Objectives
 The present study aimed to elucidate issues in maternal and child health in suburban areas by comparing the effects of increases in population, economic power, and amount of information on health behaviors among mothers such as pregnancy, childbirth, and child care in village A in the suburbs of Kathmandu between 2001 and 2006.
Methods
 We conducted an interview survey on mothers of children aged 0-12month in village one in Lalitpur district in Nepal. Data from 2001 and 2006 were compared for the educated group, non-educated group, and all subjects.
Results
 The number of mothers in ethnic minorities increased in 2006. The most commonly used facility for pregnancy examinations, delivery, and child illnesses was hospitals, and their use tended to increase from 2001 to 2006 for each type of visit. In addition, the cost of pregnancy examination and delivery increased approximately 7-and 2-fold, respectively. Kaup index increased by one point for the condition of child development. Prevalence of general infections among children decreased.
Conclusion
 Subjects were polarized into the middle class, which included individuals who had increased income by working as migrants abroad, and an economically disadvantaged group which included individuals who had migrated from rural areas. The active use of health services at hospitals among pregnant women and children was attributed to recognition of the safety and comfort of hospitals as well as the consumer culture resulting from growth of the middle class. The economically disadvantaged group was considered to be at high risk with regard to maternal and child health, and was thus thought to require affordable and accessible support. Issues in child care appeared to be shifting from “nutritional improvement” and “infection control” to “nutritional balance”.

Objective : Although current preventative care policies consider the issue of the homebound elderly to be important, effective means of intervention have not been established. Therefore, it is necessary to elucidate the relevant causes of the poorly understood “homebound” problem. As little expertise exists on the social and psychological factors of those who are homebound, this study focuses on the sense of coherence (SOC) —a new estimate of the psychosocial factors involved in being homebound—and examines the connection between being homebound and SOC.
Methods : A mail survey was conducted among 1,895 elderly adults, none of whom had been issued a Certification of Long-Term Care Need. Survey items included basic attributes, physical characteristics, psychological and socioenvironmental characteristics, and the condition of being homebound. Furthermore, SOC was investigated as part of the psychosocial and environmental evaluation. The 853 respondents chosen for the analysis were divided into three groups depending on their level of homeboundedness, and an ordered logistic regression analysis was conducted using homeboundedness as the dependent variable.
Results : The following items were found to have a significant association with homeboundedness : age, sex, low motor function, depressive tendencies, low SOC, and the low TMIG Index of Competence.
Discussion : This study identified a relation between being homebound and SOC, suggesting that in addition to interventions for depression and motor function, new SOC focused aid must be considered in the prevention of homeboundedness.

We encountered 15 cases of surgical site infection (SSI) by Methicillin-resistant Staphylococcus aureus (MRSA) among 153 patients who underwent a cardiovascular operation in 2000. SSIs consisted of 5 mediastinal infections, 9 surface wound infections and 1 artificial graft infection after an abdominal aortic surgery. All infected cases had been operated on between June and December 2000. Eighty-three cases, which underwent cardiovascular operations during this period, were divided into SSI or no-SSI groups and their clinical data were analyzed. The data included age, gender, preoperative diabetes, urgency, preoperative usage of a device like Swan-Ganz catheter or IABP, preoperative albumin level, preoperative physical state by ASA score, National Nosocominal Infections Surveillance index, duration of operation, usage of a cardiopulmonary bypass, duration of bypass, type of operation, and number of distal anastomoses in CABG operations. Multivariate analysis showed gender (male), diabetes, and emergency operation as independent risk factors for the incidence of SSI by MRSA. One patient, who suffered a mediastinal infection after CABG, had confirmed as demonstrating the colonization of MRSA in sputum preoperatively. Microbiological screening of medical staff showed 2 of the 6 surgical doctors and 3 of the 25 ward nurses exhibited colonization with MRSA. DNA analysis of MRSA, harvested from 5 infected patients, indicated at least 2 strains of MRSA and 1 of the 2 strains was identical to the MRSA that was detected in a doctor. We applied prophylactic measures with reference to the guideline for prevention of surgical site infection announced by CDC in 1999, which included the following: routine work-up of MRSA-colonization, and treatment of all MRSA colonized patients and those undergoing emergency operations with Mupirocin. Preoperative patients were isolated from MRSA-infected or colonized patients. MRSA-colonized surgical personnel were treated with Mupirocin ointment. Cephazoline was administered shortly before and after the operation as a prophylactic antibiotic. Vancomycin was added to Cephazoline in patients with a history of MRSA-colonization or infection. Through hand washing before and after daily contact with patients was emphasised to all medical staff. SSI surveillance conducted by an infection control team was implemented. After the introduction of the prophylactic measurements, one MRSA-SSI was observed among 113 cases who underwent a cardiovascular operation between January and September 2001.

