To understand the present situation of elderly patients with pneumonia, all 3,784 inpatients of our Department of Respiratory Medicine from April 2010 to March 2015 were analyzed. In total, 718 patients (pts) were diagnosed with pneumonia (median age, 78 years) and they were classified into two groups: those aged>65 years (elderly group, EG: 600 pts and those ≤d65 years (younger group, YG; 118 pts). Annual change in the ratio of EG/YG, mortality rate, respiratory assist mode, and number of hospital days were analyzed. The ratio of EG/YG was 0.11 in 2011 but was higher at 0.20 in 2014. The mortality rate was significantly higher in EG than in YG (147/600 vs 15/118; p<0.05). In the group of deaths, among patients who were intubated, 6 of 15 were in YG and 5 of 147 were in EG, respectively. The median number of hospital days was not significantly different between the groups for patients who died (EG 13, YG 14) or were discharged (EG 15, YG 12). In EG, the proportion of patients who changed hospitals for recuperation was up to 10% and the median hospital stay was 48 days, compared to 28 days in YG. With regard to pneumonia, because the guidelines are well established and because elderly individuals, in particular, often do not require additional treatment, it is possible to provide treatment at general hospitals or at home by strengthening the cooperation between clinic and hospital as well as hospital and hospital in the community through the incorporation of information technology.

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　　Hepatitis C virus, discovered from viral nucleic acids in blood samples in 1989, was revealed to be a virus causing the hepatitis that was previously diagnosed as non-A, non-B, particularly post-transfusion viral hepatitis. After the discovery, the Japanese Red Cross Society swiftly introduced HCV screening of blood products for transfusion, and this contributed to the sharp drop in the number of new cases. In this context, the population of hepatitis C patients has rapidly aged in Japan, and cases that antiviral therapy was contraindicated were not negligible. Antiviral therapy against hepatitis C, starting with interferon in 1992, has rapidly advanced in recent years, and now interferon-free therapy has become the first choice, as it has shown remarkably improved tolerability as well as antiviral effect. Thus, antiviral therapy is now suitable for elderly patients, and its indications are expanding.

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　　It is widely recognized that the elderly show an increased prevalence of cardiac arrhythmias. In this population, abnormalities in the conduction system can be the result of degenerative and fibrotic changes that occur with aging. Underlying disorders such as hypertension, diabetes mellitus, ischemic heart disease, congestive heart failure, and electrolyte imbalance may lead to the onset and exacerbation of arrhythmia. Cardiac arrhythmias, particularly in the elderly, are disorders of sinus node function (sinus bradycardia and sick sinus syndrome), abnormalities in the conduction system (AV block and bundle branch block), and supraventricular arrhythmia (supraventricular premature contraction and atrial fibrillation). The variety of symptoms, variation in individual constitution, and associated dementia reported can be attributed to the difficulties in eliciting clinical signs. In drug treatment, age-related changes of the pharmacokinetics and pharmacodynamics of antiarrhythmics have been evaluated extensively. Treatment of arrhythmia in elderly patients is complicated, and a clinical dilemma may often be encountered because of multiple comorbidities, decreased physiologic reserve, and polypharmacy. The incidence of atrial fibrillation (AF) increases with age. Cardiac embolic stroke is a major complication of AF. The CHADS₂ score could be used to evaluate the risk of stroke in patients with AF. Oral anticoagulation, using either vitamin K anticoagulants or novel oral anticoagulants (NOACs), has consistently demonstrated a reduction in the risk of ischemic stroke. In terms of non-pharmacologic treatment, the indications for permanent pacemaker implantation, cardiac ablation, and cardioverter defibrillators in the elderly should be established without any age limit. However, careful consideration of invasive techniques is necessary. Because of the lower cardiac reserve, physiological pacing is useful in elderly patients.

