The Japanese Guidelines for management of acute cholangitis and cholecystitis were published in 2005 as the first practical guidelines presenting diagnostic and severity assessment criteria for these diseases. After the Japanese version, the Tokyo Guidelines (TG07) were reported in 2007 as the first international practical guidelines. There were some differences between the two guidelines, and some weak points in TG07 were pointed out, such as low sensitivity for diagnosis and the presence of divergence between severity assessment and clinical judgment for acute cholangitis. Therefore, revisions were started to not only make them up to date but also concurrent with the same diagnostic and severity assessment criteria. The Revision Committee for the revision of TG07 (TGRC) performed validation studies of TG07 and new diagnostic and severity assessment criteria of acute cholangitis and cholecystitis. These were retrospective multi-institutional studies that collected cases of acute cholangitis, cholecystitis, and non-inflammatory biliary disease. TGRC held 35 meetings as well as international email exchanges with co-authors abroad and held three International Meetings. Through these efforts, TG13 improved the diagnostic sensitivity for acute cholangitis and cholecystitis, and presented criteria with extremely low false positive rates. Furthermore, severity assessment criteria adapted for clinical use, flowcharts, and many new diagnostic and therapeutic modalities were presented. The worldʼs first management bundles of acute cholangitis and cholecystitis were also presented. The revised Japanese version was published with the same content as TG13. An electronic application of TG13 that can help to diagnose and assess the severity of these diseases using the criteria of TG13 was made for free download.

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This study aims to investigate some biomechanical effects of a thigh corset with side bars (TC-SB) on the gait of a transtibial amputee. During two test conditions of with/without TC-SB, the angles of prosthetic lower limb joints, stride time, stance time and maximum vertical ground reaction force were evaluated. Only the angle of hip joint at initial contact and its maximum flexion at swing phase had significant changes (P < 0.05). This may suggest the amputee has used a compensatory mechanism to overcome the additional weight of the TC-SB suspension. It seems that the participated amputee has no need for this auxiliary suspension.

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Performance and sensor characteristics of a monitor for volatile organic compounds (VOC monitor) using the interference enhanced reflection (IER) method were investigated for 52 organic solvent vapors that are designated as class 1 and class 2 organic solvents by the Ordinance of Organic Solvent Poisoning Prevention in Japan. Test vapors were prepared by injecting 1 to 3 μl of liquid solvent into a 20 l Tedlar^® bag and perfectly vaporizing them. The vapor concentration was simultaneously measured with the monitor and a gas chromatograph (GC) equipped with flame ionization detector, and both values were compared. The monitor could detect all the solvent vapors that we used. Linear response was obtained between the concentration measured by the monitor and those by the GC. The monitor could detect 1/10 of the administrative control level for 37 of 52 solvent vapors, including toluene and xylenes. For 15 vapors, on the other hand, the monitor could not be used for the working environment measurement because the sensor response was low or the regression lines did not pass through the origin.

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We reviewed clinical features of patients who we treated for obturator hernia. The subjects were 13 patients who underwent an operation for obturator hernia in our hospital between April 2002 and December 2012. The mean age was 78.5 years, and all patients were female. The mean body mass index was 16.8 kg/m². The Howship-Romberg sign was present in only 3 patients. All patients were correctly diagnosed by preoperative pelvic computed tomography. All patients underwent operation. Operative procedures included the laparoscopic approach in 8 patients, the open approach in 3 patients and the inguinal approach in 2 patients. The hernia hilus was repaired with a simple closure in 5 patients, and with a mesh in 8 patients. The hernia contents were small intestine in all the patients. Three patients underwent partial resection of the small intestine because of necrosis of the intestine wall. Three patients had a recurrence of the obturator hernia. In our present series, the patients with obturator hernia were slender females at an advanced age. Plevic CT was useful for the diagnosis of obturator hernia.

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How to control the increasing health expenditures is a common problem in the developed countries. The main causes of this increase are ageing of the society and medical innovation. The UK government has introduced a market oriented health reform in order to balance the increasing expenditures and the quality of care. For example, they have introduced the GP Fundholding, Private Financial Initiative (PFI) for construction of public hospital, and personal budget system (a patient owns a budget for buying health services in the deregulated market). However, there is little evidence indicating the effectiveness of these programs. On the other hand, it is important to strengthen the labor policy in order to maintain the social security system. For example, programs for increasing the employment rate and those for increasing productivity work sharing are such policies. From this viewpoint, the EU countries have introduced a series of active employment policies, i.e., job training for unemployed persons and work sharing. Furthermore, as other authors report in other articles of this volume, the government of the UK has introduced the Fit for Work (FFW) program that intends to medically support workers.

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The Statement of Fitness for Work, so called Fit Note, was introduced in the UK in 2010. Physicians issue Fit Note to workers when requested. The Fit Note provides the physician’s advice about the worker’s fitness for work when he or she has health problems, writing their advice of either “may be fit for work” or “not fit for work” on the form. The Fit Note also records details of the functional effects of workers’ condition. Then the Fit Note is used to consider and arrange support from employers in order for workers to return to work. This paper reports the general background and practical implementation of Fit Note based on a literature review and interviews from general practitioners, occupational physicians, and physiotherapists in the UK.

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The Statement of Fitness for Work (Fit Note) policy was started in the UK in 2010 in order to promote return to work after sickness absence. Fit Note is issued by General Practitioners (GP). We conducted an interview survey of 2 occupational physicians working in the UK to ascertain the impact of the introduction of Fit Note on occupational health in the UK. They regard the low coverage of occupational health services in the UK, especially among small companies and self-employed workers, as a serious issue. Fit Note was regarded as a tool to induce GPs to participate in occupational health services, and it is expected that they will be new partners in occupational health. The English occupational physicians evaluated the Fit Note system highly, and believe that the increasing participation of GPs in occupational health services will be a steady advancement in occupational health in the UK

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Statutory Sick Pay, Jobseekerʼs Allowance, and Employment and Support Allowance are employment-related benefits in the United Kingdom (UK). They correspond to the Injury and Disease Allowance and Unemployment Insurance in Japan. The Government of the UK is determined to reform the benefit system to make it fairer and to improve financial work incentives, using the slogan “Welfare to Work”. Against this background, the government of the UK united some non-contributory benefits into a new “Universal Credit” scheme, which started in April 2013. The labor policy was also reformed to improve work incentives, for example by abolishing the Flexible New Deal program and uniting all the “Welfare to Work” policies into the “Work Programme”. These reforms are useful for reconsidering the labor and employment-related policy and benefit system of Japan.

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The Industrial Injuries Disablement Benefit (IIDB) is a benefit for people who are disabled either as a result of an accident at work or because of a prescribed disease. IIDB does not cover the self-employed, military personnel, or certain kinds of trainees. “Prescribed diseases” are defined by the Department of Work and Pension in a list of diseases covered by IIDB. Delivery of medical services, such as the medical treatment benefit in Japan, is not included in this scheme because most medical services are provided for in the scheme of the National Health Service (NHS). Prevention Projects, such as the Follow-up Medical Examination Benefits in Japan, are also not included. Benefits for people who have Pneumoconiosis (including asbestosis) are provided in the IIDB scheme.

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