Family issues are common in daily life, and the impact of illness and health on family has been researched in various contexts. In Japan's primary care settings, many patients face family problems. One approach proposed to address these issues is "family-oriented care." Family-oriented care is based on "systems theory" and "family therapy" and involves collaborations between family physicians and family therapists. Although several previous studies have discussed its practice and effectiveness, standardized training programs have yet to be established, leaving each facility to refine its approach through trial and error. Furthermore, limited literature exists on the current state of education in this field, making it difficult to grasp the overall landscape. This review article provides an overview of the current status of family-oriented care practice and education in Japan, compares it with advanced efforts in the U.S., and discusses challenges in standardizing education in Japan. Furthermore, we propose the development of a standardized education model for "Japanese-style family-oriented care," tailored to Japan's unique cultural context, customs, family dynamics, and societal structures.

Purpose: To investigate the clinical significance of adaptive radiotherapy (ART) in locally advanced nasopharyngeal carcinoma treated with intensity-modulated radiotherapy (IMRT). Materials and Methods: Eligible patients were treated with concurrent chemoradiotherapy using IMRT. Planning computed tomography in ART was performed during radiotherapy, and replanning was performed. Since ART was started in May 2011 (ART group), patients who were treated without ART up to April 2011 (non-ART group) were used as the historical control. The Kaplan-Meier method was used to calculate overall survival (OS), locoregional recurrence-free survival (LRFS), progression-free survival (PFS), and distant metastasis-free survival (DMFS). LRFS for the primary tumor (LRFS_P) and regional lymph node (LRFS_LN) were also studied for more detailed analysis. Statistical significance was evaluated using the log-rank test for survival. Results: The ART group tended to have higher radiation doses. The median follow-up period was 127 months (range, 10 to 211 months) in the non-ART group and 61.5 months (range, 5 to 129 months) in the ART group. Compared to the non-ART group, the ART group showed significantly higher 5-year PFS (53.8% vs. 81.3%, p = 0.015) and LRFS (61.2% vs. 85.3%, p = 0.024), but not OS (80.7% vs. 80.8%, p = 0.941) and DMFS (84.6% vs. 92.7%, p = 0.255). Five-year LRFS_P was higher in the ART group (61.3% vs. 90.6%, p = 0.005), but LRFS_LN did not show a significant difference (91.9% vs. 96.2%, p = 0.541). Conclusion Although there were differences in the patient backgrounds between the two groups, this study suggests the potential effectiveness of ART in improving locoregional control, especially in the primary tumor.

Introduction   Redox state of glutathione as an oxidative stress marker changes by exercise. Therefore, oxidative stress marker has been used to evaluate the physical condition of athletes. In athletics it is important to prevent fatigue for peak performance. Acupuncture has been used for fatigue prevention of athletes. However, there is little scientific evidence to prove the effect. The purpose of this study is to examine the effects of electroacupuncture (EA) on the change in redox state of glutathione as an oxidative stress marker in the blood by ergometer exercise. Methods   In this crossover study, the EA and control (CONT) groups each included 12 healthy male volunteers. EA at 2 Hz and optimum intensity was performed on each subject at both the SP10 (Xuehai) and SP11 (Jimen) locations for 10 min before exercise. Respiratory metabolism was recorded during bicycle ergometer exercise by ramp rate until exhaustion. Blood samples were collected from the fingertip of each subject before and after exercise. Oxidized glutathione (GSSG) and total glutathione (tGSH) concentrations in the blood were biochemically determined as a marker of oxidative stress. The degree of fatigue before and after exercise was evaluated by the visual analogue scale (VAS). Results   The ventilatory threshold (VT) and the respiratory compensation point (RC), parameters of respiratory metabolism during exercise, did not differ significantly between the EA and CONT groups. Between both groups, the significant difference was not recognized to the amount of change in tGSH, GSSG, GSH, GSSG/tGSH by exercise. The GSSG/tGSH values after exercise was significantly lower than that before exercise in the EA group (p<0.05). In contrast, this level did not change significantly in the CONT group. The VAS values increased significantly after exercise in both groups (p<0.05); however, the VAS value in EA group showed a low tendency in comparison with that in CONT group. Discussion   VT and RC did not differ between the two groups, indicating that the level of exercise was nearly the same for both groups. In comparison of both groups, there was no significant difference on the amount of change of each glutathione parameters by exercise. On the other hand, The GSSG/tGSH and the VAS values after exercise were lower than those values before exercise in the EA group. Therefore, it might be possible that the EA affects the change of the glutathione due to the exercise. Our results might suggest that EA-mediated change of GSH bear some related to suppression of fatigue.

[Objective]To investigate whether acupuncture is effective to prevent fatigue and oxidative stress in distance runners.
[Methods]A total of 17 runners were recruited and randomized to receive acupuncture (Press Tack Needle) or placebo treatment. Subjects received treatment from licensed acupuncturists before a 10 km race. The primary outcome measures were oxidative stress, as determined by electron spin resonance (ESR), and fatigue, as assessed using the Visual Analogue Scale (VAS). Secondary outcome measures were GOT, LDH, and CPK.
[Results]Fatigue was significantly increased in both groups after the race. There was no difference in both groups.
Hydroxyl radical scavenging activity tended to increase in both groups after the race.
[Conclusion]The study found no useful acupuncture aspects of oxidative stress and fatigue.