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　　In 2008, the National Project for the Operation of Medical Centers for Dementia was initiated to establish core medical institutions for dementia in the community. In 2010, our hospital among others was appointed to serve as a dementia medical center for the community to realize the mission of a “society where community living is possible for people with dementia”, which is described in the Five-Year Plan for Promotion of Dementia Measures (Orange Plan) established in 2012. As an inpatient psychiatric unit of a general hospital, our department admits patients with dementia accompanied by physical disorders. We considered it important to elucidate dementia-related issues that have not been shared between healthcare professionals and community supporters, that is, to clarify the indications for hospital admission and the goal of inpatient treatment. 　　In addition, to prevent prolongation of hospitalization, appropriate medical treatment should be provided to improve symptoms, and a support system is needed for prompt hospital discharge. To achieve these, we improved in-hospital and out-of-hospital cooperative systems. As a representative example, we developed a multidisciplinary care pathway for medical and rehabilitation care to improve the quality of inpatient care, and encouraged healthcare professionals to participate in outreach project with community activities to support early hospital discharge.

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　　We investigated whether elderly patients treated for a proximal femoral fracture who lived together with an elderly spouse were able to return home and walk after treatment. Subjects were 85 patients aged > 65 years with a proximal femoral fracture that were treated between January 2007 and December 2013 and who lived at home with their spouse. We recorded the number (proportion) of patients who were directly discharged home from the hospital. We also analyzed their activities of daily living (ADL) using the Barthel index before the injury and again at the time of discharge. We investigated whether there was a sex difference in the ability to return home. Seventy patients (80%) returned home directly from the hospital or from a rehabilitation hospital. The Barthel index before injury and at the time of discharge was 90 points and 81 points in female patients and 84 points and 70 points in male patients, respectively. Forty women (85%) and 30 men (75%) returned home.

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　　Benign prostatic hyperplasia is a common condition in elderly men, and its incidence rate increases with age. The condition needs to be diagnosed and treated in accordance with the clinical practice guidelines for benign prostatic hyperplasia. Although treatment can be initiated differently depending on disease severity, pharmacotherapy is initially provided in most cases, and then surgical treatment is considered when patients’ responses to pharmacotherapy are unsatisfactory. In addition to trans-urethral resection of the prostate, which is the long-standing gold standard in surgical treatment, procedures employing lasers have been developed and are becoming widely used. Given the age-related increases reported in the incidence rates of nocturia-related falls and consequent fractures and mortality, the option of surgical treatment should not be ruled out solely because of old age. However, postoperative complications specific to elderly patients can occur, and thus careful consideration is necessary when deciding on surgery. Comprehensive evaluation using the patient’s age as one of influencing factors is essential when deciding an appropriate treatment plan for each patient.

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　　In Akita Prefecture, nine Koseiren Hospitals, with at least one located in each of the 8 secondary medical care districts, have long been played a pivotal role as community medical institutes. Akita Prefecture is regarded as an area with the most prominent depopulation in the country due to the declining birthrate and aging population. Consequently, the number of patients has been decreasing over the past decade. Nevertheless, we believe that our role in the community, such as the provision of acute medical care and response to radically changing medical needs, will not change. There is no doubt that the significance of cooperative community medical care will become greater than before. This article describes our tasks related to cooperative community medical care and measures to address them, with an emphasis on: (1) removing awareness of differences between ward staff and staff in the cooperative unit, (2) strengthening the cooperative unit staff and restructuring the organization, and (3) deepening the cooperation within the community. To fulfil the mission of Koseiren Hospitals─to sustain community medical care─it is necessary to establish a sufficient system for cooperative community medical care, and this will be achievable only through continuous steady efforts.

