Although malignancy is high rank in the causes of mortality in children, the survival rate of the children with cancer has been improved in last thirty years. Almost 80% of them can be cured. Multimodal therapy including surgery, chemotherapy, radiation therapy and supportive care has been contributed to it. The group studies for pediatric cancer also play significant roles both in clinical trials and research works. Generally, children with cancer are required a long time hospital care more than several months. Total care for sick children and their family are mandatory. The physical, psychological, educational, social and economical supports are provided by the many kinds of specialist of the supporting team. Also, the survivors should be followed for a long term to take measures against the late effects of multimodal therapy.

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Although the diagnostic criteria for eating disorders have been revised gradually to focus on the Diagnostic and Statistical Manual of Mental Disorders, the essential nature of eating disorders has no difference from that described by Bruch H (1978) in her book, "The Golden Cage : The Enigma of Anorexia Nervosa". Patients with eating disorders, especially those with anorexia nervosa are characterized by an obsessive concern regarding body shape, the desire to be thin, related to nutritional problems and conflicts among the family, especially with mother before or after the onset of the disorder, isolation from society, and low self-esteem. Furthermore, such patients have an intense anxiety about being cured. The treatment of eating disorders has been conducted mainly on the outpatient basis. However, if the patient's focus is on nutritional and/or electrolyte problems or the patient wishes to correct his/her eating habits and struggles with his or her desire to be thin, we adopt an integrated inpatient treatment approach comprising nutritional, cognitive behavioral, and family therapy, treatment with psychoactive drugs, and brief psychotherapy. However, we do not impose a strict framework in term of behavior limitation. Tube feeding and hydration is conducted depending on the patient's physical condition, which results in a form of behavior limitation ; however, a detailed analysis of behavior limitation is not undertaken. The aim of hospital treatment is to give the family the assurance that the patient can be responsible for their own eating behavior and to give the patient the confidence that he or she can eat. We tell the patients that nutrition is the source of body and thoughts. Regardless of whether a patient is an outpatient or hospitalized, psychoeducation regarding eating disorders is important and undertaken as during the education we can ascertain the patient's inherent or expressed mood, thinking, and/or behavior. We have adopted a collaborative approach to the treatment of eating disorders.

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Objective : Anorexia nervosa (AN) continues to be a refractory disease because of its unknown pathogenesis. The role of adiponectin in AN has not been clarified. Moreover, few reports have described the relations between adiponectin isoforms and AN in the physical and psychological states. Therefore, we measured plasma adiponectin and its isoforms levels in patients with AN to examine their roles in AN. Methods : Eighteen women participated in this study : nine patients with AN and nine age-matched healthy controls. We examined plasma adiponectin and its isoforms levels in all subjects and administered three types of psychological test to patients with AN : the Eating Disorders Inventory-2, the Maudsley Obsessional-Compulsive Inventory, and the Beck Depression Inventory-2. Results: We found that the percentage of high-molecular-weight (HMW) to total adiponectin (%HMW) was significantly low and the percentage of low-molecular-weight (LMW) to total adiponectin (%LMW) was significantly high in the AN group compared with the control group. The %HMW positively and the %LMW negatively correlated with body mass index in the entire study population. The %HMW was also positively correlated with psychological symptoms such as social insecurity or cleaning evaluated with the Eating Disorders Inventory-2 or the Maudsley Obsessional-Compulsive Inventory. Conclusions: Our study indicates that all adiponectin isoforms should be evaluated in patients with AN in addition to total adiponectin. The decreased %HMW and the increased %LMW that were correlated with the body mass index and some components of psychopathology in our patients may indicate a complex role of adiponectin isoforms in maintaining energy homeostasis and emotion during extreme malnourishment.

