Objective: The rates of care-needs certification were mainly compared between two cohorts: 7,820 specific health checkup examinees/basic checklist respondents and 29,234 non-examinees/non-respondents.

Subjects and Methods: Among approximately 37,000 elderly citizens of X City, the number of individuals newly certified as requiring long-term care were observed from the date of the first specific health checkup in 2008 to March 31, 2013. The aggregated totals of these individuals and associated factors were evaluated.

Results: 1. Support Required 1, Support Required 2, and Long-term Care Required (level 1) certified individuals accounted for approximately 80% of newly certified individuals aged 65–74 years. Newly certified individuals aged 75 years and over had similar results with 37.2% of them being certified Support Required 1, 19.4% certified Support Required 2, and 22.9% certified Long-term Care Required (level 1). 2. The primary factors for care-needs certification in individuals aged 65–74 years were arthritic disorder in 27.6%, falls and bone fractures in 11.3%, and malignant neoplasm and cerebrovascular disease, among others. This was similar for individuals aged 75 years or over. 3. Of the 7,820 specific health checkup examinees/basic checklist respondents, 1,280 were newly certified as requiring long-term care (16.4%) compared to 7,878 (26.9%) of the 29,234 non-examinees/non-respondents. Therefore, the latter cohort had a significantly higher rate of individuals who were newly certified as requiring long-term care.

Conclusion: Both specific health checkups and basic checklists are effective health policies to protect frailty in community elderlies.

Objective: Community-based medical education (CBME) serves as a complement to university medical education, and it is practiced in several urban undergraduate and postgraduate curriculums. However, there are few reports on CBME learning content in rural Japanese settings.

Materials and Methods: This research aimed to clarify learning content through semi-structured interviews and qualitative analysis of second-year residents who studied on a remote, rural island located 400 km from the mainland of Okinawa, Japan. Analysis was based on Steps for Coding and Theorization (SCAT).

Results: Fifteen concepts were extracted, and four categories were generated: a strong connection among the islanders, the necessary abilities for rural physicians, islander-centered care, and the differences between rural and hospital medicine. In contrast to hospital medicine, various kinds of learning occurred in deep relationships with the islanders.

Conclusion: Through CBME on a remote island, the residents learned not only about medical aspects, but also the importance of community health through the social and cultural aspects, whole-person medical care in a remote location, and the importance of reflection in their self-directed learning.

Objective: Participation in social activities is associated with physical and psychological health in the community-dwelling elderly population. We examined the two factors of social relations and community health resources, associated with higher self-rated health levels in the community-dwelling elderly.

Methods: A total of 145 community-dwelling elderly people ≥ 65 years old from two neighborhood associations in Nagasaki City were recruited for this study, representing 85% of the officially registered ≥ 65-year-old population in the target area. Face-to-face interviews using a structured questionnaire were conducted by trained interviewers in August 2009, with questions related to sociodemographic characteristics, social relationships, and self-rated health (SRH). Community health resources (type and walking distance from home) were evaluated by one of the authors as a community assessment.

Results: Seventy-eight community-dwelling elderly people (25 men and 53 women) participated in the study. Elderly people who reported going out every day were more likely to show higher SRH scores (excellent/good) than those going out less often (OR: 3.7; 95% confidence interval [CI]: 1.0, 14.2; P = 0.056). The numbers of interactions with friends in higher and lower SRH groups were 6.5 ± 8.4 (mean ± standard deviation) and 2.4 ± 1.1 (P = 0.01, Mann-Whitney U test), respectively. The numbers of relatives talking on the phone in higher and lower SRH groups were 2.9 ± 1.3 and 2.2 ± 1.2 (P = 0.031, Mann-Whitney U test), respectively. Meeting scores with friends in higher and lower SRH groups were 7.8 ± 5.8 and 4.5 ± 3.6 (P = 0.068), respectively. The scores of community health resources among higher and lower SRH groups were 21.2 ± 1.5 and 20.9 ± 1.4 (P = 0.547), respectively. The scores of community association/activities in higher and lower SRH groups were 3.9 ± 1.0 and 3.6 ± 0.9 (P = 0.227), respectively.