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　　Each prefecture has started formulating its vision for community medical care. With the aim of promoting clinical specialization and collaboration before 2025 when all the baby-boom generation will reach ≥75 years of age, the vision includes measures to implement the optimal system of medical care provision as well as data analysis-based estimation of the demand for medical care and number of beds needed in each clinically specialized area. As in other prefectures, individual communities in Akita Prefecture are discussing measures to achieve clinical specialization and collaboration, enhance home medical care, and recruit and train medical professionals. This study identified the tasks involved in the medical care provision system in Akita Prefecture. Basic data were analyzed with consideration of the discussions occurring in individual communities, in order to describe the situation in which the vision for local medical care was being formulated. The future medical care system that meets the demands for medical and elderly care in rapidly depopulating and aging communities is also discussed.

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　　Although home medical care is one of the major components of “integrated community care system”, its low efficiency in relation to the broad medical zone becomes a problem in the majority of underpopulated rural areas. Our hospital is located in a rural area approximately 30 km northern from Akita City, and has largely been responsible for home medical care in the surrounding areas reaching up to 20km. In January 2011, the hospital temporarily felt in the standstill of inpatient care because of the sudden retirement of doctors, resulting in marked increase in the demand for home medical care, and in the number of end-of-life cares (approximately 20 cases per year). In May 2014, the hospital restarted inpatient care at the same time as the opening of a new hospital as an in-home treatment support hospital. This situation could achieve a seamless medical service between home medical care and inpatient practice for frail elderly patients, and consequently might enable us to promote the quality of life of these patients. In rural areas where home medical care is scarcely provided by clinics, the in-home treatment support hospital should play a prominent role in this field of community medicine.

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　　Akita has the fastest aging community in Japan. Increasing demand for emergency care and subsequent hospital care for elderly patients is placing excessive pressure on community hospitals because of the chronic shortage of doctors and other medical staff. The characteristic features of these patients are comorbidities, high incidence of cognitive disorders of varying degrees, and physical frailty. To address these urgent problems in a comprehensive manner, the creation of a special department, the ER and GP (general practitioners) department, might be an effective solution. The absence of a GP section in the hospital and lack of family physicians is a major problem in the Japanese medical system. In this context, Akita prefectural government established a training institute for general practitioners and family physicians in Akita Kousei Medical Center in 2012. Only 6 trainees have joined the program in 4 years, so major problems remain. One is the limited human resources available: young doctors and students are still not familiar with the specific area of GP. This is because of the long history of Japanese postgraduate training that is focused on cultivating specialist physicians. The second major problem is the differences that often exist between these doctors─generalists include both hospitalists and family physicians─and these two groups sometimes have completely different mentalities. More time is needed to establish a new style of hospital medicine.

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　　The “Akita Heart-full Net” started operation as a cooperative community medical network in April 2014. It was established jointly by Akita Prefecture and Akita Medical Association and is run by the latter. Problems experienced in its operation have been addressed, and a duplex system was introduced so that many medical institutions can now easily join the system. Functions in relation to participating clinics especially have been enhanced. The new functions, “unloader” and “portal window”, were included so that clinics can used the system whether or not they the use electronic health records or standardized data. A seamless system that does not distinguish between flagship hospitals and clinics enables information exchange and sharing. This will further enable a cooperative system for clinical practice to be established based on free access to information about referred patients and the use of the community medical care cooperation pass. To contribute further to medical care in Akita Prefecture, we plan to extend the system further so that it functions as a collaborative network, covering a wide area and involving different professionals, with a focus on home medical care within the context of integrated community care.

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　　Persons who are abused often have serious problems in a complicated life situation. We studied this issue and considered ways in which medical social workers (MSWs) handle these social problems. We collected data in 16 cases of elderly abuse that were managed by staff at our hospital from 2010 to 2013 and compared the characteristics in these cases with those of 23 cases of child abuse during the same period. Data analysis revealed 3 characteristics of abused persons: insufficient use of long-term care insurance service; mental disorder such as dementia or mental illness; and financial problems. Further detailed analysis found that intervention for elderly abuse cases was requested only in more difficult cases when abuse was easily identified by our staff. Therefore, staff’s awareness and motivation to become more involved in cases of elderly abuse may be low compared with cases of child abuse. Hospital staff are in a position where they should be able to readily identify maltreatment of aged persons. We need to develop a mechanism for the early detection of elderly abuse so staff can intervene easily in mild cases of elderly abuse, and ask for assistance from MSWs in more difficult cases. It is important to ensure that all employees have access to MSWs in the hospital.

