The Project for Improving Maternal and Newborn Care through Midwifery Capacity Development by Japan International Cooperation Agency (JICA) was initiated for capacity building through pre-and post-service midwifery training.
  Firstly, we have shared the concept of ideal midwifery care based on the definition of evidence-based medicine (EBM) with our counterparts, which involves the integration of the best research evidence with clinical expertise and patient values. In addition to evidence-based midwifery care, we tried to provide individualized woman-centered care.
  After sharing these concepts in our project sites, we tried to modify the lectures on the basic concepts of midwifery care in the Health Center Midwifery Training program, and care providers’ attitudes based on EBM in the Basic Emergency Obstetric and Neonatal Care Training program.
  Our trial is an essential first step towards the further reduction of maternal mortality in Cambodia.

We successfully performed one-stage definitive repair for 3 infants weighing 4.2, 6.1 and 5.2kg with complex coarctation without homologous blood transfusion. The priming volume of the bypass circuits was 195ml, and their lower hematocrit values during cardiopulmonary bypass were 15, 16 and 13%, respectively. In order to diminish the aortic cross clamp time, the aortic arch was repaired with the heart beating, using isolated cerebral and myocardial perfusion methods. The base excess in each patient decreased to -9.4, -8.0 and -4.9mEq/l during the rewarming phase, however, their postoperative hemodynamic and respiratory conditions were satisfactory. They have grown without any sequelae for at least 2 months.

We describe a young adolescent patient with spontaneous abdominal aortic rupture who was treated successfully. A 14-year-old boy was admitted to our hospital with severe abdominal pain and hypovolemic shock, without any episode of trauma. Computed tomography (CT) revealed massive hematoma in the retroperitoneal space and extravasation of copious amounts of contrast medium in front of the terminal aorta. Neither aortic aneurysm nor dissection was observed in this CT. An emergency operation was carried out. At first, left thoracotomy and clamping of the thoracic descending aorta were performed in order to reduce the aortic bleeding. Midline laparotomy revealed an aortic perforation of approximately 8mm at the bifurcation of the abdominal aorta. The aortic wall surrounding the perforation was nearly normal without any aortic aneurysm or dissection. A segment of the terminal aorta (length, 3cm) including the perforated lesion was excised and reconstruction was performed with a woven Dacron tube graft (10mm in diameter). On microscopic examination, the marginal tissue near the perforation showed diminished elastic fibers and minimal dissection of the medial layer of the aortic wall; however, no cystic medial necrosis or inflammation was seen.

  The purpose of this study was to accumulate fundamental data for use in the future project for preventing or delaying institutionalization of the aged by clarifying the relationship between the Kihon Checklist and bone density. All the subjects were residents of the southern part of Akita Prefecture in the 65-74 age band. The Kihon Checklist was used. The women who marked the items on the list related to “intraoral conditions” tended to be low in bone density. Those who checked off the items related to “oral functions” -- the standard of judgment in determining the level of care needed - were inactive and depressed.   Since bone density was an indicator of whether the elderly women were in need of nursing care, we thought it of paramount importance to encourage them to participate in the screening for osteoporosis on a regular basis and to take measures to maintain or improve bone density.

Several studies have reported that molecular hydrogen (H₂) acts as a therapeutic medical gas owing to scavenging reactive oxygen species (ROS). However, little is known about effects of H₂ on exercise-induced oxidative stress. The purpose of this study was to investigate the effects of weekly hydrogen bathing on exercise-induced oxidative stress and delayed-onset muscle soreness (DOMS). Nine healthy and active young men participated in this study, and each subject performed hydrogen bathing trial and placebo bathing trial in a crossover design. The subjects performed downhill running (8 % decline) at 75 % peak oxygen uptake (VO₂peak) for 30 min, and each subjects conducted hydrogen or placebo bathing for 20 min, respectively, 1-6 days after downhill running. Before and after exercise, we measured visual analogue scale (VAS) and collected blood samples (Pre- and 5 min, 60 min after the end of bathing, 1day, 2days, 3days, 7days after downhill running). Blood sample analyses include creatine kinase (CK), myoglobin (Mb), malondialdehyde (MDA), reactive oxygen metabolites (d-ROMs), biological antioxidant potential (BAP), myeloperoxidase (MPO), interleukin-6 (IL-6), interleukin-17a (IL-17a) and lactate concentrations. Weekly hydrogen bathing had no effects of exercise-induced oxidative stress and muscle damage. On the other hand, hydrogen bathing significantly reduced DOMS (VAS) 1 and 2days after downhill running (p=0.033). These findings suggest that hydrogen bath after downhill exercise can be effective for reduction of DOMS.