Conclusion: This study indicated the importance of interaction with friends and relatives for maintaining higher SRH among community-dwelling elderly people.

Objective: We clarified the relationship between the degree of subjective fatigue, sleep, and physical activity among nurses working 16-hour night shifts in a rotating two-shift system.

Materials and Methods: We investigated 15 nurses who were surveyed regarding their individual attributes, physical activity level (consumed calories), hours of sleep, sleep efficiency, sleep onset latency, sleep diary, and subjective symptoms. Nurses wore a Fitbit One (Fitbit Inc., San Francisco, CA, USA) for 7 consecutive days to measure sleep and physical activity.

Results: Results were analyzed for nine participants, excluding those who withdrew or had missing data. The years of nursing experience, nurses’ age, and the length of nocturnal awakening time of the high fatigue group were significantly longer than of the low fatigue group (p < .05). Years of nursing experience in the affiliated department of the high fatigue group was significantly shorter than of low fatigue group (p < .05). The number of nightshifts during the survey period was significantly higher in the high fatigue group than in the low fatigue group. Fatigue after work and body mass index (r = 0.46, p < .001), consumed calories (r = 0.30, p < .05), bedtime (r = –0.36, p < .05), and hours of sleep (r = –0.37, p < .01) were significantly correlated; however, the sleep indices were not correlated.

Conclusion: We clarified that the degree of fatigue in nurses working 16-hour night shifts in a rotating two-shift system was related to individual factors, such as age, years of nursing experience, years of nursing experience in the affiliated department, number of nightshifts, and length of nocturnal awakening time. Nurses with greater fatigue had significant differences in their bedtime on days off and work days, which suggests that sleep rhythm may also affect fatigue.

Objectives: To compare experiences regarding the perpetration of intimate partner violence among Japanese university freshmen between 2008 and 2014.

Study design: Two-stage cross-sectional study.

Methods: A self-administered questionnaire survey was completed in both 2008 and 2014 by students at the same university.

Results: There were significant reductions in episodes of verbal harassment (adjusted odds ratio [AOR]: 0.601, 95% confidence interval [CI]: 0.382, 0.945, P = 0.027) that occurred when a boy/girlfriend said “you don’t give me priority” to his/her partner when they did not see them (AOR: 0.450, 95%CI: 0.207, 0.979, P = 0.044), and also in instances of irritation that resulted when a boy/girlfriend disobeyed his/her partner (AOR: 0.385, 95%CI: 0.161, 0.921, P = 0.032) from 2008 to 2014. The perpetration scores were reduced from 1.87 ± 0.16 in 2008 to 1.41 ± 0.117 in 2014 (t test, P = 0.016). The perpetration scores in 2014 were significantly lower than those in 2008, regardless of gender, age, university faculty, and participation in lectures/seminars about domestic violence (DV) and/or dating DV (P = 0.030).

Conclusions: Findings showed reductions in some types of harassment, as well as in perpetration scores, between 2008 and 2014 among Japanese university freshmen at the same university. However, further study is required to determine the factors related to the perpetration of harassment.

Aim: To evaluate the costs associated with healthcare and long-term care during the last 24 months before death according to major disease groups.

Methods: Individual data regarding healthcare and long-term care costs according to public insurance schemes during the last 24 months before death among all decedents older than 75 years reported in a city in Japan between April 1, 2010 and March 31, 2014 were identified; the data for nine major diseases were then analyzed.

Results: For the 2149 decedents studied, the average healthcare costs per capita in the last 24 months of life for moderately-old (75 to 84 years) and extremely-old (85 years and older) decedents was 4,135,467 JPY and 2,493,001 JPY, respectively, while the average long-term care costs per capita for 24 months was 1,300,710 JPY and 2,723,239 JPY, respectively. The total costs (healthcare and long-term care combined) ranged from 9,169,547 JPY for chronic kidney disease to 5,023,762 JPY for ischemic heart disease. In all the diseases studied, the moderately-old decedents incurred higher healthcare costs while the extremely-old decedents incurred higher long-term care costs. However, for the care costs of chronic lower respiratory diseases, this pattern was not observed.

Conclusion: A shift in expenditure from healthcare to long-term care as the decedents’ age increased was observed in major diseases, with some exceptions.