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　　This study sought to identify whether the inter-rater reliability of lower limb muscle strength measurements made using a hand-held dynamometer differs for patients with hip fracture according to the severity of their cognitive impairment. Of the 144 patients with hip fracture hospitalized at our institution, we excluded 28 from this study (18 with level III, IV, or M of independence in daily living for the demented elderly, 8 with a history of central nervous system disorders, and 2 who were transferred to another department), leaving 116 patients for analysis. These 116 patients were divided into three groups according to their severity of cognitive impairment: 44 with a normal level of independence in daily living for the demented elderly, 38 with level I independence, and 34 with level II independence. We compared the intra-class correlation coefficients and the standard error of measurement between the groups. There were no significant differences in the intra-class correlation coefficients between the groups. The standard error of measurement in the group with level II independence in daily living for the demented elderly was significantly lower than that in the other two groups. These findings indicate that the inter-rater reliability of lower limb muscle strength measurements using a hand-held dynamometer in patients with hip fracture did not differ between patients with mild or moderate cognitive impairment. Furthermore, the inter-rater reliability was high.

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　　This study investigated data on cardiopulmonary exercise testing (CPX) indices in order to estimate exercise intensity and ramp load from maximum walking speed (MWS) in elderly hospitalized patients with acute coronary syndrome (ACS). Subjects were 66 male patients hospitalized with ACS (49 young-old patients and 17 old-old patients). We measured exercise intensity by CPX using a cycle ergometer and MWS over 10 m, and examined the patients’ clinical characteristics. Stepwise multiple regression analysis was performed to identify variables that most closely predicted exercise intensity. We then estimated the ramp load from the relationship between exercise load at anaerobic threshold and MWS. The results indicated that MWS was an independent predictor of exercise intensity in old-old patients (adjusted R²=0.278, p=0.037) but not in young-old patients. The regression formula predicted the proper ramp load to be 5 and 10 watts as MWS was less than 1.5m/s or more than 1.5m/s, respectively. MWS was related to exercise intensity and could be used to consider the ramp load in CPX in old-old male patients with ACS.

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　　We researched intrauterine fetal death (IUFD) after 22 weeks of gestation from 2009 to 2014 in our departments. During this period, there were 6236 childbirths and 35 cases (0.56%) resulted in IUFD. We researched the background and causes of IUFD in these 35 cases. The median age was 34 years and advanced maternal age accounted for 48.6% of cases, while elderly primipara accounted for 20%. There were 5 cases (14.3%) of pregnancy after fertility treatment. The median gestational age when IUFD was recognized was 30 weeks, but the gestational age in 4 cases was unclear because of lack of antenatal check-ups. The main risk factors for IUFD were maternal age over 35 (0.95% to 0.40%) and lack of antenatal check-ups (3.7% to 0.5%). The major causes of IUFD were umbilical cord abnormalities (n=10) and placental abruption (n=8), but IUFD of unknown etiology accounted for about 30% of cases. We should better inform mothers about the importance of antenatal check-ups and manage pregnancies carefully for those who have risk factors for IUFD. Furthermore, we should increase research into the causes of stillbirths.

