Objectives: Despite the increasing utilization of in-home services, the assessment of in-home services used by those that have certified levels of care needs has been limited to the actual changes in individual outcomes. The purpose of the present study was to determine factors affecting how the utilization of in-home services could have sustained and/or improved or deteriorated the care needs levels of frail persons. We also examined the effect of in-home services used in the lower level of care needs subgroup and the higher level of care needs subgroup during a two-year period.
Subjects and Methods: We used longitudinal data from Izumo City of those individuals with certified levels of care needs to analyze the changes in care need levels in Izumo City between 2002 to 2004. In 2002, 2,651 persons had certified levels of care needs. All permanent residents of care facilities, at care needs level 5 in 2002, those who died since 2002 and people who could not be traced during the two-year follow-up period were excluded. The remaining data from 1,788 frail persons were ultimately analyzed. We arbitrarily divided the changes in care needs levels into two categories: sustained/improved and deteriorated. The care needs levels were also stratified into a lower level of care needs subgroup and a higher level of care needs subgroup at the baseline. Simple statistical analysis and binary logistic regression analysis were used to analyze factors that were thought to be related to in-home service utilization data to predict changes in care needs levels.
Results: Approximately 63.3% of the respondents had a sustained or improved care needs level, and 36.7% of the respondents showed deteriorated of care needs levels. In the lower level of care needs subgroup, utilization of home help/bathing (OR=2.59) was associated with significant sustained/improved care needs levels. In the higher level of care needs subgroup, day care service (OR=0.90) and short stay services (OR=0.87) were significantly related to deteriorated care needs levels, respectively.
Conclusions: This study shows that home help/bathing care in the lower level of care needs subgroup was a significant predictor of sustained/improved levels of care needs for frail persons but that short stay services and day care services in the higher level of care needs subgroup have a negative impact on sustained/improved levels of care needs. Our results suggest that utilization of home help services can prevent deterioration of these levels of care needs in frail persons.

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Mental disorders cause a substantial amount of the burden of disease. Although they are less frequent in rural areas, their provision of care is disproportionately lower. Reimbursement claims in the federal state of Mecklenburg-West Pomerania of the years 2006/2007 serve as the basis for the descriptive distribution of subgroups on the total number of mental disorders and their outpatient care. Of all claims, 35.3% were allotted to neurotic, stress-related and somatoform disorders, 24.2% to affective disorders and 12.5% to substance use disorders. Claims for reimbursement were made for 44.7% by general practitioners, 15.1% by neurologists and psychiatrists, 12.6% by gynaecologists, and 8.1% by internists. Psychotherapists claimed 3.1%. These results cause considerations regarding the establishment of psychotherapeutic and neurological / psychiatric practices as well as the significance of mental disorders in the training of general practitioners.

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Objectives: Bony impingement of the proximal femur on the pelvis is an important factor for dislocation after total hip arthroplasty (THA). We evaluated bony impingement after THA using the rotation matrix derived from postoperative computed tomography (CT) images.
Patients and Methods: One hundred and seven hip joints were subjected to primary THA via a posterolateral approach. We used the rotation matrix derived from CT images to calculate internal rotation (IR) limit prior to bony impingement, and compared this limit with the intraoperative limit.
Results: The average calculated IR limit was 63 degrees (range: 30 to 85 degrees). The average intraoperative IR limit was 49 degrees (range: 20 to 70 degrees). The correlation between the intraoperative IR limit (Y) and the calculated IR limit (X) was expressed as Y=8.9+0.66X (R=0.73; p < 0.0001).
Conclusions: We could show a patient´s safe range of motion prior to bony impingement, and this will be a good indicator for dislocation not occurring during postoperative rehabilitation.