  A look at the reports of accidents or near accidents in our hospital revealed that the incidence of falls or stumbles in children was at the top of the list in frequency. In the past five years, our pediatric ward has experienced an average of about 10 such cases annually. Regarding the risk of falling, advice is given by nurses to parents during the orientation session when their babies and little children are hospitalized. However,the advice was entirely subjective - not going by any rule or guidelines. Recently, an assessment score sheet for the risk factors for falling and a preventive measure against falls was drafted and trial used, with the result that changes were observed in the way the nurses in their 20s watch and take care of the little patients. Moreover, they became able to look after the infants according to their age, developmental stage and disposition. The use of the common pamphlet helped the young nurses gain selfconfidence even though they are inexperienced in child-rearing and nursing.  From these results, we concluded that the uniform guideline and order of priority led to the improvement of the quality of nursing in the nurses in their 20s.

To promote habitual participation in physical activity, a 3-month program for lifestyle physical activity intervention (L group) and structured exercise intervention (E group) was carried out in a community in Okayama Prefecture. One year later, we compared the two intervention groups in terms of cost-effectiveness and behavioral change in habitual physical activity. A total of 250 subjects voluntarily participated in the lifestyle physical activity intervention ; and a total of 42 subjects participated in the structured exercise intervention. The number of participants decreased to 115 (46%) and 21 (50%), respectively, one year later. However, the proportion of subjects who practice endurance exercise increased significantly in both L and E groups ; and an additional 35 subjects (30%) started to practice endurance exercise in L group and 5 (24%) in E group after the interventions. The cost-effectiveness for a person newly starting the endurance exercise practice in the L group intervention was 29,206 yen ; and the E group intervention was 124,731 yen, a ratio of 1/4.3. The study suggests that the cost-effectiveness for the lifestyle physical activity intervention was 4 times better than the structured exercise intervention.

It is believed that one of the principal effects of negative air ion is refreshing human psychological condition. Negative air ion can be observed in natural environments such as forest, fountain, and hot spring. In order to elucidate scientific reason of psychological effects by negative air ions, quantifying psychological effects will be important.
Healthy sixteen examinees (8 young candidates around 20 years, 8 old candidates around 60 years) are tested by SRS-18, blood pressure, questionnaire, and electroencephalogram. SRS-18, blood pressure, questionnaire was performed before and after experiment. Electroencephalogram was continuously measured during whole experiment and used for emotional spectrum analysis method (ESAM) calculation. Experiment was divided into three conditions (initial normal condition, negative air ion boosted condition at middle concentration, after ventilated condition) and three phases (accommodation, rest, calculation) at each condition.
At young group, excessive negative air ions increased human psychological concentration which is calculated by ESAM. At calculation phase, psychological concentration has a positive correlation with psychological stress (correlation factor 0.505). Otherwise at old aged group, no significant change was observed. It shows that sensitivity of negative air ions at old persons will be reduced. It also suggests that human sensitivity for negative air ion decreases with aging.
At rest phase of young group in negative air ion boosted condition, elementary emotions are balanced at ESAM. This shows that balancing among four elementary emotions is related with psychological effects of negative air ions.

Personal lifestyles constitute one of the strategic frontiers of preventive medicine. We carried out a survey of eating habits of people in three rural communities in the southern part of Akita Prefecture, where fundamental health screening programs have been implemented regularly. Differences in eating habits between men and women and between age groups were found. The health status of the examinees was judged by using data on blood pressure, obesity and lipid levels measured at the latest health checkup.
To find a correlation between eating habits and physical health status, the frequency of illness was examined according to the number of times of eating various kinds of food. It was found that with age, people take in fish and shellfish, cow's milk, beans, vegetables, Japanese confections and soup more frequently and eat less meat. The incidence of hypertension varied by age and sex, but was higher in those who eat less soup, pickles and milk. Likewise, abnormally high levels of total serum cholesterol were found in women who eat meat, eggs and greasy food less than twice a week. It was thought that those hypertensives and those with high cholesterol values are cuttingdown on their intake of those foods of their own accord. Therefore, we would like to point out that, in the secondary prevention setting, physicians and other health care providers should know in advance whether their patients are putting themselves on a restricted diet or not.
When the average serum lipid values were examined according to the number of times of eating meat or fish and shellfish per day, it was found that men aged 70 years or above who eat those foods more than once every day have high HDL cholesterol values and that these values significantly vary depending on the kind of meat. These findings suggested that persons of advanced age who eat well and who are not particular about their food are full of vitality. This could serve as an important point in the care of the aged with serum lipid abnormalities.
A study of evacuation and its relation to vegetable intake showed that the less the frequency of bowel movements, the smaller the amount of vegetable intake. There was a significant difference in the frequency of evacuation between vegetable eaters and those who do not consume an adequate amount of fiber.