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In this paper, we describe a newly developed regimen for the physical and psychological treatment of anorexia nervosa (AN) inpatients at Kyushu University Hospital. Somatic aspects: Both prevention of and treatment for the somatic problems of AN patients who require urgent hospitalization are important. (1) We previously reported that the consumption of energy by patients in a starvation state of BMI>13-14kg/m^2 is by adipolysis and that energy consumption by patients with BMI<13-14kg/m^2 is by protein catabolism. (2) The necessity of urgent hospitalization was associated with the volume of fat free mass, such as muscle, internal organ tissue, and blood. (3) Protein assimilation has priority over fat synthesis when BMI is<12-13kg/m^2. (4) Phosphate-rich beverage (Arginaid^[○!R] intake from the early stage of hospitalization prevents refeeding syndrome in AN patients with BMI<12kg/m^2, even if administered at 30 kcal/kg/day. These findings support the importance of the physical management AN patients with a key BMI of 13kg/m^2. Psychological aspects : AN inpatients are mainly treated with our protocol that we call the "cognitive behavioral approach (CBT) with behavioral limitation." In this integrated approach to the somatic and psychological aspects of AN, the behavioral limitations are lifted step by step as a token for weight gain. In the latter half of our treatment program, we add Naikan therapy for patients who continue to have strong negative feelings about others or who continue to have social and/or family relationship problems. Naikan therapy is combined with CBT to promote introspection. Naikan therapy and "CBT using behavior limitation" are complimentary and promote more effective treatment of AN.

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Home parenteral nutrition (HPN) is a well-established intervention that can sustain life in patients with gastrointestinal failure or cancer. Patients with anorexia nervosa (AN) develop anorexia or binge eating with purging as a stress-coping mechanism that serves to distract them from difficulty or pain. Since it is difficult for AN patients to gain body weight or stop binge eating accompanied by purging, patients with serious AN require repeated hospitalization. The Japanese Ministry of Health, Labor and Welfare has recently promoted home medical care to reduce medical expenses. Although HPN has not commonly been used for AN patients in Japan, we used this approach to treat 7 female AN patients (3 restricting type ; 4 binge-eating/purging type). Mean age at start of HPN and duration of illness were 28.1±4.8 years and 9.7±5.5 years, respectively. Mean body mass index at the start of HPN was 11.4±0.8kg/m^2. All patients had undergone repeated hospitalizations due to life-threatening emaciation without adequate oral feeding, hypokalemia due to self-induced vomiting and uncontrollable renal failure. The criteria for HPN to treat anorexia nervosa in our institution is as follows : severe emaciation to about 55% of ideal body weight, as a recommendation for urgent admission in the guideline for AN from the Survey Committee for Eating Disorders in Japan in 2007 ; life-threatening complications that cannot be resolved without nutritional support or infusion therapy in hospital ; past history of repeated admissions and aggravation of disease after discharge ; unwillingness of the patient to undergo hospitalization ; informed consent for HPN from both the patient and their family ; and cooperation in home nursing care from the family or others living with the patient, a pharmacy, and a regional hospital. During the observation period (range, 13-90 months), all patients were able to keep above the critical low weight or control hypokalemia or renal failure, and quality of life was improved. No patients required re-hospitalization during the study period. Two patients reached their target weights and ended HPN. HPN was also stopped for another patient who sometimes threw away the infusion contents. HPN was suspended for a patient who asked to stop HPN because of marked weight gain. Four patients experienced catheter-related blood stream infection or catheterrupture, and 2 patients showed mild hyperalimentation-induced liver dysfunction. Three patients remain on HPN. In summary, despite its related complications, HPN may offer a useful measure for patients with enduring AN to avoid multiple hospitalizations.

