This article presents harm reduction, which was recently developed in response to the expansion of injection drug use and the HIV/AIDS epidemic. The authors describe the essence of harm reduction, proposing that harm reduction is a pragmatic strategy from a public health perspective to deal with injection drug use. Also, how harm reduction complements the traditional strategies to eradicate illicit drug use based on abstinence (so called, War on Drugs, or Just Say NO) is discussed. By describing key principles of harm reduction, such as low-threshold programs, non-judgmental attitudes, priority of immediate goals, and balancing costs and benefits, the authors introduce major harm reduction programs, which include needle/syringe exchange, outreach, counseling and education, supervised injection sites, and substitution treatment. Substantial evidence demonstrates harm reduction is effective in preventing the spread of HIV. Although international bodies, such as UNAIDS and WHO, advocate harm reduction strategies for the better prevention from the spread of HIV/AIDS, and some countries have adopted national harm reduction policies, United States discourages harm reduction policies in fighting the global HIV/AIDS pandemic. Finally, the authors address the effectiveness of harm reduction from the public health perspectives to deal with AIDS epidemic among injection drug users and the necessity of comprehensive understanding and multifaceted application of harm reduction. They also present the need to rethink Japanese government policies and social programs to meet drug users' health needs.

A questionnaire was sent to school health nurses in rural districts of Shimane Prefecture asking them about health conditions and emergency accidents of children, problems of the health care, and safety administration in schools.
The health conditions of children in rural districts were almost common with those of children in cities of Japan. It was suggested that the increase of psychosomatic complaints and disorders of children was directly or indirectly affected by the changes of life conditions in households of side-work farmers, the inhumane competition in education and the drastic urbanization of life style.
The cooperative approach to comprehensive health care of children by the participants of school health and community health is urgently needed to promote the health level.

　Simulation specialist who masters simulators is important for a management of simulation center. Okayama university medical school started to train simulation specialists. Now simulation training are familiar in our university through the simulation specialists helps course directors.

Actual conditions of the health care of school personnel in rural districts of Shimane Prefecture were investigated, concentrating our attention on the structure of diseases, the contents of health examination, factors impeding health, and so forth.
As a result of our investigation we found that the incidence of adult diseases among school personnel is considerably high. Health examinations with complete contents should be practised in the near future.
Further, the establishment of health care system in the work place, the improvement of working conditions considering sufficiently the peculiarity of mental work and of femininity, the independence of school nurses as specialist should be realized on the basis of the understanding of actual problems, which are obtained by examinations of health care conditions at each work place including epidemiological examination.

The recent urbanization of rural communities and the associated changes of the living environments influenced the health conditions of children in rural districts of Shimane Prefecture, Japan. It obliged therefore to review the usual school health approach and to evaluate the care system to new trends of critical health problems of children.
A questionnaire was sent to school nurses asking their worries and problems about each step of the scientific school health procedure to recognize the health needs, to analyse the health problems, to plan the appropriate counterplans, to practice and to evaluate.
As a result of our investigations, the following remedies were necessary for the development of rural school health activities.
Firstly, the specialization of school nurses should be established without delay, and their working conditions should be more improved.
Secondary, school nurses should strengthen the contacts with teachers, parents and other school staffs to organize the developed school health system.
Finally, school nurses should make their efforts to delop the community-based school health care which connected the comprehensive community health care.

BACKGROUND: Postoperative pain relief can be achieved with various modalities. However, there are only few reports that have analyzed postoperative analgesic techniques in total hip arthroplasty patients. The aim of this retrospective study was to compare the postoperative outcomes of three different analgesic techniques after total hip arthroplasty. METHODS: We retrospectively reviewed the influence of three analgesic techniques on postoperative rehabilitation after total hip arthroplasty in 90 patients divided into three groups (n = 30 patients per group). Postoperative analgesia consisted of continuous epidural analgesia (Epi group), patient-controlled analgesia with morphine (PCA group), or a continuous femoral nerve block (CFNB group). We measured the following parameters relating to postoperative outcome: visual analog scale scores, the use of supplemental analgesia, side effects, length of the hospital stay, plasma D-dimer levels, and the Harris hip score. RESULTS: Each group had low pain scores with no significant differences between the groups. The PCA group had a lower frequency of supplemental analgesia use compared to the Epi and CFNB groups. Side effects (nausea/vomiting, inappetence) and day 7 D-dimer levels were significantly lower in the CFNB group (p < 0.05). There were no significant differences between the groups in terms of the length of the hospital stay or the Harris hip score. CONCLUSIONS: Although there were no clinically significant differences in outcomes between the three groups, the CFNB provided good pain relief which was equal to that of the other analgesics with fewer side effects and lower D-dimer levels in hospitalized patients following total hip arthroplasty.
Adult ; Aged ; Aged, 80 and over ; *Analgesia, Epidural/methods ; *Analgesia, Patient-Controlled ; Analgesics, Opioid/*administration & dosage ; *Arthroplasty, Replacement, Hip ; Female ; *Femoral Nerve ; Fibrin Fibrinogen Degradation Products/analysis ; Humans ; Length of Stay ; Male ; Middle Aged ; Morphine/*administration & dosage ; *Nerve Block/methods ; Pain, Postoperative/*prevention & control ; Retrospective Studies ; Treatment Outcome

