 of 9 patients; 44.4%) in the EULAR improvement criteria. A significant reduction was made in MHAQ and depression scale after 30 weeks (mHAQ; 0.51 to 0.26, SDS; 47.2 to 43.3), while there were no significant differences after 14 weeks in mHAQ and depression scale. Notably, clinical remission of RA was observed in 2 patients after the combination therapy. Adverse events were observed in only 1 patient, who showed common cold. Treatment was not discontinued in all patients. No abnormal laboratory data were seen during the study period. Conclusions: Although a double-blind, controlled study will be required to confirm the efficacy of TAC, the present preliminary study suggests that low-dose TAC in combination with biologics agent is safety and well-tolerated and provides clinical as well as economic benefit.

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