The purpose of this cohort study is to clarify the risk factors of low well-being of elderly people who residing in a local city of a super-aging country, Japan.

Subjects are people, who have selected randomly from healthy elderly people resided in Kizugawa City, Kyoto Prefecture, in 2010, followed until 2015. Question survey was conducted in both year, and questionnaire consisted of items such as basic attributes, lifestyles (health practices, consultation behaviors, social activities and so on) and well-being (WHO-5). In analysis we made multi-logistic regression analysis using lifestyle variables as an independent variable and well-being as a dependent variable.

The results were as follows.

1. Risk factors were not to exercise, knowledge of appropriate diet, subjective feeling of stress for at least a month, not to participate in voluntary activities, age and bad subjective feeling of health.

2. Risk factors in regard to changes of lifestyles using good-good lifestyles as a reference were sustainment of having no time for hobby or relaxation, sustainment or deterioration of subject feeling of stress for at least a month, sustainment or deterioration of having no time for relaxation and deterioration of having no activities with pleasure or aim. A factor promoting well-being is to have more frequencies for going out home.

This study shows that in a longevity society it is important for community-dwelling elderly Japanese to have good health practices, appropriate consultation behaviors and good social activities for the purpose of keeping good well-being, and that these results are contributed to health promotion policy for community-dwelling elderly people.

Purpose: Endoscopic submucosal dissection is a promising method for the resection of superficial gastric neoplasms. To date, several institutions have used proton pump inhibitor injections over the perioperative period. However, there is very little evidence regarding their efficacy. To overcome this limitation, we compared procedural outcomes and the prevention of adverse events of proton pump inhibitor injection with an orally administered active potassium-competitive acid blocker alone.

Participants and Methods: We enrolled a total of 150 patients treated for superficial gastric neoplasms at a single institution between April 2015 and December 2018. Patients treated for 2 days with proton pump inhibitor injections following 12 days of oral potassium-competitive acid blocker (proton pump inhibitor group=80) were compared with patients treated for 14 days orally with potassium-competitive acid blocker alone (potassium-competitive acid blocker group=70) using propensity score analysis. We evaluated intragastric pH levels prior to endoscopic submucosal dissection, frequency of intraoperative major bleeding, procedure time, en bloc resection rate, curability, ulcer reduction rate 14 days after endoscopic submucosal dissection, and adverse events (including perforation and postoperative bleeding).

Results: Propensity score analysis yielded 43 matched pairs. The comparison demonstrated similar values for the outcomes. For all cases, we observed intragastric pH levels >6.4 prior to endoscopic submucosal dissection. Postoperative bleeding rates were 2.3% (1/43) in the proton pump inhibitor group and 0.0% (0/43) in the potassium-competitive acid blocker group (P=0.315).

Conclusions: Oral potassium-competitive acid blocker alone was as effective as proton pump inhibitor injection, with a low incidence of adverse events. Based on these results, proton pump inhibitor injection might be omitted during gastric endoscopic submucosal dissection.

Objective: To determine whether severe kyphosis is one of the risk factors of umbilical trichophytosis in elderly people.

Patients and Methods: Four cases with umbilical trichophytosis in the last 3 years and all 143 patients who visited to our clinic during from April 2018 to March 2019 were included in this study. The relationship between the condition of umbilical region and kyphosis was investigated. As regards the levels of senile kyphosis, simple visual classification of the kyphosis method was used (Level 0–4).

Results: All four cases with umbilical trichophytosis were elderly women aged ≥80 years, had severe kyphosis, skin overlaps, filthy umbilical region, and lumps of dirt in the umbilical region and had nail tinea. Only two cases had umbilical trichophytosis among 143 patients who visited our clinic during the 1 year study period, with incidence is of 1.4%/year. About 65.7%, 60%, and 37.1% of 35 patients with kyphosis with forward-bent posture had skin overlap, moist, and filthy umbilical regions, respectively. However, these symptoms were not found in patients without severe kyphosis.

Conclusion: Severe kyphosis with forward-bent posture could be one of the risk factors of umbilical trichophytosis in elderly people.

Objective: This study is unique as it examines biological materials brought to the emergency department. The purpose of this study was to investigate the reasons behind the presence of nonhuman biological material in the emergency department.

Methods: The materials brought were photographed and a pre-prepared survey form was filled in following examination.

Results: A total of 46 biological materials were brought to the emergency department within a 12-month period. Ticks were the most frequently brought material, and the most common reason for bringing them was to get the creature removed from the body. Situations in which the physician did not have knowledge about the material were more frequent among those that were neutral about being satisfied with the attitude of the physician towards the material brought, and satisfaction was higher in cases when the physician was knowledgeable, although this was not statistically significant.

