PROBLEM: In the Taro District (population: 4434), the great tsunami of 11 March 2011 destroyed the central region including the clinic, the sole medical facility (one physician, 13 nurses and other staff) in the district, and many citizens were forced to live in evacuation centres.

CONTEXT: The Taro District experienced massive damage during the tsunamis of 1896 and 1933. Since then countermeasures to tsunamis have been implemented. The great tsunami on 11 March 2011 caused catastrophic damage to the lowlying areas where approximately 2500 people lived; 1609 buildings were completely destroyed, and approximately 200 people died or were missing across the district.

ACTION: The Taro National Health Insurance Clinic, the sole medical facility in the Taro District, was required to play a central role in a variety of activities to care for residents in severely affected areas. First of all, evacuees needed to move to neighbouring hospitals or safer evacuation centres because lifeline services were cut off to the first evacuation centre. Then, the clinic staff worked in a temporary clinic; they visited the evacuation centres to assess the public health and medical situation, cared for wounded residents, managed infection control and encouraged a normal lifestyle where possible. Additional medical, pharmaceutical and logistical support was received from outside the district.

OUTCOME: There was no noticeably severe damage to health, although there was manifestation of and deterioration in lifestyle-related diseases (e.g. diabetes, hypertension, obesity). Health care activities gradually returned to their pre-disaster levels. At the end of July 2011, the evacuation centres closed, and all evacuees moved to temporary accommodations.

Discussion: Isolated rural health practitioners were required to be involved in a wide variety of activities related to the disaster in addition to their routine work: e.g. preventive health (public health and safety activities), routine medical care, acute medical care, psychological care, post-mortems and recovery of medical facilities. Although the whole health care system returned to near-normal six months after the disaster, it is important to plan how to develop more resilient medical systems to respond to disasters, especially in rural areas. This article describes my experience and lessons learnt in responding to this disaster.

Objectives: The purpose of this study was to examine common experiences among patients and primary family caregivers as they transition to hospice and palliative care units (PCU), with focus on the perspectives of cancer patients and their primary family caregivers. Methods: We conducted semi-structured interviews using a questionnaire with a purposive sample of 5 terminal cancer patients and 9 primary family members of patients who were admitted to the PCU from November 2005 to December 2006. The questionnaires consisted of questions about the PCU, and semi-structured interviews inquired about perceptions of the PCU. We analyzed interview contents from 14 participants (mean age ±SD; patients, 77.2±4.0 years; family members, 53.7±14.6) by summarizing content analysis. The Aiwa Hospital Institutional Review Board approved the present study. Results: Content analysis identified common perceptions about the PCU. Perceptions prior to the transition were summarized into 2 categories for patients and 5 categories for families, including general impressions of the PCU, PCU environment and equipment, treatment, cost, and other patients. After being admitted to the PCU, perceptions were summarized into 3 categories for patients and 7 categories for families, including general impressions of the PCU, PCU environment and equipment, treatment, staff, cost, other patients, and religion. Conclusion: Identification of these themes from patient and family perspectives suggested that patients transitioned to hospice with no particular impressions about the PCU, while families perceived the PCU as both “a place to relax” and “a place where one only waits to die” before entering the PCU. These results may aid in designing interventions that consider patient and family needs and desires during the transition to the PCU.

Since distal femoral varus osteotomy (DFO)
Asian Continental Ancestry Group ; Humans ; Japan ; Knee ; Osteoarthritis ; Osteotomy ; Tibia ; Weight-Bearing

OBJECTIVETwo simple, commercially available and semiquantitative dust mite allergen tests, namely, the Acarex test(®) and Mitey Checker(®), were compared using 2 and 10 μg of Der 1 allergen per gram of dust, as evaluated by enzyme-linked immunosorbent assay (ELISA), to clarify which method is better suited for practical use.

METHODSMite allergen exposure levels of 106 floor, bed and sofa surfaces were evaluated by the Acarex test(®), Mitey Checker(®), and ELISA. A template of 100 cm×100cm was placed on the same surfaces to identify the examined areas. A dust collection filter was attached to a vacuum cleaner, and the area in the template (1 m(2)) was vacuumed. Then, to evaluate the other two tests, samples from the two other areas in the template (1 m(2)) that neighbored each other and did not overlap were vacuumed.

