The aim of this study was to determine how age-related changes in body fat and muscle distribution affect elderly women living in the community. 131 elderly women from A-shi, Yamanashi, took part in the study. According to their age, they were divided into two groups: the early elderly group （EG: age 65 to 74 years） and the late elderly group （LG: age 75 years and older）. Bioelectrical impedance analysis was used to determine their body weight, total and regional body fat and muscle mass, and visceral fat level. LG had a higher percentage of body fat and a higher level of visceral fat than EG, but it had a lower total muscle mass than EG. LG had higher body fat mass in the trunk than EG. The body fat mass in the trunk and arms relative to total body fat mass was significantly higher in LG than in EG. In contrast, LG’s body fat mass in the legs relative to total body fat mass was significantly lower than that of EG. The fat mass in the trunk and the level of visceral fat were found to have a significant correlation. LG had significantly less muscle mass in the trunk and legs than EG. The muscle mass of all parts of the body relative to total muscle mass did not differ between EG and LG. These findings suggest that EG and LG have different body fat distributions. The distribution of body fat in LG was influenced by visceral fat content and was distributed over the upper body. There was no difference in muscle distribution between EG and LG.

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The present study aimed to identify changes that pregnancy, childbirth and child-rearing experiences have on midwifery views and midwifery support after midwives return to work, and to use the findings as a resource for creating a return-to-work program. A qualitative descriptive study was conducted using semi-structured interviews of 10 midwives who returned to work at University A Affiliated Hospital after their maternity leave. The study was conducted upon receiving approval from the ethics committee at Showa University’s School of Nursing and Rehabilitation Sciences. The study period was from March to July 2018. A total of 24 codes, 12 subcategories and the following categories were extracted: “understanding the feelings of the clients”, “midwifery support during child delivery”, “beliefs of midwives towards breastfeeding”, “improvement in breastfeeding guidance based on their own experiences”, “increased motivation towards breastfeeding” and “feelings towards the midwife profession”. Reliving the experiences of pregnant and postpartum women and a positive interpretation of their childbirth experiences allowed the midwives to have a deeper understanding of their clients. Experiencing breastfeeding and having an awareness of the need for midwives reinforced their feelings toward breastfeeding, and the methods for providing midwifery support changed in many ways. Furthermore, changes in working conditions after returning to work gave rise to a desire to learn about new fields, while their existing professional identities of midwives were heightened. Individualized strategies that balance child-rearing and work, boost self-efficacy, and develop one’s career need to be considered.

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This study aimed to clarify occupational therapists’ use of interactive reasoning to establish collaborative relationships with clients in clinical situations. This qualitative study used the grounded theory approach to evaluate five occupational therapists through semi-structured interviews. The participants were selected on the basis of their years of experience, organization, and the amount of time they spent in occupational therapy. The analysis revealed 299 data points, 20 subcategories, and 7 categories. We found that building collaborative relationships begin with the cues of “words and actions that lead to involvement.” The participants were influenced by the “experience of receiving feedback” and “learning from the interventions provided by fellow occupational therapists.” This step was followed by engaging in “objective involvement based on judgment” and “gentle and humane involvement.” Eventually, the process moved from “sharing experiences and goals with patients” to “building a collaborative relationship.” Occupational therapists recognize that their words and actions lead to involvement and the confrontation of occupational therapists’ self about supporting the client affects the beginning of the collaborative relationship. In the relationship-forming stage, the client was understood from two different relationships: “objective involvement based on judgment” and “gentle and humane involvement,” which weighted toward the viewpoint of the medical provider and human relationship, respectively. In the relationship-strengthening stage, “sharing experiences and goals with clients” and being involved in decision-making led to increased client participation and promoted “building a collaborative relationship.” Hence, the collaboration between the occupational therapist and clients is developed through a step-by-step process.

