Objectives The aim of this study was to systematically review intervention programs for frail elderly people enrolled in the Japanese social long-term care insurance system to clarify the effects and identify any problems.
Methods We reviewed 61 articles (7 in English and 54 in Japanese) from four databases: MEDLINE, CINAHL, PsycInfo, and “Igaku Chuo Zasshi Web” (the Japana Centra Revuo Medicina) version 5. We focused on the following three areas: age and male/female ratio of participants, study design, and intervention program.
Results The results showed that (1) participants tended to be ≥75 years of age and female, (2) more than half of the programs were of a before and after design, and (3) most interventions took place in local community centers and were group programs for muscle training and/or physical exercise that improved physical function.
Conclusion Future studies focusing on the following intervention programs are necessary: individual programs such as home visits for those who do not want to participate in group programs and programs that improve instrumental activities of daily living, nutrition, oral function, cognitive function, and depression. Additionally, while there are many studies reporting the effect of muscle training and exercise, randomized controlled studies are necessary to more accurately evaluate the effects.

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Objectives Health and welfare professionals experience difficulties during their casework on individuals in the community. The purpose of this study was to identify the characteristics and related factors of those in the community who refuse the support of health and welfare professionals.
Methods Since 2006, based on a signed research agreement between researchers and local government office A, the series of psychiatric consultation services was initiated for healthcare professionals who experienced difficulties in carrying out their casework on individuals in the community. Data were acquired from local government office A and included the patient's basic attributes, family-related factors, psychiatric factors, and problematic behaviors. Additionally, information on whether individuals refused support was obtained. The data did not include private information. To investigate risk factors for refusing healthcare professional support, 372 profiles of patients who underwent consultation services from 2006 to 2012, were analyzed by logistic regression analysis.
Results Among 309 persons, only 102 (33.0%) accepted support from health and welfare professionals, and 207 (67.0%) persons refused support. Logistic regression analysis revealed that individuals in the community who received welfare benefits (odds ratio [OR]=1.86, 95% confidence interval [CI]=1.02–3.39), refused medication (OR=2.07, 95%CI=1.10–3.90), or used abusive language towards healthcare professionals (OR=1.97, 95%CI=1.09–3.55) were more likely to refuse support from health and welfare professionals.
Conclusion The results indicate that individuals in the community who refused support of health and welfare professionals tend to have a worsening condition and a greater need for crisis intervention than those who did not refuse support.

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Objectives Analyzing the cancer treatment situation in Japan is an important public health issue, especially because of increasing crude cancer morbidity in a rapidly aging society. This study aimed to examine where cancer patients received treatment, with special attention to designated regional cancer hospitals, and the treatment modality they received.
Methods Using health insurance claim data (1,064,875 subjects on December 2011) managed by the Japan Medical Data Center, we included patients that received treatments for stomach, colon, liver, lung, or breast cancer, the most common cancers in Japan, between 2005 and 2011. We divided the medical facilities where they were treated into five groups: prefectural designated regional cancer hospitals, local designated regional cancer hospitals, large/medium hospitals (≥100 beds), small hospitals (20–99 beds), and clinics (0–19 beds). We calculated the percentage of patients treated at each type of medical facility with different treatment modalities.
Results The study included 2,901 patients. In total, 43.9% patients were treated at designated regional cancer hospitals (prefectural or local). This percentage was the highest for lung cancer (60.0%) and the lowest for colon cancer (31.3%). Surgeries for liver cancer (67.6%) and lung cancer (61.9%) were performed more at designated regional cancer hospitals (prefectural or local) than surgeries for stomach cancer (45.5%), colon cancer (40.1%), and breast cancer (49.8%). Some procedures were performed at small hospitals or clinics (surgery for stomach cancer [9.4%], surgery for breast cancer [9.3%], endoscopic procedures for stomach cancer [14.1%] and colon cancer [40.6%], and chemotherapy for breast cancer [11.4%]). Colon and breast cancer patients treated at prefectural designated regional cancer hospitals or clinics were younger than those treated at other types of facilities.
Conclusion The distribution of facilities at which cancer patients received treatment differed significantly according to cancer site, treatment modality, and patient age.

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