This study was conducted to clarify whether the health locus of control (HLC) is associated with body weight change after adjusting effects of different factors in a general adult population. 　　In male subjects with a normal weight, external locus of control was associated with weight gain, whereas internal locus of control was not significantly correlated with weight loss, after adjusting the effects of factors related to body weight change. Although the external locus of control was associated with weight gain, HLC had a limited effect on body weight change in adults. 　　Besides HLC, the factors significantly correlated with body weight change. Skipping breakfast, napping, and a weight cycling are related to weight gain, whereas obesity and stress were connected with weight loss. A look at gender differences showed that weight gain was associated with marriage, skipping breakfast, napping, and a variable body weight, whereas weight loss was associated with obesity and the declaration of weight reduction in male subjects. In female subjects, weight gain was associated with eating speed and smoking.

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　　With the introduction of the diagnosis procedure combination (DPC) system, the reduction of the health expenditure is expected. The use of generic drugs is promoted. It is imperative for introduction of generic drugs to assure the appropriate use of drugs to decrease medical costs without reducing medical services. Additionally, we should make a concerted effort to prevent the injudicious use of antimicrobial agents resulting in the emergence of drug resistance. In this study, we assessed the effects of switching to generic antimicrobial drugs on drug purchases cost, AUD (antimicrobial use density), hospital days, and antimicrobial susceptibility of Pseudomonas aeruginosa. This study was carried out at Yashima General Hospital for the period from April 2008 to September 2011. The Health, Labor and Welfare Ministry designated Yashima General Hospital as a DPC hospital from July 2009. Since the DPC introduction, the drug purchase cost has been decreased about 40% without reduction of AUD, hospital days, and antimicrobial susceptibility of Pseudomonas aeruginosa. Hospitals are making efforts to assess and improve management efficiency while maintaining the quality of medical care. Our results suggested that the introduction of generic drugs with assessment of efficacy may be one of the useful methods for pharmacy management.

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　　Chronic kidney disease (CKD) has recently been reported to be an independent risk factor for stroke. However, a detailed analysis was yet to be conducted according to stroke subtype. We attempted to determine the risk factors for stroke using data from the “specific health checkup” for metabolic syndrome conducted by the 9 hospitals affiliated with the Akita Prefectural Federation of Agricultural Cooperatives, and evaluate and determine the risk factors for stroke. There were 401 patients who had undergone metabolic syndrome checkups from 2007 and 2010 and suffered from stroke afterwards within 3 years after the screening. The controls were all 69,407 subjects who were screened during the same period. The predictors examined were sex, age, blood pressure, BMI, cholesterol values (HDL・LDL), history of diabetes mellitus, presence of atrial fibrillation, CKD, and drinking and smoking habits. Analysis was conducted using logistic regression. The risk factors for stroke as a whole were male sex, age, blood pressure, diabetes, atrial fibrillation, CKD, and smoking history. For cerebral infarction, the risk factors were male sex, age, blood pressure, diabetes, atrial fibrillation, CKD, and smoking habit. The risk factors for cerebral hemorrhage were age, blood pressure, and CKD. For subarachnoid hemorrhage, the risk factors were female sex, age, blood pressure, low HDLemia, and CKD. In conclusion, CKD is an independent risk factor for the 3 subtypes of stroke, and in particular plays an important role as a higher risk factor for cerebral hemorrhage. Smoking cessation and controls of blood pressure, diabetes and atrial fibrillation are the important measures for stroke prevention. In addition, the further intervention should also be targeted to those with the result of CKD revealed by specific health checkups.

