Objective：An actual-condition survey was conducted to verify the validity of reference values of higher brain function necessary for patients with brain injury to resume automobile driving.　Subjects：Of the 74 patients admitted to the Tokyo Metropolitan Rehabilitation Hospital between November 1, 2008 and November 30, 2012, who underwent evaluation using the hospital's automobile driving resumption system at the time of discharge, 71 patients with brain injury who were judged capable of resuming driving were included in this study. Methods：Questionnaires were sent at least 1 year after discharge, to determine whether the subjects had actually resumed automobile driving. Subjects were classified by admission date into two groups：1）A provisional reference group that included patients admitted between November 2008 and November 2011 who had resumed driving；and 2) verification group that included patients who had been admitted between December 2011 and November 2012 and had resumed driving. The relationship between results on the higher brain function test for the verification group and provisional reference values was investigated. Results：The provisional reference value group included 29 patients, and the verification group included 13 patients. In the verification group, the results of 9 patients with brain injury on the higher brain function test were within provisional reference values. Conclusion：The results of the paper-based test are a reliable predictor of whether a patient is capable of resuming driving, but do not represent an absolute standard. Therefore, the safety of resuming driving should be investigated on a case-by-case basis.

Objective : We conducted a fact-finding survey for the consecutive past 3 years to establish whether inpatients with brain injury who had wished to resume driving after discharge from our hospital had in fact resumed driving after discharge. The survey included both driving status and information about collisions. Methods : Patients who had been evaluated for resumption of driving and were discharged more than 1 year ago were sent a fact-finding survey questionnaire aimed at establishing whether they were currently driving. The patients who had resumed driving (resumers) were compared with those who had not resumed driving (non-resumers). From the questionnaire results we investigated driving status and whether collisions had occurred. Results : We obtained effective responses from 40 of the 54 people (48 males, 6 females) who were sent the questionnaire ; the collection rate was 74.1%. Of these, twenty-nine people had resumed driving, all were male. There were no significant differences between the resumers and non-resumers in higher brain function tests. In regard to driving ability, hemiparesis impairments were significantly milder in the resumers than in the non-resumers. Two respondents had hit posts or walls within the year. All these collisions occurred when parking. One respondent had a collision while driving along a road. Conclusion : We hope to provide patients with useful and appropriate information on resuming driving so that we can support them in a safe return to the driving environment.

The present study was designed to examine the effects of aerobic exercise on the change of alpha wave component in electroencephalogram (EEG) and plasma β-endorphin. Exercise consisted of 30-min cycling on an ergometer with the load adjusted to elicit a heart rate rise of 50% between resting and predicted maximal value. The EEG signals and blood samples were obtained before and after 30-min exercise. The EEG signal was digitized at a sampling frequency of 64 Hz and analyzed by means of computer-aided decomposition algorithm and frequency power spectral analyses, respectively. The blood samples were immediately centrifuged for 15-min for quantitative analysis of β-endorphin by means of radioimmunoassay method. Results indicated that β-endorphin was significatly (p<.05) greater after exercise as compared to that of the resting contorol. It was also found that the larger the changes in β-endorphin following exercise, the higher the appearance rate of alpha wave in EEG. There was a positive and significant correlation (r=563, p<0.05) between the increase in alpha wave component and that of the plasma β-endorphin. These results suggest that traquilizer effects of aerobic exercise could be explained, at least in part, by the increase of alpha wave component and plasma β-endorphin which in turn bring about the relaxation effects upon the central nervous system.

The present study was designed to examine the effects of aerobic exercise on the change of alpha wave component in electroencephalogram (EEG) and plasma β-endorphin. Exercise consisted of 30-min cycling on an ergometer with the load adjusted to elicit a heart rate rise of 50% between resting and predicted maximal value. The EEG signals and blood samples were obtained before and after 30-min exercise. The EEG signal was digitized at a sampling frequency of 64 Hz and analyzed by means of computer-aided decomposition algorithm and frequency power spectral analyses, respectively. The blood samples were immediately centrifuged for 15-min for quantitative analysis of β-endorphin by means of radioimmunoassay method. Results indicated that β-endorphin was significatly (p<.05) greater after exercise as compared to that of the resting contorol. It was also found that the larger the changes in β-endorphin following exercise, the higher the appearance rate of alpha wave in EEG. There was a positive and significant correlation (r=563, p<0.05) between the increase in alpha wave component and that of the plasma β-endorphin. These results suggest that traquilizer effects of aerobic exercise could be explained, at least in part, by the increase of alpha wave component and plasma β-endorphin which in turn bring about the relaxation effects upon the central nervous system.