A 15-month retrospective study of 1,000 outpatients was conducted to determine the exact cause of general dizziness. The most common diagnosis in all analyzed cases was cervicogenic general dizziness (89%). The majority of the patients who underwent magnetic resonance imaging of the cervical spine had narrow spinal canals. Measuring the anteroposterior diameter of the spinal canal in each case was critical to obtain an accurate diagnosis in line with the diagnostic criteria used. General dizziness may develop because of inappropriate neck posture over long periods of time in individuals with some form of underlying cervical disease. The causes of general dizziness were different between male and female patients and between patients of different age groups. Triggers leading to general dizziness included engaging in farming, gardening, or weeding activities for long periods of time, particularly in elderly women. Selection of the appropriate muscle relaxant type and dosage is important in the treatment of patients with cervicogenic general dizziness who also experience a stiff neck and shoulders. Following treatment, 90% of patients no longer experienced general dizziness or exhibited clear improvements in their symptoms within 1 week. The results of this study emphasize the importance of cervicogenic general dizziness, which is due to cervical vertebral lesions and is exacerbated by excessive stress on the cervical spine.

Objective: This study investigated the relationship between occupations and health status to obtain an overall understanding of a cohort of Japanese middle-aged women, including unemployed women, who comprised approximately 30% of the sample.

Participants and Methods: Participants of this study were 4,454 women aged 40–69 years, classified into the following five groups based on their occupation: unemployed, 1,432; agriculture, 439; self-employed, 1,596; white collared, 793; and blue collared, 194. Participants’ perceived health was assessed using a symptoms checklist called the Todai Health Index (THI, later renamed as the Total Health Index) in a baseline survey conducted in 1993. The mortality risk of the participants was assessed using the Cox’s Proportional Hazards Model.

Results: The means of the percentile values on the Total Scale 1 in the THI were as follows: agriculture, 43.7; unemployed, 50.8; self-employed, 52.5; white collared, 53.0; and blue collared, 56.1, with lower percentile values indicating better perceived health. The results showed that women engaged in agriculture were in significantly better health than were those in the other four occupations. The hazard ratios (HRs) and 95% confidence intervals of the occupational groups adjusted for age, area of residence, and Total Scale 1 scores were as follows: agriculture (reference group), 1; white collared, 1.16 (0.77–1.74); self-employed, 1.25 (0.87–1.78); unemployed, 1.27 (0.91–1.77); and blue collared, 1.50 (0.86–2.60).

Conclusions: Women engaged in agriculture had a significantly higher tendency to have a better health status on the THI as compared to those from the other four occupational groups, and they exhibited the lowest HR as compared to their counterparts, though not statistically significant. We concluded that the perceived health status of unemployed women was similar to that of women engaged in agriculture.

Objective: The burden of noncommunicable diseases (NCDs) is increasing in China, together with economic development and social changes. The prevalence of risk factors for NCDs, such as overweight/obesity, hypertension, diabetes, and dyslipidemia, is reported to be high even among poor residents of rural areas. We aimed to investigate the prevalence of hypertension among elderly adults in rural Northeast China and the proportion with controlled hypertension among those on antihypertensive medication (hypertension control rate). We also aimed to examine the association of hypertension control with health facilities that provide treatment.

Methods: We conducted a community-based cross-sectional study in six rural villages of Northeast China from February to early March, 2012. We interviewed 1593 adults aged 50–69 years and measured their blood pressure. We examined the differences in mean blood pressure between participants who obtained antihypertensive medication from village clinics and those who obtained medication from other sources, using analysis of covariance adjusted for several covariates.

Results: The prevalence of hypertension among participants was as high as 63.3%, but the hypertension control rate was only 8.4%. Most villagers (98.1%) were not registered in the chronic disease treatment scheme of the public rural health insurance. The mean systolic blood pressure, adjusted for the covariates, of participants who obtained antihypertensive medication from village clinics was significantly lower than that of participants who obtained medication from township hospitals (by 16.5 mmHg) or from private pharmacies (by 7.3 mmHg).

Conclusion: The prevalence of hypertension was high and the hypertension control rate low among elderly villagers during the cold season. As treatment at village clinics, which villagers can access during the cold season seems to be more effective than self-medication or treatment at distant hospitals, improving the quality of treatment in village clinics is urgently needed.