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　　This study aimed at clarifying the effects of intervention with the composite Dementia Prevention Program. Subjects were 46 elderly people who had participated in the program. The study method included intervention trials to test the effects on the changes in BMI, physical function, and cognitive function of the program participants before and after the trial. Those aged 75 and up (old-old participants) had significantly stronger grip strength before the intervention than those below the age of 75 (young-old participants), but there was no difference in cognitive and physical functions between old-old and young-old participants. The average number of steps taken in the young-old group had significantly increased from approximately 4,000 steps before intervention to approximately 7,000 steps after intervention. When it comes to physical functions, the time taken for the 5-m walking exercise was significantly shortened from 3.8±0.8s to 3.5±0.5s in the young-old subjects; a change from 3.5±0.8s to 3.7±1.0s was observed for TUG in the young-old subjects and from 4.1±1.0s to 3.6±1.0s in old-old subjects. As regards cognitive function, episodic memory of the young-old subjects improved significantly, from 47.9±7.5 points before intervention to 56.5±8.8 points after intervention. The improvement in the old-old subjects was gradual. Episodic memory was improved without bearing on the changes shown in the 5-m walking tests (β＝-0.751, p＝0.020). The physical functions and episodic memory in cognitive function had both improved. This study suggested early intervention could increase the dementia prevention effect.

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　　In breast cancer cases, intra-operative diagnosis of sentinel lymph node metastasis has been performed widely. It is diagnosed at present by HE staining, but more objective methods are needed. In this study using 166 examples, we compared the methods using rapid immunostaining with the genetic examination. In rapid immunostaining, we recognized metastasis using cytokeratin which was an epithelial cell marker used in the serial sections for frozen histological diagnosis. In conclusion, because metastasis could be diagnosed accurately and pathologist&rsqup;s stress would be reduced, rapid immunostaining is useful for intraoperative diagnosis.

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　　With the coming of an aging society in mind, the author used Japanese medicine together with Western medicine to examine the effectiveness in the case of elderly persons. 　　Cases of BPSD (behavioral and psychological symptoms of dementia) (ten persons), depressive symptom (ten persons), sleep disorder (ten persons), gait disturbance (ten persons), constipation (ten persons) and aspiration pneumonia (ten persons) were examined. 　　Fifty-five persons out of sixty effectively responded to the East-West combined therapy. 　　Team medical care was needed. It is required for the hospital to provide doctors and paramedics with a full-scale training course in Japanese Kampo medicine.

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　　Evaluation of the attitude of patients according to behavior modification stage when they were admitted to hospital for our diabetes educational program and various parameters after they discharged were reviewed. 　　We examined the 106 people (53 males and 53 females, average age 66.0 years) who were admitted to our hospital for diabetes education during the period from October 2009 to February 2012. We examined HbA1c levels and measurements taken during the stay in hospital, and 1 month, 3 months, 6 months, 9 months, and 12 months after leaving hospital. Compared with the measured values in the hospital, HbA1c levels measured each month showed a significant improvement (p<0.05). By evaluation of the value according to behavior modification stage, we recognized a rebound tendency in precontemplation groups. The evaluation of patients’ attitude by occupation according to stage of behavior modification revealed a difference more than 2 stages by approximately 10%. From these result, it was speculated that the patient self-management skills made a significant impact on glycemic control after hospital discharge. 　　Diabetes educational hospitalization is supported by team members who vary in specialty. It is expected that we can provide higher-quality medical care by each specialist and supporter with a good knowledge. 　　Assessment difference of behavior modification stage may appears by each specialty staff member and by changes in physical condition and feeling of the patients. In addition, these causes may change further by difference in the way each specialist deals with the patients. Therefore, we considered it was important to share information and have the mutual confirmation of the evaluation. Now, team medical care is regarded as important. It was suggested that cooperation among the staff members would lead to better medical treatment, and to improvement in patients’ QOL.

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　　The main purpose of our hospital training program for newly hired employees at Anjo Kosei Hospital is to encourage them to learn basic knowledge to live as a member of society. In this study, questionnaire surveys for all recruits were carried out at the beginning, at the end of, and 6 months after the training program to evaluate the significance of the training program. The number of the study subjects who had our training program was 138 in 2012 and 146 in 2013. We have placed great emphasis on our fundamental principles for the recruits to learn. The series of surveys showed that the lecture given by our hospital director on the ideals of hospital care was well received by the recruits. Moreover, the experience-oriented training program also satisfied the participants greatly, as it included the tour of hospital, and the training of safety in medical treatment, infection control, and customer support. Additionally, the surveys found that our hospital training program allowed the new employees to deeply understand a basic knowledge to live as a member of society. Furthermore, the questionnaire survey made at 6 months after the training program revealed that over 80% of the recruits thought our training program would play an important role in promoting their job skill. These results suggest that questionnaire surveys are useful to evaluate the change in their ideas of the recruits before and after the training program, leading to an improvement of the quality of our hospital training program.