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Background: The etiological model of eating disorders which asserts that inappropriate parenting results in the development of an eating disorder, which this study calls "the familial model," has already received much criticism. Although many Japanese medical professionals usually attempt to explain that the familial model is wrong because of its low scientific probability, the model still has a strong impact on patients with eating disorders and their families in Japan. To explain why many patients employ the familial model to understand their eating disorders in spite of the criticism, this study uses for its theoretical framework not a natural science method but an approach based on the narratives of the illness. Subjects and Method: This study conducted a qualitative interview with an anorexic patient. The interviews were conducted 14 times over a period of 27 months. Since this subject had internalized the familial model, this study analyzed how this internalization had occurred and how the patient interpreted the etiology of her anorexia nervosa. Result: The subject internalized the familial model through medical consultations, professional books about eating disorders, and her parents' attitudes, which drastically changed after her diagnosis. The subject continued to suffer severe anorexia as she faced difficult problems in her life. Indeed, the anorexic condition helped her to escape from these problems. The subject explained that she became anorexic because of inappropriate parenting from her parents who, for instance, expected too much from and exercised excessive control over their children ; therefore, she was only able to explain her psychological pain by starving herself. However, she started to recover from her anorexia after she succeeded in making social relationships outside her family. Conclusion: This study finds that the familial model is able to restore psychological coherence to the past and present of a patient disturbed by the development of an eating disorder. The study also shows how patients' guilt feelings about developing, having, and failing to recover from an eating disorder are alleviated by blaming their parents. Therefore, this study finds that through the internalization of the familial model the patient sees some gain from her illness. However, this gain at the same time results in inhibiting the recovery of their social skills, since through blaming their parents as a cause, they are allowed to escape into an eating disorder rather than confronting the real problems that they failed to handle in the process of developing their disorder.

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Objectives: Adolescents with Type 1 diabetes tend to have problems with adherence to their self-care. They have hormonal change and they tend to spend increasing time with their friends. Self-efficacy is the important psychological factor to enhance self-management behavior. Also self-efficacy for self-management is related to depressive symptoms. The purpose of the present study was to develop "The short Japanese version of Self-Efficacy for Diabetes Self-Management (SEDM)" which was designed to assess self-efficacy for diabetes self-management in situational barriers to diabetes self-management. The relationship among self-efficacy for diabetes self-management, HbA1c., and depressive symptom in adolescent with Type 1 diabetes was also examined. Methods: Participants were forty-three children and adolescents diagnosed as Type 1 diabetes (male: 17, female: 23, unclear: 3, meanage=13.16, SD=1.91), aged 10-16 years. Participants completed following questionnaires: 1) Age, Gender, 2) Duration, comorbidity, and HbA1c, 3) The short Japanese version of Self-Efficacy for Diabetes Self-Management (SEDM), 4) Insulin Management Diabetes Self-efficacy Scale, and 5) Japanese version of Children's Depression Inventory (CDI). Results: SEDM had enough reliability (α=0.85) and criterion-related validity. There was significant negative correlation between SEDM and HbA1c level (r=-0.34, p<0.01), insulin management diabetes self-management and HbA1c level (r=-0.48, p<0.05), and SEDM and CDI (r=-0.66, p<0.05). Conclusion: As adolescents with Type 1 diabetes have conflicts between life style (e.g. school, relationship with friends) and self-care behavior, it is difficult for adolescents with Type 1 diabetes to control daily self-care behavior. The results of the present study revealed that self-efficacy for self-management was the important variables to improve HbA1c and depressive symptoms. Adolescents with Type 1 diabetes need to be supported to enhance not only skills for diabetes insulin-management but also skills for self-management in situation barriers to diabetes self-management. Also SEDM had reliability and criterion-related validity. It is useful to examine the effect of a program which enhance skills for diabetes self-management

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Objective: It has been reported that some factors of mindfulness (MF) skills effect on the symptoms of depression. Also it is known that psychological factors are related to the climacteric symptoms. This article reports on the impact of mindfulness skills on psychological and climacteric symptoms in menopausal women. Method: Using survey questionnaires, we have conducted a survey of 236 women (aged between 40 and 59 years old) who live in the mountainous region of A prefecture, located at the west of Japan, covering depressive symptoms, MF, and climacteric symptoms. 183 valid responses were statistically analyzed using SPSS and AMOS. Results: MF factors were related to each other, and were found to have a negative impact on depression and climacteric symptoms in the menopausal women. Especially "Acceptance", "Non-reactivity", and "Description" were found to have an inhibitory influence on the depression. "Acceptance" was found to have an inhibitory influence on climacteric symptoms. MF skill was found to be useful for relieving some psychological and physical symptoms of the menopause.

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