Two patients with post-traumatic diabetes insipidus (DI) are reported. One had suffered a fatal injury and the other a mild contusion without amnesia before DI developed. These two instances exemplify the wide spectrum of post-traumatic DI and, hence, the importance of ruling out DI even afer a mild closed-head injury.
Adult ; Case Report ; Central Nervous System/*injuries ; Desmopressin/therapeutic use ; Diabetes Insipidus/drug therapy/*etiology/physiopathology ; Diuresis/drug effects ; Female ; Human ; Male ; Middle Age ; Vasopressins/therapeutic use ; Wounds and Injuries/*complications/mortality

Purpose: Toxins produced by Clostridioides difficile infection (CDI) can cause enteritis and diarrhea. Although the number of pediatric CDI cases is increasing, the clinical management of pediatric CDI, including patient characteristics and prognosis, remains unclear. This study aimed to elucidate the background and clinical course of patients with CDI and evaluate the reliability of diagnostic tests in a tertiary pediatric hospital in Japan. Methods: We retrospectively analyzed the clinical data of children diagnosed with CDI between 2011 and 2021 at the Saitama Children’s Medical Center in Saitama, Japan. Results: During the study period, 1,252 C. difficile antigen/toxin tests were performed, and 37 patients were diagnosed with CDI. The main underlying diseases among the patients were hematological and malignant disorders and gastrointestinal diseases, including inflammatory bowel disease (IBD) (59.4%). Two patients (5.4%) had an unremarkable medical history. Among the 37 patients, 27 (73.0%) were immunocompromised, 25 (67.6%) had a history of antibiotic use within the past two months, and 6 (16.2%) were negative on the initial test but were positive on the second test. Finally, 28 patients (75.7%) required primary antibiotic therapy only, and two patients with IBD required additional antibiotic therapy as secondary treatment. Conclusion The number of pediatric patients with CDI is increasing. Both a comprehensive interview, including underlying diseases and history of antibiotic use, and an understanding of the features of clinical examinations should be emphasized to appropriately diagnose and treat CDI.

Introduction: The regional palliative care support center (PCSC) has set the following palliative care goals for correction of misunderstanding and prejudice of the general community against palliative care, home care and home death of cancer patients: practice palliative care early after diagnosis, educate the community to understand palliative care and build a regional palliative care cooperation system. Method: This study reviewed four years (2009-2012) of data from the PCSC. Outcome data of the patients were collected during outpatient care, inpatient care, and in-home care that were supported by the PCSC. The PCSC managed palliative care based on patient conditions and symptoms in the early stage after diagnosis. The PCSC worked to spread the idea and importance of palliative care to the general community and health care professionals of the region, and also worked to promote the regional palliative care cooperation. Result: These efforts led to an increase in the number of first center visit of patients, especially introduction patients, and an extension of the period of treatments of both tumor department and palliative care department. These outcomes resulted in an increase in the rate of in-home care transitions, the length of in-home care and the number of deaths at home. These results suggest that the place of appropriate medical and caregiving treatments and the place of death are converting into home gradually from hospital.

Introduction  Asahikawa Medical University has been conducting a JICA Knowledge Co-Creation Program (KCCP) “Health Administration for Community Health Officers in Africa” in Japan since 2008. Due to the COVID-19 pandemic, the KCCP in 2020 was a hybrid of distance learning and following on-site training in Japan, which the latter was canceled thereafter. This paper reports on how this hybrid program was organized and implemented.Methods: Preparation  The program was held in January-February 2021, with eight official participants from five countries and nine observers from two countries. The participants were required to engage in self-learning by PowerPoint materials with lecturers’ audio descriptions and zoom-based interactive meetings. The PowerPoint materials were freely accessible at our Google Drive account. There were 10 zoom sessions during the program.Results: Implementation  At the beginning, all the lecture materials were converted to mp4 clips and uploaded to a Youtube channel due to the difficulties downloading heavy files with limited internet connection. A total of 24 videos were created with an average length of 58 minutes in each. Zoom-based interactive meetings were held regularly in the morning in the African continent. Almost all of the sessions were productive, but the participants were sometimes interrupted due to a weak network environment or their regular work assignments. Most provided contents were well understood.Discussion  Despite some technical and environmental difficulties, the new-style, web-based training course facilitated the participation of observers as well as regular participants, providing more opportunities for interaction and discussion among trainees than a previous old-fashioned, on-site program. Improvement of the training environment particularly for participants is necessary to produce better training outcomes in the future, such as renting a hotel room and securing virtual connections.