Introduction
 On 8 March 2009, the Workshop on Infectious Diseases Control Programmes and Health System Strengthening (HSS) was conducted in the 24th East Japan Regional Conference of the Japan Association for International Health. This article reports the discussion in the Workshop and the internet-based open forum that followed.
Method
  After four presentations reflecting on the field-based experiences regarding the relation between disease-specific programmes and HSS, following three aspects were discussed: 1) health system-wide barriers perceived through the implementation of disease-specific programmes; 2) shortcomings of the disease-specific initiatives in light of the HSS; and 3) how the disease-specific initiatives can contribute to the HSS.
Results
 As the system-wide barriers, insufficient quantity and quality of health human resources, lack of health infrastructure and material resources and limitation of the technology applicable to community level of developing countries were commonly perceived. Shortfall of disease-specific programmes in light of the HSS included the lacked coordination between different programmes and donors, duplicated heavy workload put on community health workers especially in recording and reporting, dissociation between local health needs and programme priorities, lack of contributions to strengthening mid-level health administration, deviation of resources to the priority programmes and lack of sharing of potentially sharable material resources. It was proposed that the disease-specific initiatives should contribute to resource mobilization, programme management models, capacity building of mid-level health administration, supplementing personnel cost and presenting hardware and software outcome resources to the HSS.
Conclusions
 The disease-specific initiatives need to pursue the above mentioned practical contributions to the HSS. At the same time, a wider scope addressing political and policy-wise justifications of the form of the overall health system needs to be further discussed with developing countries stakeholders.

[Objective]To evaluate the efficacy of the different depth of acupuncture on the motor function and the pain with osteoarthritis of the knee.
[Design]Single blind randomized controlled trial.
[Method]Subjects were randomly allocated to one of two groups. Acupuncture needles were inserted about 3mm in the superficial acupuncture group and 10 to 20 mm in the deep acupuncture group. Subjects in both groups received the treatments for ten minutes on ten tender points. Acupuncture sessions were performed once a week for 8 weeks and without treatment 4 weeks.
[Outcome Measures]Pain intensity (visual analogue scale :VAS) , Objective evaluation of the motor function (Timed Up &Go test, 20m walking time, Time of going up and down stairs) and QOL (Western Ontario and MacMaster Universities osteoarthritis index :WOMAC).
All measurements were recorded at baseline, 4th, 8th and 11thweek.
[Result]Motor function improved significantly only in the superficial acupuncture group(P<0.05). The degree of pain decreased significantly in both groups (P<0.05).
[Conclusion]Superficial acupuncture provided the improvements on pain and motor function and contributed to the QOL improvement. Therefore the superficial acupuncture would be suggested to be one of the most effective method for the acupuncture treatment of OA of the knee.

We evaluated 30 patients who required hemodialysis (HD) before open heart surgery between January 1990 and September 2003. The patients were divided into 2 groups according to surgical procedure: 20 patients underwent coronary artery bypass grafting (CABG group: 14 men and 6 women, mean age, 63 years), and 10 patients underwent valve replacement (VR group: 6 men and 4 women, mean age, 56 years). The mean duration of HD in the CABG group was significantly shorter than that in the VR group (67 months: 121 months, p=0.02). The actual survival rate was calculated by Kaplan-Meier's method. No patient was lost to follow-up. There were 3 hospital deaths in the CABG group (cerebral infarction, arrhythmia, and mediastinitis), and 2 hospital deaths in the VR group (gangrenous cholecystitis and sepsis). There were also 5 late deaths in the CABG group (acute subdural hematoma, pneumonia, AMI, heart failure and gastric cancer) and 4 deaths in the VR group (uterus cancer, 2 intracerebral hemorrhages and PVE). All cardiac event deaths in the CABG group had undergone CABG only with vein grafts. The 4-year actuarial survival rates were 56% (n=5) in the CABG group with a mean follow-up period of 29 months (max 156 months), and 47% (n=3) in the VR group with a mean follow-up period of 35 months (max 131 months). There are 3 points to improve the prognosis of open heart surgery in hemodialysis patients: control of postoperative infection in both groups, prevention of cardiac events in the CABG group and careful anticoagulation therapy in the VR group.

[Objective] In this study, the pain of receiving acupuncture was evaluated with or without individual finger stalls.
[Design] In a randomized, subject- and operating person-blind, controlled study.
[Methods] Sixteen acupuncturists and same number of normal volunteers participated in this study. Two needles were inserted into each side of the lumbar muscles. The trials were carried out twice using finger stalls and with bare fingers. These trials were performed in random order. Right after the insertion of needles and at the beginning of electrical stimulation, the subjects were asked to answer a questionnaire about the severity and quality of pain on receiving acupuncture. Durations of procedures were measured. We asked the acupuncturists whether they felt any difficulty in performing acupuncture using finger stalls.
[Result] The majority of acupuncturists reported that using the finger stalls during treatment was inconvenient. Although the severity of pain of acupuncture did not significantly differ between that with and that without finger stalls, the average value was slightly higher with finger stalls. The qualities of pain on receiving acupuncture did not significantly differ between the two methods, however, the numbers of selected words differed on some items. The subjects could not recognize the use of individual finger stalls. The use of finger stalls did not influence the duration of the procedure.
[Conclusion] In this study, the qualities of pain on receiving acupuncture did not significantly differ between that with and that without finger stalls. The subjects could not recognize the use of individual finger stalls.