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The symptoms of autism-spectrum disorder （ASD） and attention-deficit hyperactivity disorder （ADHD） were previously considered to be different, which did not permit the diagnosis of patients with comorbidities of ASD and ADHD using DSM-Ⅳ-TR. However, in some cases, the possibility of ASD and ADHD co-occurring was mentioned. Since 2013, the overlap between ASD and ADHD has been diagnosed using DSM-5. Individuals with ADHD frequently exhibit ASD characteristics and vice versa. This study aimed to compare the differences in clinical symptoms between ADHD and ASD using a self-rating questionnaire. This research was approved by the Institutional Review Board of Showa University under the strict management of handling personally identifiable information. The outpatients were recruited from Showa University and grouped into ASD, ADHD, and typical adults （TAs）. Patients with ADHD had a significantly higher autism-spectrum quotient score than the TAs. Furthermore, the Conner’s adult ADHD rating scale （CAARS） score was significantly higher in patients with ASD than in the TAs. In ASD, all CAARS subscale scores （inattention, hyperactivity, and impulsivity） were significantly higher than those in the TAs. In several instances, the features of ASD and ADHD overlapped. These overlapping symptoms may make it difficult for psychiatrists to diagnose ASD, ADHD, or both. Further investigations are required in this field to develop medications and psychotherapy for individuals with developmental disorders.

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Given poor extensibility of the head skin, extensive head skin defects are often reconstructed using local skin flaps and transplantation of free skin flaps, followed by reconstruction of the hair-bearing area with expanders. In this case, we performed one-stage reconstruction of a frontal skin defect caused by self-injury, using the vacuum-assisted shoelace technique combined with negative-pressure wound therapy and a superficial temporal artery island flap. The postoperative course was good at six months, and we have reported the results with a discussion on the available literature.

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Reports of facial chondromas are extremely rare. Here we report a case of chondroma of the canopy cartilage. A 69-year-old female visited our hospital with the complaint of left nasal obstruction. On clinical examination, a palpable subcutaneous tumor in the left nasal ala completely obstructing the left nasal cavity was seen. Magnetic resonance imaging findings showed a neoplastic lesion that developed within the left nasal ala and filled the left nasal cavity. The tumor in the canopy cartilage was removed via columella-rim incision. Histopathological examination was performed and a diagnosis of chondroma was made. No local recurrence or differences between the nostrils were observed one year and three months after the operation. Chondroma is a benign tumor; however, it may recur locally and become malignant. Moreover, in areas related to plastic surgery, such as the nasal ala, medium- to long-term postoperative follow-up is necessary for monitoring potential morphological abnormalities that can develop over time.

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The diagnostic criteria for oral hypofunction are constant regardless of the individual’s age. Therefore, middle-aged individuals are rarely diagnosed with decreased oral function, despite the lack of age-appropriate oral function. In addition, there is a problem that super-aged people are generally diagnosed with decreased oral function even at the “oral age” younger than the actual age. This study proposes the oral function age index. It correlates oral function with age and provides age-specific guidance. A total of 319 patients （131 males, 188 females, average age 75.5 years） visited our department complaining of discomfort in oral function. Patient records were obtained from 13 universities that participated in this project commissioned by the Ministry of Health, Labor and Welfare. Correlation coefficients and regression lines were calculated from the results of the oral hypofunction examinations and age-based scatter plots. The technique for calculating “the corresponding age” was developed based on the differences in the examination values ​​among individuals: the difference is based on the average value of the age obtained from each examination item. The occlusal force, number of remaining teeth, oral diadocokinesis （pa, ta, ka）, tongue pressure, and masticatory ability were negatively correlated with the real age. A formula to determining the oral functional age from the examination results was developed in Microsoft Excel using these items. This study presents an easy method that can be used to calculate the oral functional age of an individual. As a result, the examination item points became clear, indicating that the guidance that was memorable for the patient was established, which contributed to the improvement and increased in the number of the oral hypofunction examinations.

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