The subjects are farm housewives in two different agricultural communities of southern Tokushima Prefecture. Most of them are engaged in mixed farming on hilsides facing south. The climate is mild all the year around.
The people in the two communities, like others in the district, undergo medical checkups regularly executed under the outreach health program of our hospital.
In order to obtain data related to their way of living and working conditions, a questionnaire was conducted. In a similar way, a survey was carried out to measure the change in the attitude of the subjects toward health care after medical examination and consultation.
In Community A, the economy is largely based on orange growing in vinyl-covered hothouses and bamboo shoots. Of the housewives who responded to our survey, 87.3% said their livelihood depends chiefly on agriculture.
Working hours were longest among those in their 40s, 26.8% of whom were found suffering from anemia, in the latest health checkup.
Lower levels of neutral fat and a lower degree of albuminurea were noted among those aged 40 or under. These findings suggest that health promotion measures be taken from the standpoint of nutrition.
The latest health checkup also revealed that the health conditions remained poor among those who had given little thought to the results found in the previous group medical examination.
In Community B, agriculture is dominated by paddy rice and orange growing. But the community is suburban.
In formulating a health control program for women in Community B, emphasis should be placed on prevention of hypertension, obesity and other conditions associated with the adult disease.

This article describes the end of life of seven people with amyotrophic lateral sclerosis (ALS) under the care of a hospice. The reasons for admission to hospice were for the management of distressing symptoms and the support of families who were unable to continue care at home because of the increased burden of care and/or illness of families. The sufferings experienced by the patients with ALS included disability due to muscle weakness(100%), pain(100%), discomfort (100%), dyspnea (71%), difficulties in communication (71%), drooling (43%), insomnia (43%), loneliness (43%), swallowing difficulties (28%), clenching the mucosa inside the cheek (28%), anxiety (28%), the perception of being a burden to the family (28%), and concerns as to why they had developed ALS (28%). Opioid medication was effective in the management of dyspnea, pain and discomfort. The results showed that special attention should be paid to frequent changing of the patient's position during nursing care, including the passive movement of joints and massage. The use of communication aids was essential to allow people with ALS to communicate effectively and, together with support of joy of the patients and family, the quality of life could be improved. End of life care within a hospice is a useful alternative option for persons with ALS, extending hospice care in Japan from people with advanced cancer to other disease groups. Palliat Care Res 2010; 5(2): 137-143

Background: In terminally ill patients with cancer, sleep disturbance makes worse their quality of life. Midazolam has not ever been used for the treatment of sleep disturbance in general wards of our hospital, used in palliative care unit of other hospital, however. Method: This is a retrospective study based on chart review. Twenty-eight patients who were treated with midazolam for sleep disturbance included in this study. We designed evaluation methods to strictly follow the actual chart descriptions. Efficacy was rated as good, fair, or poor. Safety was defined by the presence or absence of respiratory depression and hypotension. Results: The median administration periods and initial doses were 6 days (range, 1-151) and 5.0 mg/night (1.8-20.0), respectively. Fourteen patients showed good sleep a night after midazolam infusion, four and nine patients showed fair and poor sleep, respectively. No patient demonstrated a respiratory rate of less than 8/min and systolic blood pressure of <60 mmHg at any point during and after midazolam infusion. Conclusion: Intravenous midazolam appeared to be safe for sleep disturbance of terminally ill patients with cancer in general wards. A future improvement administration methods are necessary to treat for sleep disturbance more effectively as well as PCU.

The patient was 62-year-old woman was brought to the emergency room with chest pain and dyspnea. Computed tomography revealed a hematoma around the ascending aorta, a notch in the aortic wall, pericardial effusion and a hematoma around the pulmonary artery. We diagnosed early thrombotic type of acute aortic dissection. An ascending aorta replacement was performed via median sternotomy under hypothermic circulatory arrest. Upon operation, there was a 1.0 cm intimal tear just above the left main trunk and there was no specific evidence of aortic dissection. So we diagnosed spontaneous aortic rapture. Her postoperative course was uneventful and she was discharged 18 days after surgery.

Mandibular chronic osteomyelitis with diffuse osteosclerosis is recognized as an intractable infectious disease. We emplyed decortication and intra-arterial infusion of antibiotics in 6 cases. Decortication on the affected mandible was performed with retrocatherization to the superficial temporal artery of affected side under general anesthesia. Antibiotics, IPM/CS or FOMX was used through the artery for 4-11 days. In addition, we administered FOMX, PIPC intravenously for 8-17 days. CT and MRI were taken postoperatively. The postoperative follow-up period ranged from 1 year and 6 months to 2 years and 5 months. Postoperative MR showed that bone marrow signal was recovered to approximately normal in 4 cases. High signal area of bone marrow and osteosclerosis image remained in 2 cases, but showed improvement. The results were satisfactory without recurrence in all of 6 cases.
Anesthesia, General ; Anti-Bacterial Agents ; Arteries ; Bone Marrow ; Communicable Diseases ; Follow-Up Studies ; Infusions, Intra-Arterial ; Mandible ; Osteomyelitis ; Osteosclerosis ; Recurrence ; Temporal Arteries

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.

Purpose: Does longer study time motivate students to learn and make them feel a sense of accomplishment? Whilst “Human Biology,” one of the required courses in the first year of the medical school, was in need of a total course design reformation to make a shift from teaching to learning, it was necessary to examine whether longer study time is effective for better learning outcomes.　Methods: To get students to learn outside of class, we flipped the course. Since the scores from weekly quizzes, which are held at the beginning of every class, and mid-term and final exams were returned to the students, fully calculated and strictly applied to their grades, students became motivated to study before class. During class time, lessons were taught in the active learning style. We used covariance structure analysis to examine the relationship between the out of class learning design, the syllabus reformation, students’ learning attitudes in the class, and their sense of accomplishment.　Results: Study time outside of class increased from 4 hours per week in 2013 to 10 hours per week in 2016, and the students became more satisfied with the course. Our analysis shows that this well-structured syllabus and designing of lessons made the students study more both inside and outside of class, and allowed students to achieve the higher goals of the course.　Conclusion: Designing out of class learning and incorporating it well with assessment resulted in longer study time and a stronger sense of accomplishment.