Background and Purpose : The willingness of the health care workers in Gunma Prefecture and neighboring areas to use the Community-Graduate School Circular Educational Program to train community health care leaders adopted by the School of Health Science, Faculty of Medicine, Gunma University was investigated. This program is aimed to accept community health care and medical personnel in graduate school and nurture them as human resources who can help improve the quality of local health care and medical services. Subjects and Methods : A questionnaire survey was performed from December 2007 to January 2008. A self-administered questionnaire was sent to 4,393 health care and medical workers in Gunma Prefecture and neighboring areas, and valid responses were obtained from 775 (recovery rate : 19.4%). Results : Of the 775 respondents, 494 (63.7%) were willing to use the program, with 197 (25.4%) willing to use the program themselves, and 297 (38.3%) wishing their colleagues to use it. Many respondents expressed opinions supporting the aim of the program, but some suggested that information which allows the prospective users to imagine the contents and style of classes and life after admission was insufficient. Conclusion : It is important to provide more detailed and specific information to attract more users to this program.

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Aims : The aims of this study were to clarify the activity level, nutritional state, and psychological changes after discharge in cancer patients who underwent total gastrectomy. Methods : Data concerning the energy expenditure, body weight, body fat percentage, and psychological state were obtained from 3 patients who were discharged after total gastrectomy by interviews and a review of the patients' personal, activity, and clinical records. Results : [Activity level and nutritional state] The body weight and body fat percentage decreased in all subjects over 1 month after discharge. The total energy expenditure and activity level showed no marked change. [Psychological changes] Despite the decrease in body weight, the patients perceived a recovery of fitness, learned how to cope with symptoms, and became confident in life. Conclusion : Total gastrectomy patients experience body weight losses and various symptoms during 1 month after discharge, and support to resume a normal life is necessary in this period. It was also suggested that closely listening to patients describe their symptoms and providing corresponding educational intervention are necessary.

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Objectives : The objectives were to identify health related activities other than delivery assistance by traditional birth attendants in rural agricultural villages in Nicaragua and to explore their effective utilization and contribution to improvement of the health status of the communities. Subjects and Methods : The subjects were 14 traditional birth attendants. The methods used were semi constitutive interview and data analysis using Berelson's content analysis. Result : All 14 traditional birth attendants were involved in health related activities in addition to their original role of birth assistance. Their activities were classified into eight fundamental primary health care activities. The traditional birth attendants were found to provide care for common diseases of the local residents who have limited access to the biological medicine. They also offered advice to rural mothers on child diseases and symptoms. They played the bridging role between local villagers and the modern medicine. Conclusions : Their roles will continue to be important, including therapeutic activities for local people, bridging community to the modern medicine and empowering local mothers to promote child health. It is indicated that utilization of traditional birth attendants who have cultural and geographical proximity to villagers is effective in developing primary health care system in those communities.

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Purpose : The aim of this study was to clarify incidence and severity of oral adverse events induced by chemoradiotherapy and to explore efficient nursing-intervention or oral-care for the oral complications. Methods and Patients : Seventy-nine subjects who were treated with chemoradiotherapy at the radiation oncology unit of Gunma University Hospital were retrospectively analyzed using collected data from patients' medical chart including location of tumor, details of treatment, incidence and care of oral adverse events. Result : Oral adverse events occurred in 7 ( 9 %) of 79 patients. The complication rate in patients with lung or esophageal cancer was much higher than that with rectal or cervical cancer. All patients with the events received a total irradiation dose of 60 Gy in 30 fractions or higher. Oral mucositis was observed in 5 patients given antimetabolic chemotherapeutic agents, but they were successfully treated with steroids and/or gargles. Conclusion : Our results suggest that early intervention of oral care may reduce risks of developing severe oral adverse effects induced by chemoradiotherapy.

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Aim : We investigated the influence of the law and policy on the number of malignant neoplasm reports (M.N. Reports) and the accuracy of reporting to the Gunma Prefecture cancer registry. Methods : We compared the number of reports and the rate of "Death Certificate Only" reports from 1994 to 2009 in relation to changes of the law and conferences about the cancer registry and the policies of a research group at the Ministry of Health, Labour and Welfare (MHLW). Result : The number of M.N. Reports increased for several years, but decreased in 1999 after discussion about protection of personal infor-mation nationwide and in Gunma Prefecture. The number of reports was lowest in 2003 when the Act for Protection of Personal Information became law. Conferences to improve the accuracy of reporting started at Gunma University in 2004 and these strongly promoted the cancer registry, while receiving support from the Health Promotion Act, the activities of an MHLW research group, and government policy on cancer treatment. As a result, these reports began to increase again and the accuracy has improved. Conclusion : Both law and policy influence the number of M.N. Reports and their accuracy. Legislation about cancer registration would be preferable to achieve more accurate reporting.

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Purpose : The purpose of this research was to verify the effectiveness of a lecture, which programmed for the ability promotion of interpersonal relationship and autonomy in novice nurses, in order to prevent early resignation and to establish high-quality nursing. Methods : This intervention program consisted of a lecture and a self-check exercise, and it took for 2 hours. To evaluate their emotional changes after the educational intervention program, the participants were asked to answer self-reporting questionnaires including Emotional intelligence Quotient Scale (EQS) and Nursing Autonomy Scale (NAS). Results : Out of 3 areas of "self-effect", "human-relations" and "situation-reactions", a significantly higher increase was observed in "situation-reaction". Furthermore, out of 5 factors in NAS, each score of 4 factors except "Autonomic decision-making ability" and the total score significantly increased after the intervention. There was a significant correlation between the increases in scores of "Self-effect" of EQS and those in "Practice ability" of NAS after the intervention. Consideration : The lecture and self-check exercise were effective on self-understanding and autonomy in novice nurses.

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We report a 66 year-old Japanese man with Fournier's gangrene developed from pressure ulcers. Pelvic computed tomography (CT) scan confirmed subcutaneous gas accumulation from the scrotum to the gluteal region. Emergent debridment and the administration of systemic antibiotics improved the symptoms. Fournier's gangrene is a necrotizing fasciitis of the perineal and genital region. Proper treatment for bacterial infection in pressure ulcers is critical and clinicians should be alert to early signs of necrotizing fasciitis.

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Primary malignant lymphoma of the small intestine is uncommon. We herein present a case of malignant lymphoma of the ileum, which was treated by laparoscopically assisted surgery. A 60-year-old male with lower abdominal pain and vomiting was admitted to our hospital. A standing abdominal X-ray showed niveau formation. Computed tomography demonstrated circumferential wall thickening in the terminal ileum. Laparoscopically assisted surgery was performed under a diagnosis of tumor of the ileum. Under laparoscopic exploration, tumor of the ileum was detected. Partial resection of the ileum and dissection of lymph nodes were performed extracorporeally. Histological findings demonstrated diffuse large atypical lymphocytes with vesicle-like chromatin and clear nucleolus. Immunologically, CD20 and CD79a were positive. These findings were compatible with those of diffuse large B-cell lymphoma. Paraintestinal lymph nodes were also involved. The postoperative course was uneventful. Neither gallium scintigraphy nor FDG-PET showed any scintillation. The patient was given R-CHOP therapy and is currently doing well with no sign of recurrence. In conclusion, we propose that laparoscopic surgery for malignant lymphoma of the small intestine is a feasible and promising therapeutic option, especially in a case demonstrating bowel obstruction, because this procedure is thought to be minimally invasive, allows quick postoperative recovery and shortened hospital stay could be expected.

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[in Japanese]

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