Objective: Prescription check and inquiry is one of the most important operations of pharmacists to provide optimal drug therapy to the patient.  Although a number of studies related to inquiries of prescriptions have already been reported, there is little report about requests for doctor and hospital based on the examples.  Therefore, this study aimed to clarify the current problems revealed by inquiries about prescriptions by not only analyzing these inquiries but also investigating requests for doctors and hospitals.
Methods: We investigated 6,255 inquiries about prescriptions and requests for doctors and hospitals at 584 insurance pharmacies from August 4 to 10, 2014.  Then, the inquiries about prescriptions and requests for doctors and hospitals were categorized.
Results: The most frequent category of inquiries about prescriptions was “Questions about administration and dosage” (21.5%).  On the contrary, the most frequent request for doctors was “Efficiency in gathering information from and providing information to a patient” (2,067 cases).
Conclusions: The present study clarified current problems revealed by inquiries about prescriptions by investigating requests for doctors and hospitals that were based on examples.  Furthermore, the problems were classified into ten categories, and these should be noted by doctors and hospitals at the time the prescription was issued.

Objective: A perception survey of healthcare providers and pharmaceutical industries about the current package insert (PI) was conducted to evaluate whether its layout and issues such as the contents concerning drug-drug interactions are found appropriate.
Methods: A questionnaire was sent via the Internet to physicians of various subspecialties, or via the postal service to pharmacy-employed pharmacists and pharmaceutical industries.  It consisted of questions regarding the PI layout, the information contents on drug-drug interactions and other matters about PI revision.
Results: The survey showed that the PI is a major source of drug information for physicians (82.4%) and pharmacists (98.7%).  The layout (order of appearance of headings and information about drug interactions in a tabular format) of the current PI is widely accepted by physicians, pharmacists, and pharmaceutical industries.  There was, however, some degree of disagreement within these three groups in the perceptions about the presentation/contents of the several drug interactions, as well as about the timing for its updating.  Around 24% of physicians and 35% of pharmacists view that the content of drug interactions is insufficient, and that information about adverse drug reactions and drug interactions is not enough updated in the PIs.  On the other hand, near 86% of pharmaceutical industries were prone to wait for accumulation of enough data until revising the information in PIs.
Conclusions: Differences of perception were found between healthcare providers (i.e., PI users) and industries.  Our survey revealed that the basic layout of the current PI should be preserved, but there are issues such as the contents and updating of information regarding drug interactions and adverse drug interactions that may require modifications according to the healthcare providers’ point of view.

In Akita Prefecture, there are nine hospitals established by the Akita Prefectural Federation of Agricultural Cooperatives for Health and Welfare (Koseiren). Half of the stroke patients in the prefecture were treated in these Koseiren hospitals, and half of the mass screening projects for the prevention of cardio vascular diseases were undertaken by these hospitals. A retrospective cohort study was done using mass-screening data (age, sex, past history of diabetes mellitus, blood pressure, body mass index, smoking and drinking habits) of 175,033 cases stored at these hospitals from 1988 to 1999, and the prefecture-wide stroke data of 2,520 initial stroke events registered from 1988 to 2003. The number of stroke cases was broken down into 1,428 cases of cerebral infarction (57%, CI), 693 cases of cerebral hemorrhage (27%, CH) and 399 cases of subarachnoid hemorrhage (16%, SAH). The subjects were also divided into five age groups:30-49, 50-59, 60-69, 70-79 and 80-89. Blood pressure (BP) was classified into six categories according to the JNC 6 criteria. Risk factors were determined using the Cox analysis. The hazard ratio for CI and CH was increasing with advancing age. CI showed a higher hazard ratio in men than women (hazard ratio for men was 1.8). The hazard ratio was increasing as BP became higher in any of three stroke subtypes, and especially CH showed the strongest correlation with BP. Uncontrollable risk factors were very closely associated with the attack of CI. On the other hand, BP (controllable risk) was closely linked with the attack of CH. Our results showed the prevention of CI was not easy. Controlling BP may be the most effective strategy for preventing hemorrhagic stroke (CH and SAH).
Cerebrovascular accident ; Cephalic index ; Blood pressure determination ; hazard ; Risk Factors