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　　The patient was an 84-year-old man. On July 1, 20XX, he experienced great difficulty in walking. On July 3, he suffered from serious complaints of backache and hyperhidrosis and was rushed off to a nearby hospital. A blood test was performed immediately. It showed that all the values conformed to DIC criteria. (?) A ultrasound scan revealed phiebothrombosis in the deep part of the legs. CT using a contrast medium found iliopsoas muscle abscess and periaortitis. The man was diagnosed with DIC, multiple organ failue, septic shock, and deep part phiebothrombosis. Treatment was done with an antimicrobial medicine and immunoglobulin preparations. In addition, an anticoagulant therapy was performed using DOA and heparin. Inflammation began to subside gradually but his fever did not abate. Contrast enhanced CT indicated abscess all over the body. After a 34-day stay in the hospital, he died. Although this case occurred in an urban area, MRSA was detected in the patient, suggesting that this strain is now one of the omnipresent bacteria. In this respect, this case was significant. Generally, a drainage procedure is taken for the treatment of iliopsoas muscle abscess. However, in this case, a remedial drainage was not used because the diameter of abscess was so small. As his temperature did not fall, a diagnostic drainage should have been used.

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　　Pancreatic neuroendocrine tumors, relatively rare cancers, mostly arise in the pancreatic parenchyma with infrequent involvement of the main pancreatic duct. Now and then, however, case reports have been published on pancreatic neuroendocrine carcinoma in which the main pancreatic duct is obstructed by tumor cells with severely fibrous stromal cells. Here, in this paper, we report a case of pancreatic neuroendocrine carcinoma with obstruction of the main pancreatic duct. A 59-year-old man complained of right upper abdominal pain. Magnetic resonance cholangiopancreatography and fat-suppressed T1-weighted magnetic resonance imaging showed gallbladder stones, a low-intensity-area measuring 8 mm in diameter in the pancreatic body, and club-shaped dilatation at the distal end of the pancreatic duct. The patient was thus diagnosed with a tumor in the pancreatic body and cholecystolithiasis, and underwent distal pancreatectomy and cholecystectomy. HE-staining showed tumor cells with eosinophilic cytoplasm and nuclear atypia. The infiltrative growth of the cells with severe fibrosis caused stenosis of the pancreatic duct. Based on the positive results of immunohistochemical staining for chromogranin A and synaptophysin and the Ki-67 index, the tumor was finally identified as pancreatic neuroendocrine carcinoma. The patient has been under follow-up with no additional treatment for >3 years since the surgery, without evidence of tumor recurrence.

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　　Hospital A is supposed to assume the role of a core hospital in the district, treating patients having an acute illness or injury. Nurses in the hospital are extremely busy due to the shortage of nurses and a high turnover rate. In this paper, we report the results of a survey we performed to find the degree of stress the nurses are suffering from in their workplace. 　　The survey was conducted by distributing questionnaires to registered nurses and practical nurses excluding head and deputy head nurses. Sources of stress were classified into four categories -- workload, type of work, interpersonal relationships and private matters? and generational differences were examined. 　　The results showed that, for the nurses young and old alike, “workload” was the number one source of stress, followed by “type of work.” The major factor in stress are conceivably the pressure of time. Hospital nurses are intensely busy with tending the sick, always keeping in mind patients’ conditions, assisting physicians, ensuring patients’ safety, making contact with other departments and so on. It appeared that they always racing against the clock. “Interpersonal relationships’ came third as the major source of stress. It was surmised that many nurses were dissatisfied with the present state. They do not have enough time to keep personal contact with their patients, to develop better communication with the physicians or to establish better relationship with their superiors or colleagues. Stress from the No. 4 stress source -- i.e., private matters -- seemed to weigh heavily on the mind of the nurses in their 30s to 40s, many of whom are considered to be married. They are stressed out in the conflict between their role as mother and wife and their role in the workplace. Against their wishes, their time is occupied with many tasks in the hospital. Moreover, the participation in training programs, night duty and overtime work must cause them to feel stressed greatly. 　　Based on our findings, we concluded that it would be possible to reduce stress on the job by making worker-friendly environment through mutual help and cooperation with colleagues who are also experiencing a great deal of stress.