Conclusion: Physicians should not condemn biological materials brought into the department after exposure. If possible, they should try to gain more knowledge about them. If the material is not to be stored, once it is made sure that it is not dangerous, it should be disposed of in a medical waste bin. Physicians should be knowledgeable toward the frequency and the types of such agents in their region.

Objective: The aim of this study was to examine the effectiveness and efficiency of interprofessional case conferences on home-based end-of-life care to bridge perceptions gaps regarding ethical dilemmas among different healthcare professionals and analyze essential issues extracted the interprofessional discussions.

Patients and Methods: The participants could spend only a limited amount of time after their working hours. Therefore, we shortened and simplified each of three case scenarios so that the discussions do not last longer than 90 minutes. For the case conferences, we selected 3 cases, which entailed the following ethical dilemmas pertaining to home-based end-of-life care: refusal of hospital admission, passive euthanasia, and emergency transport. Participant responses were audio-recorded, transcribed, and analyzed using qualitative content analysis and Jonsen’s four topics approach.

Results: A total of 136 healthcare professionals (11 physicians, 35 nurses, and 90 care workers) participated in the case conferences. The physicians, nurses, and care workers differed in their perceptions of and attitudes toward each case, but there were no interprofessional conflicts. Despite the short duration of each case conference (90 minutes), the participants were able to discuss a wide range of medical ethical issues that were related to the provision of appropriate home-based end-of-life care to older adults. These issues included discrimination against older adults (ageism), self-determination, an unmet desire for caregiver-patient communication, insufficient end-of-life care skills and education, healthcare costs, and legal issues.

Conclusion: The physicians, nurses, and care workers differed in their perceptions of and attitudes toward each case, but there were no interprofessional conflicts.

Background: In Japan, in 2016, the School Health and Safety Act was revised and examination of extremities in addition to scoliosis became mandatory. Musculoskeletal examinations were subsequently started using a mark sheet-type questionnaire. In the present study, we aimed to analyze the relationship between physical findings and musculoskeletal problems and propose a preventive strategy for musculoskeletal injuries.

Methods: In 2017, a total of 4,073 elementary and middle school students underwent direct musculoskeletal examination. In a direct examination, the following elements were included: torticollis; scoliosis; stiffness of the shoulder, elbow, hip, knee, and ankle; flexion and extension in standing position; flat foot; hallux valgus; and alignment of the upper and lower extremities. Of the 4,073 students who underwent direct examination in early 2017, only 3,754 were able to complete the mark sheet-type questionnaires in early 2018. A prospective longitudinal analysis of the data gathered was performed.

Results: A total of 396 (11%) students had injuries. The ankle sprain/non-ankle sprain group comprised 119 (3%)/3,635 (97%) students, while the fracture/non-fracture group comprised 105 (2.8%)/3,650 (97.2%) students, respectively. Comparing the sprain group with the non-sprain group, ankle stiffness significantly correlated with ankle sprain in the univariable and multivariable analyses. Injuries occurred more frequently among boys, older students, students with stiff bodies, and students who were involved in sports activities of longer duration.

Conclusion: Ankle stiffness was assumed to be a risk factor for ankle sprain. Stretching of the ankle might be effective for preventing ankle sprain. However, further interventional studies are needed to confirm this finding.

Objective: Atopic dermatitis (AD) is one of the known risk factors for Staphylococcus aureus infection. The authors report the case of a patient with cervical spondylosis and AD who developed delayed surgical site infection after posterior cervical instrumented surgery.

Patient: A 39-year-old male presented to our hospital with paralysis of the left upper extremity without any cause or prior injury. He had a history of severe AD. We performed C3–C7 posterior decompression and instrumented fusion based on the diagnosis of cervical spondylotic amyotrophy. One year after surgery, his deltoid and bicep muscle strength were fully recovered. Nevertheless, his neck pain worsened 2 years after surgery following worsening of AD. One month after that, he developed severe myelopathy and was admitted to our hospital. Radiographic findings showed that all the screws had loosened and the retropharyngeal space had expanded. Magnetic resonance imaging and computed tomography showed severe abscess formation and destruction of the C7/T1 vertebrae.

Result: We diagnosed him with delayed surgical site infection. Methicillin-resistant Staphylococcus aureus was identified on abscess culture. The patient responded adequately to treatment with antibiotic therapy and two debridements and the infection subsided.

Conclusion: We should consider the possibility of delayed surgical site infection when conducting instrumented spinal surgery in patients with severe AD.

Fothergill and Carnett signs are used to distinguish intrabdominal from abdominal wall diseases. These bedside techniques may be useful in distinguishing intrabdominal from an abdominal wall cause of disease. Timely and accurate diagnosis of rectus sheath hematoma in at risk patients in the appropriate clinical setting is important because of the associated morbidity and mortality associated with this condition. Diagnosis requires an accurate and thorough history and bedside physical examination and performance of these maneuvers as originally described.