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　　In this study, to establish a system unique to our hospital, an awareness survey of physical therapists was conducted using a newly developed form to investigate the degree of anxiety about, and participation in supporting, pediatric patients with a developmental disorder, managing patients’ families, and interdisciplinary cooperative activities. The level of anxiety and the degree of participation were evaluated using a visual analog scale. The Mann-Whitney U test was used to compare cooperative activities with different professionals. The results showed that 20 (90.9%) of the physical therapists were anxious about supporting and handling pediatric patients with a developmental disorder and their families. No significant difference in the degree of anxiety was observed among different professionals, but the highest anxiety was observed when working in cooperation with physicians (Dr), followed by clinical psychotherapists (CP), nurses (Ns), medical social workers (MSW), occupational therapists (OT), and then speech therapists (ST). Physical therapists cooperated most frequently with Dr, followed by Ns, OT, MSW, ST, and then CP, with a significant difference between Dr and CP. The findings of this study, showing current awareness and challenges related to pediatric patients with a developmental disorder, provide information that is fundamental for the establishment of a system unique to our hospital.

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　　The process of creating health promotion activities in the community was analyzed by means of document examination. The results showed that the process has four periods, namely, the preparation period, consensus period, planning-implementation period, and continuation period. Based on our results, we propose a general-purpose design for community resident-centered health promotion activities in areas with different characteristics.

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　　We describe a case of Inose-type hepatic encephalopathy due to congenital gastro-renal shunt that was effectively treated with balloon-occluded retrograde transvenous obliteration (B-RTO). An 80-year-old woman repeatedly experienced syncope. Her plasma concentration of NH₃ was elevated to 2363 level and syncope attacks improved after the gastro-renal shunt was closed by B-RTO. Although a congenital gastro-renal shunt is usually treated by surgical ligation, B-RTO is can be effective and less invasive treatment for such cases.

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　　A 59-year-old woman, para 2, attended our hospital for an abdominal mass and atypical genital bleeding. Magnetic resonance imaging revealed a 30×25cm uterine myoma. A preoperative blood examination showed the following results: hemoglobin, 21g/dl; hematocrit, 71.5%; erythropoietin, 38.5mIU/ml; and estradiol, 29.9pg/ml. Abdominal total hysterectomy and bilateral salpingo-oophorectomy were performed, with an estimated blood loss of 1650ml. The weight of the uterus, including the myoma nodule, was 4740g, and the results of histology confirmed the diagnosis of leiomyoma. By postoperative day 28, her hemoglobin, erythropoietin, and estradiol levels had fallen to levels of 15.1g/dl, 6.0mIU/ml, and 5.8pg/ml, respectively, which are normal for a postmenopausal woman. The findings suggest that the leiomyoma secreted erythropoietin and induced erythrocytosis. Estradiol stimulates erythropoietin secretion and enlargement of the leiomyoma. Some studies have shown that erythropoietin is also a growth factor for leiomyoma. More than half of the erythropoietin-producing leiomyomas are detected after menopause. It was discovered that leiomyoma cells can produce aromatase, which transforms androstenedione into estradiol. Although estradiol secretion from the ovaries decreases in the postmenopausal period, the estradiol and erythropoietin autocrine/paracrine system in leiomyoma might promote its own growth after menopause.

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　　The patient was a 66-year-old woman who had a hysterectomy for myoma uteri 20 years before presenting to us, followed by vaginal stump prolapse about 10 years later. At the age of 64 years, she developed dysuria and vaginal stump prolapse and visited the urology clinic. An indwelling urethral catheter was inserted and surgical treatment was recommended. In January 2013, she underwent a complete transvaginal mesh operation for vaginal stump prolapse. Postoperatively, the prolapse was cured but stress urinary incontinence occurred. In June 2013, transobuturator tape was used to treat urinary incontinence. Three months later, transurethral inversion of the bladder became obvious associated with pain, and severe incontinence recurred. In November 2014, urethroplasty and a rectus muscle fascia sling procedure were performed. The transurethral inversion of the bladder was cured and the patient could void without urinary incontinence.