The preparation for influenza pandemic has become very important. However, no standardized educational package against pandemics has been established to date. We developed a simulation–based education drill for Japanese medical students based on the package developed by U.S. medical school. The drill was adapted to 201 medical students, and was evaluated by self–administered questionnaires.
1)More than 90% of the students indicated that the use of this drill is appropriate to experience a simulated pandemic situation, and to learn skills and attitudes such as teamwork and communication.
2)Up to 65% of the students answered they learned a "very clear image" for the "Importance of working as a team with other professionals".
3)The results suggest that this simulation–based education drill make the students aware not only of the need for the preparation for pandemic but also the importance of team–based approach.

The purpose of this study was to introduce our patient-specific bioactive porous titanium implant manufactured using selective laser melting (SLM) and to establish the efficacy and safety of the implant for stand-alone anterior cervical discectomy and fusion (ACDF) based on a prospective clinical trial. We designed a customized ACDF implant using patient-specific data and manufactured the implant using SLM. We produced a bioactive surface through a specific chemical and thermal treatment. Using this implant, we surgically treated four patients with cervical degenerative disc disease and evaluated the clinical and radiological results. We achieved successful bony union in all but one patient without autologous bone grafting within 1 year. We observed no implant subsidence during the follow-up period, and all clinical parameters improved significantly after surgery, with no reported implant-related adverse effects. Our customized bioactive porous titanium implant is a safe and promising implant for stand-alone ACDF.

Methods: For this prospective multicenter study, 40 patients were followed up through radiologic and clinical examinations for at least 1 year postoperatively. All surgical procedures were either single- or double-level LLIF using bioactive porous titanium spacers without bone grafts. Results: Four patients were excluded from the study owing to aggravation from other comorbidities. Another 36 patients, including 26 and 10 with single- and double-level LLIFs, respectively, participated in the follow-up. The mean age at the time of surgery was 63.7 years. The mean operating time was 50.5 minutes per level. The mean estimated intraoperative blood loss was 11.6 mL per level. Clinical scores improved in all cases and were maintained throughout the follow-up period. The intervertebral bony union rates were 67.4% and 84.8% at 6 and 12 months, respectively. Endplate cyst signs were observed in 13.0% and 8.7% of patients at 6 and 12 months, respectively. Fused segmental angles were maintained throughout the follow-up period, indicating no cage subsidence. Conclusions Single- and double-level LLIFs using bioactive porous titanium spacers without bone grafts were found to be minimally invasive, resulting in clinical and imaging results comparable with conventional procedures. Therefore, this type of implant may be an option for minimally invasive spinal fusion surgery.

The purpose of this study was to introduce our patient-specific bioactive porous titanium implant manufactured using selective laser melting (SLM) and to establish the efficacy and safety of the implant for stand-alone anterior cervical discectomy and fusion (ACDF) based on a prospective clinical trial. We designed a customized ACDF implant using patient-specific data and manufactured the implant using SLM. We produced a bioactive surface through a specific chemical and thermal treatment. Using this implant, we surgically treated four patients with cervical degenerative disc disease and evaluated the clinical and radiological results. We achieved successful bony union in all but one patient without autologous bone grafting within 1 year. We observed no implant subsidence during the follow-up period, and all clinical parameters improved significantly after surgery, with no reported implant-related adverse effects. Our customized bioactive porous titanium implant is a safe and promising implant for stand-alone ACDF.