Introduction : This study aimed to clarify any associations between familial smoking, especially parental smoking, and high school students' perceptions of smoking.
Methods : Questionnaires on familial smoking and the Kano Test for Social Nicotine Dependence (KTSND) were distributed to junior high school students. The KTSND is a tool to evaluate positive perceptions of smoking. We analyzed the relationship between the total KTSND score and school grade, gender, familial smoking, paternal smoking, and maternal smoking.
Results : We received 761 valid responses (valid response rate : 90.4%). Five hundred forty-three students had family members who smoked (71.4%), 394 had smoking fathers (51.8%), and 214, smoking mothers (28.1%). The total KTSND score correlated with familial smoking (10.55 vs 9.46, p=0.009) and maternal smoking (11.18 vs 9.87, p=0.002).
Conclusion : Familial smoking, especially maternal smoking, correlated with positive perceptions of high school students towards smoking. Promoting smoking cessation in women with children may be effective in preventing tobacco use among children.

Association between smoking prevention education for elementary and junior high school students and the modification of their parents' smoking behavior — Can child education change parental behavior?
Introduction : This study aimed to investigate an association between a smoking prevention education program for elementary and junior high school students, and the subsequent behavior modifications of their parents.
Methods : Preventative education programs for smoking were provided to four elementary and three junior high schools in Kamisu City, Ibaraki Prefecture, Japan. We encouraged participating students to discuss the knowledge derived from the education sessions with their families. One month after completing the program, questionnaires were distributed to the parents of the students to investigate whether they had modified their smoking behavior as a result of what they had learnt from their children.
Results : Two questionnaires were distributed to each of 1109 families, and 1427 valid responses were received. Analysis showed that 794 parents had been informed about tobacco use from their children (55.6%) and 271 parents had modified their smoking behavior (19.0%) as a consequence. This included smoking cessation, decreasing tobacco consumption, and smoking avoidance in the presence of their children. Behavior modification was significantly correlated with the knowledge they had derived from their children based on the preventative smoking education program (odds ratio = 3.3 ; 95% CI : 2.4-4.6).
Conclusion : Implementation of an education program for smoking prevention focused on elementary and junior high school students can lead to modification of smoking behavior in both students and their parents, respectively.

Postgraduate residents face formidable stress. Unfortunately, many residents withdraw from training programs because of reactions to stress, such as depression. We performed a comprehensive study to examine the working conditions and stress of residents to improve the conditions of resident-training programs and reduce levels of stress.
1) The study examined 548 first-year residents starting postgraduate clinical training at 41 hospitals in Japan. A selfadministered questionnaire, which included questions about working conditions, job stressors, buffer factors, and stress reactions, was answered before and 2 months after the start of training.
2) A total of 318 subjects completed the survey.Of these subjects, 80 (25.2%) had depression after the start of training.
3) Job stress patterns of residents were characterized by high workload and extremely low “reward from work” and “Job control.”
4) Many residents had depression after the start of training.To improve residency programs, program directors should recognize the specific characteristics of residents' job stress and focus on buffer factors.

The shortage of physicians in Japan has been a social issue since the new postgraduate clinical training system started in 2004.The difficult working conditions of hospital physicians may influence this problem.We used a questionnaire to investigate the working hours, on-call frequency, work contents, and mental health of supervisors at various residency training hospitals in Japan.
1) We surveyed 479 physicians who worked at hospitals certified as residency-training facilities and who participated in a development workshop for supervisors or for residency training program managers held at 8 locations in 2004.
2) We found that supervisors worked, on average, more than 100 hours longer than statutory working hours per month and that more than one-fifth of supervisors worked more than 160 hours longer.
3) As for mental health, more than one-fifth of supervisors showed a depressive tendency.
4) These results suggest that the working conditions of supervisors at residency-training hospitals in Japan should be improved by reducing their clinical duties or managing their work content.

The new postgraduate clinical training system that started in 2004 is expected to have positive effects on the health of residents and the quality of treatment they provide.We performed a survey to examine the effects of this training system on the mental health of residents.
1) The subjects were first-year residents (458 in 2003 and 549 in 2004) who had started postgraduate clinical training at 38 hospitals in Japan.Self-administered questionnaires, which included items about working conditions and mental health, were mailed to each subject.
2) The mean score on the 12-item version of the General Health Questionnaire was 4.8 both before and after the new training system was introduced.The mean Center for Epidemiologic Studies Depression Scale score was 15.3 before and 14.4 after the system's introduction.The results showed no significant difference in mental health of residents before and after the system was changed.
3) The results suggest that the new training system has a positive effect on residents' mental health by increasing sleep time and decreasing occupational stress; however, the new system has also decreased job satisfaction and negatively affected their mental health.
4) Job satisfaction may significantly affect the mental health of residents.

We reported a clinical case in which decreased concentration of hydromorphone citrate in subcutaneous infusion therapy led to the improvement of subcutaneous induration. A subcutaneous infusion therapy with hydromorphone citrate was initiated in a 60-year-old female pancreatic-cancer patient with back pain. A subcutaneous induration has emerged when the infused concentration of hydromorphone citrate was increased from 0.17% to 0.83%. After the reduction in its concentration (0.28%), that subcutaneous induration has improved. For the alleviation of nausea and sedation, administration of haloperidol and midazolam were added at day 61 and day 70, respectively, with keeping the low concentration (≤0.28%) of hydromorphone citrate. Under this condition, further occurrence of subcutaneous induration was not observed. As a result, we suggested that the concentration of hydromorphone citrate in subcutaneous infusion therapy determined the onset of subcutaneous induration.