Food and the environment support human life, but Japan's food self-sufficiency, based on the amount of calories consumed, was only 39% in 2010. The Japanese Government strived to raise food self-sufficiency in the rural setting to 50% by 2020, but so far the situation has only worsened, as compared with 2008. Aging and depopulation in the countryside and the devastation of rural communities are also in progress. Shimane University intends to develop knowledge centers in communities. We started community-based education and research programs in the fields of agriculture, industry, education and medicine. The Shimane Cohort Study, undertaken in collaboration with rural communities, revealed that the prevalence of lifestyle-related diseases increased in proportion to aging and lifestyle urbanization. Ruralists took in less lipid and protein but do more exercise than urbanites. We began to develop a new community- and ICT-based program in 2010 with the central and local governments to solve problems posed to rural communities. We have new empirical evidence that social capital is a determinant of psychological stress and support community development by enhancing social capital.

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　　In the mid-1990s in Sweden, the care of large groups of patients, including many with chronic disorders, was transferred from hospitals to primary health care. This change made it necessary to increase clinically relevant research in primary health care. To meet this need, Lund University and Region Skane (the county council in Skane, the southernmost county in Sweden) jointly founded in 2008 a clinical research unit dedicated to primary health care: the Center for Primary Health Care Research (CPF). The overall goal of the CPF is to conduct ground-breaking clinical research in order to increase the quality of primary health care and thereby improve public health. The clinical research is performed in close collaboration with primary care clinicians to exploit their ideas, experiences, and expertise. In order to build bridges between academia and primary care, the CPF established a network of nine Academic Knowledge Centers (AKCs) in Skane. At each AKC, an active clinical researcher (AKC coordinator) employed by the CPF provides on-the-job assistance with tasks including study design, implementation and applying for research funding. Each AKC supports a fixed network of primary health care centers and the nine AKCs together support all 150 primary health care centers in Skane. The AKC network has the potential to establish Sweden at the international forefront of clinical research in primary care. Its ethos and infrastructure could serve as a template for research collaboration between academia and clinicians in primary care around the world.

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1. Stress problems at interpersonal service workplaces 　Since interpersonal service business requires control over one's emotion and an approach with words and attitudes tailored for other persons, this business is called emotional labor (Hochschild). Emotional fatigue and trauma, accompanied by emotional labor, are characterized with difficulty in recovery simply by taking rest and vacation. Words used for strict criticism, reproach and abuse, spoken ruthlessly by other persons, are lingering even after work and sometimes lead to a traumatic experience, which results in increasing the number of persons who have lapsed into mental insufficiency because of the inability to change the feeling. 2. Mental health problems at interpersonal service workplaces 　Burnout, depression and suicide are taken up as serious mental health problems in the interpersonal business. 　Burnout is a pathological condition which is greatly influenced by excessive emotional labor and presents exhausted emotion under the excessive suppression of natural emotions, including dissatisfaction and anger toward other persons. This condition does not spontaneously recover and needs to be taken care of in the emotional aspect. In the delivery of mental health care at workplaces, early detection with proper approaches is necessary for staffers who have lapsed into a burnout state. Besides, it is necessary to improve the workplace environment, which is liable to develop a burnout state. In Japan, burnout is not recognized at workplaces to a full degree. Burnout should be recognized and treated as a serious mental problem, which causes not only personal health problems for staffers but also reduces functions in the whole family. Additionally, it cuts down on labor productivity at the workplace. 　Depression and suicide: In Japan, the number of patients with depression has rapidly increased in recent years, and this trend is not exceptional for the interpersonal service business. In recent years, the expanding concept of depression has given rise to problems for psychiatrists. The increase in the onset of what is described as “atypical depression” makes it necessary to review conventionally typical methods for the treatment of depression and come out with new approaches. Therefore, it is essential to realize differences in the pathological conditions, and treatment or approach between endogenous depression and “atypical depression.” 　In recent years, the effectiveness of rework programs in terms of social rehabilitation has been put into focus in Japan, too.Besides, the serious problems concerned with depression involve suicide, which may possibly be prevented by the early detection of, and the approach to, depression. 3. Mental health activities at interpersonal service workplaces 　Reports came out on the current state of, and problems on, the mental health activities of staff workers at two institutions, in which the author is involved. They are the Utsunomiya Municipality (public service with 3,449 staffers) and the Kamitsuga General Hospital (medical service with 606 staffers). In addition, the importance of assessment on poor mental health has been emphasized as factors which should be taken into account for mental health activities. Besides, it is essential to the evolution of effective mental health activities that there is close coordination between in-house industrial physicians and specialists at workplaces and with staffers for industrial health care.

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　　Severe infections arising from nosocomically encountered gram-negative bacteria, such as extended-spectrum beta-lactamase producing bacteria and multidrug-resistant Pseudomonas are serious problems today. While carbapenems are looked upon as the preferred agents for treatment of infections caused by extended-spectrum beta-lactamase producing bacteria, carbapenemases have been recently reported. Surveillance data is needed to treat infectious diseases due to resistant organisms.