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　　For the prevention of complications in dialysis patients, what counts is self-reliance efforts. Patients with hyperphosphatemia are prone to arteriosclerosis and pathologic fracture as well. Therefore, controlling serum phosphorus levels is supposed to be a key to longevity. After all said and done, it is extremely difficult for the patients to maintain the target levels of serum phosphorus by self-management alone, because phosphorus concentrations in serum are subject to dietary habits. Furthermore, the patients need to restrict the intake of phosphorus, since the chemical is excreted only in feces and urine, or gotten rid of by dialysis. In this study, we had the patients tell what they eat, examined the contents and advised them on the proper amounts and types of foods. Considering that the cooperation from their family is essential, we held a food-sampling event. In addition to the dietary guidance, lectures were delivered to them about complications and medication. Our efforts led to an increase in the number of patients who succeeded in maintaining the normal levels of serum phosphorus.

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　　The purpose of this study was to shed light on the originality of dementia day service center through focus group interviews with the center administrator and caregivers. With the participation of a total of six people, a discussion was held. The participants exchanged views ideas about what day services should be like for the benefit of the elderly with dementia. From the debate, we drew the following conclusions. (1) Given that the level of dementia day service is high in specialty and technicality, it would be possible to admit the patients who were unacceptable to ordinary day care centers. (2) Users, their families and caregivers have vicarious pleasure from the alleviation of BPSD. (3) The delight gives the care staff an incentive to learn more and contributes toward upgrading the technical level further. 　　From the above, we concluded that the specialty and originality of the dementia day service center had been supported by a high quality of life of users, their families and the staff who had experienced in caring old people with severe BPD successfully.

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　　It is often said that care coordinators without health care background are no good at talking with home-visiting nurses. The communication gap is wide. So, we planned to make textbooks with a view to bridging the gap. To garner some basic data, we sponsored a workshop on “home healthcare nurses’ behavior that troubles care managers.” The contents of the discussion were analyzed using the KJ method, though partially, and obtained the following seven groups: (1) demanding the same level of medical management as that of a hospital from home-visit nursing teams; (2) being not inclined to do only irreducible minimum work; (3) having not enough experience in home-visit nursing service with their knowledge inclining to medical care; (4) intending to control home care teams authoritatively; (5) do not control their emotions in front of clients and families; (6) using technical terms too much: and (7) being eager to change to special instructions. The results of the present study will provide important information to home-visiting nurses and care managers as well.

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　　The Gene testing techniques have made a remarkable development in recent years. The number of studies on an association between chronic effects rapidly of pesticide exposure and gene polymorphism has increased. This tendency is probably because some genes are related to the metabolism and transport through the cell membrane of the toxic chemicals. 　　Many studies on the cancer risk have found the significant interactions between pesticide exposure and gene polymorphism. The cancers associated with pesticides included gallbladder cancer, prostate cancer, renal cell carcinoma, breast cancer, bladder cancer, childhood leukemia, childhood brain tumor and so forth. The interactive factors of the pesticide exposure have been given as follows: The serum DDT level, the agricultural use of malathion or dichlorvos, the pesticide exposure indices representing the job history, the history of prenatal or postnatal insecticide exposure, among others. The genes of significant interaction with polymorphism have been given as follows: Cytochrome P450, glutathione-S-transferase, P-glycoprotein, flavin-containing monooxygenase, quinone oxidoreductase, among others. 　　The risk of Parkinson&rsquo:s disease was reported to have the interaction with pesticide exposure and paraoxonase or dopamine transporter polymorphism. 　　Some studies on birth defect and nuerodevelopmental retardation have reported the significant interactive relations. For example: Preterm delivery with organochlorine pesticide exposure and cytochrome P450 polymorphism, reduction of head circumference or retardation of neurobehavioral development with organophosphorous insecticide exposure and paraoxonase polymorphism. 　　When it comes to multiple chemical sensitivity, some gene polymorphisms were reported to have significant relations. Further research is needed to gain a deeper insight into multiple chemical sensitivity including the interaction between gene polymorphism and chemical exposure epidemiologically.

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