The purposes of this study were to review investigations on ‘Tojikomori’ elderly in Japan, and to examine valid definitions of ‘Tojikomori’ as a risk factor for functional decline.
 In the present study, we reviewed 94 studies in the literature. 86 obtained from Japan Centra Revuo Medicina, version 3 (systematic literature search system for Japanese literature). We added 8 studies from references in 86 reports in the literature. The number of publications on ‘Tojikomori’ has rapidly increased since 2000. In the existing literature, ‘Tojikomori’ has been defined using one or more of the following four elements; (1) Extent of daily activity, (2) Frequency of going out, (3) Frequency of contact with others, and (4) Mobility. The definition using “Frequency of going out” has gained favor in recent years.
 This study reviewed three papers that examined the validity of the ‘Tojikomori’ definition as a risk factor for functional decline. Future study is required with attention to the following three points: (1) larger sample size and longer follow-up: (2) plural definitions: and (3) control for confounding factors.

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Objective To identify factors associated with successful smoking cessation among adolescent smokers in a smoking cessation program involving nicotine replacement therapy.
Methods We recruited adolescent smokers who were prepared to quit smoking and participated in the smoking cessation program in Kanagawa prefecture. All participants fulfilled a questionnaire beforehand, covering gender, age at the beginning of the study, age at onset of smoking, the number of quit attempts, the number of cigarettes per day and the smoking status of their families and friends. Seven nicotine patches (nicotine 52.5 mg/day) were given to them free of charge for daily use. Their smoking status and the use of nicotine patches were confirmed by telephone or postcard at the 1 and 6 month follow-ups. The relationships between successful smoking cessation and different factors among eligible participants were analyzed using the Fisher's exact test and the Mann-Whitney U test.
Results The subjects included 39 adolescent smokers (mean 16.4 years). The mean age at onset of smoking and the mean duration of smoking were 13.3 years and 2.3 years, respectively. The average daily number of cigarettes smoked was 12.8. Of 39 eligible participants at the one month follow up, 14 (35.9%) were found to be abstaining from smoking. The subjects treated with nicotine patches were significantly more likely to be abstinent than those without them (P<0.05). However, no significant associations with other factors were found. Of 39 participants at the six months follow up, 10 (25.6%) were still abstinent but there were no significant associations with any of the factors, including use of nicotine patches. Subjects living with smokers were significantly less likely to be successful in their efforts to quit than those living with non-smokers (P<0.05). There were no significant associations with other factors, including using nicotine patches. No adverse events relating to the use of the nicotine patches were encountered during the study period.
Conclusion The smoking cessation program involving NRT provided for adolescent smokers appeared effective at the one month follow up. Those adolescents living with smokers had more difficulties in quitting smoking than those with non-smokers at the 6 month follow up. In order to increase the number of adolescent smokers in the smoking cessation study, the need to obtain parental consent might be considered as a barrier to be overcome. Additionally, more effective follow-up procedures should be considered for the purpose of avoiding dropouts during the study.

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Objective This study was performed to examine effects of an intervention aimed at promoting partnerships between professionals and self-help groups for family members (family groups) of persons with severe mental illness in Japan.
Methods A group randomization design where the unit of randomization was the family group as a whole was used, with family groups (N=24) randomly assigned to either intervention or control groups. Twelve family groups and 15 professionals made up the intervention group, and 12 family groups and 14 professionals made up the control group. A total of 149 family members were eligible participants in the study; 76 from family groups in the intervention group and 73 from the control group. A semi-structured program was conducted for six months. The effects of the intervention were analyzed at three levels: the family group level, the individual family member level and the individual professional level.
Results Significant increases were found in the number of family members registered in family groups and program satisfaction for members of the intervention family groups. Professionals involved with family groups in the intervention group felt greater empowerment than those in the control group.
Conclusion The tested intervention proved effective for both family groups and professionals associated with the groups.

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Objectives To examine and describe the reactions of Amagasaki City Health Center to the train derailment accident that occurred on April 25th, 2005 on the Japan Railway (JR) Fukuchiyama Line in order to provide useful information for health centers to help them deal with such catastrophic disasters in the future.
Methods Each day after the accident reactions and actions were examined and described. They included mental health care provided by the health center for the inhabitants of the condominium building into which the derailed train had crashed, as well as the volunteers who participated in the rescue work. Health checkups were also provided for the latter.
Results Actions directly related to the rescue were continued by the health center for four days after the accident. The mainly consisted of the following. The health center asked hospitals to input information concerming their ability to respond to the emergency situation into the Hyogo Emergency Medical Information System. A relief party was organized by the health center staff and engaged in the rescue and on-site rescue triage. The health center slso coordinated the mortuary work. Two days after the accident, “postmortem triage,” to insure that bodies were taken directly to a mortuary after death certification by a physician was needed on site after rescue triage was concluded. The health center confirmed all information for the passengers’ safety. The rescue volunteers and the nearby inhabitants who were affected consulted with the person in charge of mental health care provided by the health center from immediately after the accicent for a period of five months to September 30. Health checkups for rescue volunteers were conducted for infections and post-traumatic stress disorder.
Conclusions This JR accident was characterized by many civilian volunteers engaged in rescue over the relatively long period of rescue of four days. Mental health care and health checkups were needed for civililian volunteers and were therefore provided by the health center. During the four days of rescue, triage was begun immediately after the accident and subsequent postmortem triage was also required.

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Objective The objective was to conduct a survey to examine what support is necessary for patients with Parkinson's Disease (PD) given in-home care in Japan and to determine the current status of care service utilization.
Methods In 2004, a questionnaire survey was conducted on the Tokyo chapter members of the Japan PD Association and the results were compared with those from the 1995 survey performed on subjects from the same association. In the 1995 survey, half of the association members of the chapter were selected via random systematic sampling. In the 2004 survey, the questionnaire was mailed with a newsletter to all the association members of the chapter. The individuals returned their questionnaires by postal mail.
Results The collection rates were 52.9% in 1995 and 21.3% in 2004. In both surveys, the mean age of the participants was 69.0 years old. The respondents in the 2004 survey had a higher severity of disease and a larger percentage answered that they had predominant symptoms and difficulties with daily life. Regarding participation in various activities, opportunities to work had decreased, but the possibility of meeting people other than at work and to engage in hobbies and relax had increased. Regarding sources of information, decrease was noted for public health nurses and increase for magazines. There was an increase in the number of people who were told that their problem was psychological at their initial diagnosis.
 58.2% of the respondents in the 2004 survey received approval for long-term care insurance, and 37.3% of these reported that they their symptoms were more severe than the level for which they were approved. 7.5% of the respondents answered that their condition had worsened after admission to a nursing facility.
Conclusion The results of this 2004 survey have limitations and might not be characteristic of all PD patients. However, the respondents answered that their severity of disease was high and their difficulties increased, despite increase in opportunities to enjoy hobbies and to relax. Clearly, some patients feel that their condition is more severe than the level recognized by the primary nursing care authorities, with some considering that their conditions worsened after receipt of services. Understanding the characteristics of PD, provision of services appropriate to patients' symptoms, and ways of incorporating rehabilitation in patients' daily lives appear to be increasingly necessary. Information support is necessary to understand how best to provide psychological support for PD patients.

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