Background: Although acute pancreatitis is listed among the exclusion criteria for the administration of recombinant tissue plasminogen activator according to the Japanese Guideline for the Management of Stroke, the co-occurrence of acute pancreatitis and acute ischemic stroke has not been investigated. The present study aimed to assess the incidence rate of acute pancreatitis in patients with acute ischemic stroke.

Methods: This study consecutively enrolled all patients with ischemic stroke admitted to the Department of Neurology, JA Toride Medical Center between April 2014 and March 2016. Diagnosis of acute pancreatitis was made according to the revised Atlanta Classification of Acute Pancreatitis. We retrospectively analyzed serum amylase activity and the frequency of acute pancreatitis as a comorbidity of ischemic stroke.

Results: A total of 411 ischemic stroke patients were included. Serum amylase activity was measured for 364 patients, 27 of whom presented with amylase activity exceeding the upper limit of normal. In two patients with serum amylase activity greater than three times-fold the upper limit of normal, computed tomography or transabdominal ultrasonography showed no characteristic findings of acute pancreatitis. No patient in the cohort met the diagnostic criteria for acute pancreatitis.

Conclusions: Acute pancreatitis is a very rare comorbidity of acute ischemic stroke.

Objective: As a minimal invasive surgery for the treatment of thumb carpometacarpal joint (trapeziometacarpal [TMC]) arthritis, we performed an arthroscopic synovectomy for Eaton stage II to IV arthritis.

Patients and Methods: We included patients who were effectively treated with a corticosteroid injection, experienced recurrence of TMC pain, and had no major instability of the TMC. Surgery was performed in 17 female patients. Synovectomy was performed, when possible, using radiofrequency and a shaver. The mean follow-up period was 27.2 months.

Results: Two patients required additional surgery; however, 15 patients were satisfied with the outcome. The mean visual analogue scale score improved from 8.8 preoperatively to 2.2 postoperatively.

Conclusion: Arthroscopic synovectomy is indicated to be an effective treatment for stage II to IV TMC arthritis. The goal of this treatment was to relieve severe pain minimally invasively. Furthermore, if symptoms remain or reoccur, another curative procedure can be chosen.

A 10-year-old boy fell from a one-meter-high Jacuzzi ladder in a hot spring facility, landing in a straddle position, and injured his perineum. He visited the emergency room of our hospital immediately after the injury. Magnetic resonance imaging (MRI) revealed a tear of the corpus spongiosum urethra, and compression due to a hematoma. With the hematoma spreading to the scrotum, the testes became inverted and dislocated to the inguinal region on both sides. Without surgery or interventions, the testes descended into the scrotum on the third day after the injury before fibrillation and scarring began. Testicular dislocation by injury is rare and encountered exclusively in children. It is generally treated with surgery to retain testicular function. We selected conservative management, as our patient had a closed injury without testicular torsion, and the testicular dislocation was associated with compression by hematoma, which could possibly recover with regression of the hematoma.

Objective: Both infected subdural hematoma (ISH) and Edwardsiella tarda infections are rare in humans. E. tarda is a motile, facultative anaerobic, gram-negative rod bacterium, which is isolated from fresh or brackish water, but not usually from humans. Extra-intestinal E. tarda infections are rare and might cause severe clinical symptoms. However, ISH caused by E. tarda has not been reported previously. We report the first case of ISH due to E. tarda.

Patient: A 76-year-old man was admitted to our hospital with a headache, loss of appetite, and nausea. Computed tomography revealed bilateral subdural hematoma.

Results: We performed burr hole drainage. A hematoma with pus was found on the left side and chronic hematoma was found on the right side. Consequently, we diagnosed him with ISH on the left side and chronic subdural hematoma on the right side. E. tarda was detected in a culture from the hematoma with pus on the left side. As postoperative antibiotic therapy, we administered ceftriaxone and metronidazole for 47 days. The patient was discharged with no residual neurological deficit.

Conclusion: Our case implied that favorable outcomes can be obtained by drainage and appropriate antibiotic therapy for ISH caused by E. tarda.