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　　Anti-androgen therapy is commonly used for prostate cancer and it has been reported to induce severe hyperglycemia. Diabetic chorea is characterized by acute uni- or bilateral chorea or ballismus and hyperintensity of the striata on T1-weighted magnetic resonance imaging (MRI) images, and is associated with changes in the blood glucose level. We report here a case of diabetic chorea caused by severe hyperglycemia induced by anti-androgen therapy. A 71-year-old man received a diagnosis of prostate cancer and was given leuprorelin acetate (11.25mg, every 3 months) and bicalutamide (80mg/day). After the third injection of leuprorelin acetate, he developed involuntary movements of the right extremities. His glucose and hemoglobin A1c levels were found to be markedly elevated (691mg/dl and 19.5%, respectively), and brain MRI showed high-intensity areas in the left striatum on T1-weighted imaging. The diagnosis was diabetic chorea and he was admitted to our department. His involuntary movements diminished immediately after intravenous infusion of 500 ml saline. His blood glucose level was decreased after initiation of basal/bolus insulin therapy and discontinuation of leuprorelin acetate, but he gradually developed involuntary movement of right extremities again.

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　　A 77-year-old woman was admitted to our hospital because of low-grade fever and lightheadedness 7 days after the removal of a carious broken tooth. Neurological examination revealed disturbed consciousness and meningeal sign with mild ophthalmoplegia. Cerebrospinal fluid examination showed elevated levels of polymorphonuclear cells and enhanced magnetic resonance imaging revealed a left masticator space abscess. On the basis of these findings, the diagnosis was meningitis complicated by a masticator space abscess. Although her symptoms were ameliorated after the administration of antibiotics, her consciousness deteriorated accompanied by bilateral total ophthalmoplegia. Enhanced head computed tomography revealed a filling defect of the superior orbital veins with enhancement of the cavernous sinus, suggesting cavernous sinus thrombosis. After the addition of anticoagulants to antibiotic therapy and surgical drainage of the abscess, she recovered without residual neurological impairment. Because cavernous sinus thrombosis is potentially life-threatening, early diagnosis and initiation of appropriate therapy are extremely important.

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　　Case: A 62-year-old woman underwent high anterior resection and partial lobectomy for colon cancer and lung metastasis, respectively, and postoperative chemotherapy. During the follow-up period, she visited the Department of Otolaryngology at our hospital, complaining of expectoration of a mass. Laryngeal fiberscopy showed no abnormality, but thoracic computed tomography revealed nodular lesions protruding into the bronchial lumen. Bronchoscopy confirmed the presence of multiple granular nodules protruding from the bronchial wall. The nodules had a polyp-like appearance and were easily dissected or detached. Anti-cancer drug therapy was initiated for endobronchial metastases from colorectal cancer diagnosed in transbronchial biopsy. Conclusion: This was a rare case of endobronchial metastases that were discovered after expectoration of tumor masses. Bronchoscopic findings were extremely unusual, showing multiple tumors that were easily detached because of their extremely weak connection to the bronchial wall. The findings suggest that it is important to consider endobronchial metastasis from colorectal cancer and perform early diagnostic imaging and bronchoscopy when patients present with recurrent expectoration of masses after surgery for colon cancer.

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　　A 63-year-old woman was admitted with complaints of thirst and polyuria about 1 year after ceasing therapy in November, X and in October, X+1. Her blood glucose levels at the beginning of her admissions were 347 at the first admission and 486 at the second admission. We administered glargine, a long-acting type insulin, 8U/day, and　a short-acting insulin, glulisine, 4U/day, during the first admission. We administered glargine, a long-acting type insulin, 4U/day, and a short-acting insulin, glulisine, 3U/day, during the second admission. We also administered a GLP-1 receptor agonist, liraglutide, 0.3mg/day. Blood glucose levels (mg/dl) during the 5 days of the first admission were as follows: first, -, -, 347, and 180; second, 273, 266, 109, and 188; third, 75, 192, 186, and 182; fourth, 93, 194, 91, and 144; fifth, 78, 95, 124, and 127. In the second admission, blood glucose levels were as follows: first, -, -, 486, and 299; second: 140, 137, 195, and 128; third: 101, 122, 114, and 108; fourth: 101, 123, 123, and 137; and fifth, 89, 136, 111, and 129. CGM data showed an average of 128mg/dl and standard deviation of 34 during the first admission. CGM data showed an average of 125mg/dl and standard deviation of 20 during the second admission. The reduction of insulin and rapid flattening of blood sugar were achieved by GLP-1 receptor agonist with promotion of insulin secretion and suppression of glucagon secretion.