RESULTSTo predict Der 1 levels of 2 μg/g dust or higher, the sensitivity and specificity of the Acarex test(®) were 100% and 13.3%, and those, of Mitey Checker(®) were 91.8% and 71.1%, respectively. To predict Der 1 levels of 10 μg/g dust or higher, the sensitivity and specificity of the Acarex test(®) were 50.0% and 96.2%, and those of Mitey Checker(®) were 85.7% and 79.5%, respectively. Compared with Der 1<2.0, 2.0-9.9.≥10.0 (μg/g dust), the percent agreement and kappa of the Acarex test(®) were 47.2% and 0.234, and those of Mitey Checker(®) were 70.0% and 0.505, respectively.

CONCLUSIONTo evaluate mite allergen exposure level for practical use in Japanese living environments, Mitey Checker(®) is better than the Acarex test(®) because of its higher sensitivity and specificity.

Since students who would like to study Kampo medicine more have no opportunity to communicate each other in Northern Japanese Universities, we newly started joint study conferences held by medical students in 2013. The objectives of this paper are to report on these annually held student-based Kampo study conferences in the Hokkaido and Tohoku areas, and the ways each university studies Kampo medicine. In the conference, the students reported on their club activities. Then they studied the history of Kampo medicine and simulation of abdominal diagnosis, and performed group work on case reports together. The number of student participants in these conferences has tripled over 3 years from 18 to 58 (for a total of 111 participants). All members were satisfied with the content. And this reflects medical students' need for a wider perception of Kampo medicine, rather than a limited one gained in their university club activities. We hope this conference will play a major role in other nationwide student-based Kampo study conferences in the years to come.

BACKGROUND: More than 140 million people drink arsenic-contaminated groundwater. It is unknown how much arsenic exposure is necessary to cause neurological impairment. Here, we evaluate the relationship between neurological impairments and the arsenic concentration in drinking water (ACDW). PARTICIPANTS AND METHODS: A cross-sectional study design was employed. We performed medical examinations of 1867 residents in seven villages in the Thabaung township in Myanmar. Medical examinations consisted of interviews regarding subjective neurological symptoms and objective neurological examinations of sensory disturbances. For subjective neurological symptoms, we ascertained the presence or absence of defects in smell, vision, taste, and hearing; the feeling of weakness; and chronic numbness or pain. For objective sensory disturbances, we examined defects in pain sensation, vibration sensation, and two-point discrimination. We analyzed the relationship between the subjective symptoms, objective sensory disturbances, and ACDW. RESULTS: Residents with ACDW ≥ 10 parts per billion (ppb) had experienced a "feeling of weakness" and "chronic numbness or pain" significantly more often than those with ACDW < 10 ppb. Residents with ACDW ≥ 50 ppb had three types of sensory disturbances significantly more often than those with ACDW < 50 ppb. In children, there was no significant association between symptoms or signs and ACDW. CONCLUSION Subjective symptoms, probably due to peripheral neuropathy, occurred at very low ACDW (around 10 ppb). Objective peripheral nerve disturbances of both small and large fibers occurred at low ACDW (> 50 ppb). These data suggest a threshold for the occurrence of peripheral neuropathy due to arsenic exposure, and indicate that the arsenic concentration in drinking water should be less than 10 ppb to ensure human health.
Adolescent ; Adult ; Arsenic ; analysis ; toxicity ; Cross-Sectional Studies ; Dietary Exposure ; adverse effects ; Dose-Response Relationship, Drug ; Drinking Water ; adverse effects ; chemistry ; Female ; Groundwater ; chemistry ; Humans ; Male ; Middle Aged ; Myanmar ; epidemiology ; Peripheral Nervous System Diseases ; chemically induced ; epidemiology ; physiopathology ; Sensation Disorders ; chemically induced ; epidemiology ; physiopathology ; Water Pollutants, Chemical ; analysis ; toxicity ; Young Adult