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　　Objective: This presentation is designed to clarify the sense of satisfaction entertained by home visiting nurses and nosocomial nurses and relations among the “sense of efficiency,” “work stress,” “sense of satisfaction with duty work,&rdquo and “posture toward terminal care.” 　　Methods: The subjects of this study include 106 home visiting nurses and 120 nosocomial nurses and were asked about the factors cited in the Objective. 　　Results: In the group of home visiting nurses, the age and the sense of self-efficacy were high, the number of years in service was great and they had many children. In both groups, significant correlations were observed between the “sense of satisfaction with the delivery of full terminal nursing care to the last moment” and the “yardstick of attitude toward terminal care.” In the home visiting group, significant correlations were noted between the “sense of satisfaction with the delivery of full terminal care to the last moment” and the “sense of self-efficacy.” In the group of nosocomial nurses, significant correlations were witnessed in the “sense of satisfaction with the delivery of full nursing care to the last moment” and the “sense of satisfaction with hospital work.” 　　Discussion and conclusion: Home visiting nurses appeared to have a high sense of self-efficacy as their ages were high and they had many years of experience in nursing care and family life. 　　The sense of satisfaction with the delivery of full nursing care to the last moment was considered high among nosocomial mursesandhome visiting nurses, as they have grappled with the delivery of terminal care in a forward-looking posture. 　　The sense of satisfaction with the delivery of full terminal care was presumably looked upon as having an effect on the sense of satisfaction with nursing care as a line of duty.

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　　When a patient with acute drug intoxication is brought to our hospital, the pharmacist must immediately collect pertinent information regarding the causative agents involved, present the collected data and propose therapeutic methods to the doctors and nurses based on the basis of their earlier experience. 　　For the life-saving treatment of a 99-year-old woman who happened to swallow a large amount of diphenhyramine ointment, we proposed gastric lavage and time-lapse measurement of the diphen- hyramine concentration in the blood. The results of this therapy showed a clinical improvement with a drop in the concentration of diphenhyramine in the blood. 　　The conduct of gastric lavage and the clinical determination of diphenhyramine concentration in the blood were found useful in this case.

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　　The team organized by a diabetologist, a pediatrician, a nationally-registered dietitian, a midwife, a child care worker, a nurse and a physical therapist worked out the concept for a better living support center involved themselves in the establishment of a livelihood betterment center which would evolve around a facility to practice cooking. A mother-and-child support center, a health control support center and a rehabilitation center were set up so that those facilities could be spatially tied in with a support center for improvements in the lifestyle, thereby making it feasible to unfold measures to combat lifestyle-related diseases. The system which centers on the facility to practice cooking presumably made it possible to make progress from “spatial coordination” to “functional coordination.” With this system, it has become feasible to evolve a wide variety of measures in the sectors of health care, medical care and welfare for not just the sick but also people good in health. It is important for hospitals in the future to make contributions in the sectors of health, care and welfare. The system we have discussed here may well serve as a model for contributions by hospitals to their communities.

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　　The purpose of this study is to clarify the depression symptoms of persons, aged 75 and over, and discuss physical and cognitive aspects and impacts on QOL. On the basis of this clarification, furthermore, the authors aim at examining social support to the elderly. 　　The subjects include 122 persons, aged 75 and over, consisting of 24 males (85.7 years old with SD at 5.81) and 98 females (85.34 years old with SD at 5.15) who receive day services at welfare facilities for the elderly in Saga Prefecture. The items checked in interviews consisted of basic properties, geriatric depression scale (GDS), Barthel index, mini-mental state examination (MMSE) and health-related QOL (SF8). As an analytical method, the subjects’ GDS scorewas assumed to be cutoff 5/4. As they were divided into two groups, they were compared item by item in a t test. Ethical considerations: The authors briefed the intervieweeson the purposes of the study and had their consent, both orally and in writing. We also told them that the participation was utterly at their own discretion. 　　The subjects consisted of 48 patients in need of care (39.3%), 38 patients in need of support (31.1%) and 27 “specified” elderly patients (22.1%), among others. It was revealed that 61 patients (50.0%) had mild depression symptoms with the GDS score at 5 to 10 points, eight patients (6.6%) had severe depression symptoms with the GDS score at 11 points, and 53 patients (43.4%) had no depression symptoms with the GDS score at less than 4 points. 　　Depression symptoms were observed in 69 out of 122 subjects, or in excess of half of them, and a significant difference was observed between the two groups in growth hormone (subjective healthy feeling), indicating that the results were similar to those of an earlier study by Nagata et al.

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　　The number of bedridden inpatients has increased year by year. Recently, I have been assigned to look after an inpatient (Mr. “A”) with two progressively intractable diseases - ossification of the posterior longitudinal ligament (OPLL) and the multiple system atrophy (MSA). Usually, he would time and again phone the nursing station to demand a change in his posture or replace the bedpan. In order to clarify what lay behind Mr. A’s behavior and grasp clues to his care, I referred to “My Posture and Feeling” in the booklet entitled the “Center for Management of Care for Dementia,” and the referral enabled me to realize the pains caused by immobility of his body. The achievements I have made are: (1) That the in patient’s expression has brightened and there have appeared changes in his feeling, (2) That the nursing staff has begun to clean up their cheap misunderstanding about his assertions and take legitimate action for him before his complaint, and (3) That the nurses’ posture to try to know about the desire of inpatients has enabled them to come out with help of the kind the patients really wished to have. This experience of mine has enabled me to realize that the realization of the kind of daily lifestyle the patient wishes to have in an early phase, enabling him to lead the kind of life he wishes to have in hospital.

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