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　　Hospitals and their affiliated institutions established by the same organization (hereinafter, Organization A) provide level-specific training programs to cultivate nurses who are independent professionals and continuously perform high-quality nursing practice, but no program has been developed for mid-level nurses. In this study, the current status of continuing education for mid-level nurses and the educational content and teaching method required by mid-level nurses were investigated in order to develop basic educational materials for them. We conducted an anonymous self-administered questionnaire survey of 355 nurses who had ≥10 years of experience in nursing (excluding those in management) and were working at hospitals established by Organization A. A qualitative descriptive analysis of 192 survey responses (response rate, 54.0%) was conducted by simply summarizing qualitative answers and by categorizing written answers through inductive classification in content analysis. The rate of participation in workshops held inside and outside the hospitals in the past 1 year was 92.5% and 69.2%, respectively. When asked about their feeling toward workshops, 56% of the nurses answered by saying “they wanted to attend workshops if attendance was considered as a part of the job”. When asked about whether their preference on educational content and teaching method had been incorporated, 56% of the nurses answered “unsure”. Among the nurses surveyed, 25% did not attend in-hospital workshops because “they were tired” and 24% did not attend out-of-hospital workshops because “the venues were far away”. In addition, 61% of the nurses wanted to attend workshops that help improve professional skills as a mid-level nurse, 54% selected “nursing practice skills” as educational content, and 47% preferred “lecture/practice”, all for the reason that “practice is the mother of all skills”. Our future challenge is to establish a training program for nursing practice skills that teaches how to perform the skills.

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　　We performed a survey of the psychological influence of exercise intervention by walking with set goals in the elderly. The participants were 14 elderly individuals between the ages of 65 and 79 who were divided into two groups according to whether they achieved the set goals or not. The goals were at least 8000 steps and 20 min of moderate-intensity physical activity daily. We conducted a questionnaire survey on psychological status before and after the 24-week intervention. Eight participants achieved the goals and 6 did not. The findings of psychological status showed no significant changes in all participants or in the two groups. However, we found that psychological status improved in the group that had achieved the goals but not in the group that had not achieved them. Psychological status, such as subjective well-being and the degree of satisfaction with life, were better in the group that achieved the goals than in the group that did not. An exercise intervention with set goals may lead to improvements in psychological status and health. However, if participants cannot achieve their goals, the intervention may worsen their psychological status. Our study suggests that goals could be an inhibiting factor for health promotion.

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　　There is a need for measures to prevent accidental ingestion at hospitals that provide food for children with food allergies. The dietetics department of our hospital attempts to prevent accidental ingestion by providing meal tags that clearly indicate the dishes prepared without allergens (“allergen-free meal”), which are attached in the designated area by a licensed cook in charge of food preparation. During the 1-year period between January and December 2014, 258 children with food allergy were treated in our hospital and received allergen-free meals. There were 3 cases in which dishes containing allergens were served by mistake, and accidental ingestion by the patient occurred in 2 cases. Regarding the cause of these serving errors, it is likely that they occurred because allergen-free dishes were served using tableware with the same color as that used for allergen-containing dishes. Accordingly, we have revised our preventive measures against accidental ingestion so that all of the tableware and trays used for allergen-free dishes are yellow in color, in order to distinguish them from other dishes. Furthermore, we have provided a dedicated shelf for allergen-free dishes, and have also made it a requirement for final confirmation to be performed by 2 responsible cooks who double-check the food before serving. We will continue to monitor and improve our measures to prevent accidental ingestion as necessary.

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