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Effects of gender and employment situation on weight loss and lifestyle modification were assessed in a 3-month intervention study done for overweight and obesity. A total of 384 individuals in Izumo City Japan, participated from 2000 to 2006. Lifestyle modifications were quantitatively evaluated by calculating calories of energy intake and expenditure. Eleven men and 15 women failed to complete the intervention; they were significantly younger in both genders, and the women had a higher rate of employment than the completing group (91 men and 267 women). Intervention induced a weight loss of 1.9 kg for men and 1.6 kg for women, with no significant differences by gender. Significant differences were found in changes in energy intake and expenditure in both genders, but these disappeared after adjusting for weight. There were significant decreases in weight (1.6 kg in unemployed, 2.5 kg in employed) in men. Increases in walking and exercise for the employed were smaller than those for the unemployed. The relationship between changes in weight and energy balance by employment status was independently significant using multiple regression analysis. Employment is associated with difficulty in losing weight due to limited exercise time in behavioral intervention.

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Objective: The purpose of this study was to evaluate the relationship between improvement of health-related quality of life (QOL) and participation in self-care activities and coronary risk factor management at 6 months after discharge for acute myocardial infarction (AMI) patients treated with percutaneous coronary intervention (PCI).
Methods: A total of 118 patients were asked to complete the MOS 36-Item Short-Form Health Survey (SF-36) questionnaire at discharge and 6 months after discharge. The SF-36 consists of eight subscales: Physical Functioning (PF), Role Physical (RP), Bodily Pain (BP), General Health Perception (GH), Vitality (VT), Social Functioning (SF), Role Emotional (RE) and Mental Health (MH). We examined self-care activities and coronary risk factor management and related factors from SF-36 scores to measure quality of life (QOL) at discharge and 6 months after discharge.
Results: The PF and BP scores at 6 months after discharge were significantly higher than those at discharge. Increasing PF and BP scores indicated improvement in ability to perform physical activities and absence of intense bodily pain that would interfere with activities of daily living or work. Improvement of PF in AMI patients treated with PCI was related to performing exercise after discharge and absence of diabetes mellitus. However, there were no related factors for BP.
Conclusion: Our results indicated that exercise, as a self-care activity after discharge, for AMI patients treated with PCI may be related to the improvement of QOL.

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There is systematic evidence that community-based education is effective in the recruitment of rural physicians to remote communities. However, various obstacles may exist that prevent rural physicians from sustaining their mentoring activities. The aim of this study was to explore ways for rural physicians to overcome such adversities and continue their mentoring activities. We interviewed four nominated physicians (all male, mean age 48 years) based in Hokkaido, Japan, who practiced in an area with less than 10,000 inhabitants. Semi-structured interviews of approximately 60 minutes were performed and focused on topics rural physicians’ found necessary for their teaching activities. All interviews were tape-recorded and transcribed, the verbatim transcripts were analyzed and repeated themes were identified. Three themes that emerged as needs were 1. sustained significant human relationship, including the formation of a network between students and university faculty, as well as developing partnerships with many community relationships, or other medical professions; 2. intrinsic motivations and satisfaction, including pleasure in mentoring the younger generations; and 3. rewards, including financial compensation. Rural physicians as preceptors require nonremunerative, intrinsic motivational factors, such as a sense of satisfaction regarding the education of medical students and being able to relate to residents and others health-care professions, when pursuing their educational activities. To support them, focusing only on monetary facets may be unsuccessful in encouraging them to continue their educational work.

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The pharmacovigilance of vaccines is defined as the science and activities relating to the detection, assessment, understanding, prevention and communication of adverse events of immunization, or any other vaccine, or issues related with immunization. The strengthening of pharmacovigilance is very important in every country because it helps professional health care workers to avoid the problems with immunization, protect the health of people from adverse events during immunization. The success of the immunization system is reducing morbidity and mortality related to the vaccine. The vaccines are biological products used to prevent infectious diseases, but sometimes the vaccines can cause some AEFI (Adverse Events Following Immunization). The detection of adverse events following correct immunization is one very important step for prevention of problems in the immunization system. The vaccines are injected into an infant body on the day of their birth and the safety of these products is vital. In Albania, the Pharmacovigilance department is established as the structure of the National Center of Drug Control. The strengthening of pharmacovigilance in Albania and other countries is necessary, because this will help to identify the risk and the risk factors, and to avoid or minimize the harms.

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