Using the results of a questionnaire survey, a study was made to ascertain whether or not the March 11, 2011 Great East Japan Earthquake influenced the attitude of survivors toward terminal illness and end-of-life care. The survey was taken one year after the devastating earthquake with the cooperation of 76 hospitals affiliated with the National Federation of Agricultural Cooperatives for health and Welfare. A total of 7,811 people ranging in age from 14 to 91 (M/F＝1/1.9) responded to the survey. They consisted of high school students, nursing school students, staffs of hospitals, and people with other types of occupation.　　Respondents from the two hardest hit regions (Fukushima and Ibaraki Prefectures: FIP) and three neighboring ones (Akita, Niigata and Nagano Prefectures: ANNP) were devided into the suffered and the non-suffered. The average suffering rate was 11% throughout the areas covered by the survey, which was compared with about 55% in FIP and 14-3.2% in ANNP.　　Analyses of sufferings of the respondents, broken down by age, sex, studentship and occupation, revealed that female sufferers outnumbered male sufferers and were younger in FIP than in ANNP. It was also found that female sufferers included many nursing students and medical staffs. A large number of male medical progessionals also fell victim to the quake.　　Interesting to note are the findings that a large number of male respondents from Fukushima and Ibaraki replied that they had religious faith, would prefer to be told the truth if they were terminally ill, had pondered over death, would like to see a man of religion when they realized their days were numbered, would desire the use of an optimum dose of opium to ease pain, and wished to deepen their knowledge of terminal illness. By contrast, more women than men said that they would choose to stay at home when they realized their days were numbered.　　These findings showed that the Great East Japan Earthquake significantly influenced the attitude toward terminal (care) with striking differences between men and women.

　　This paper deals with an analysis of responses to a questionnaire survey to look at the attitude of Japanese toward the problems involving telling the terminally ill patients the truth, palliative care and other related matters. The survey, designed to understand and treat the terminally ill patients properly, was carried out with the cooperation of 76 out of 114 hospitals affiliated with the National Federation of Agricultural Cooperatives for Health and Welfare.　　Effective responses came from 7,811 people (females/ males＝1.9 and age from 14 to 91). They consisted of high school students, nursing school students, hospital staffs and people with other occupations. Most of them were ready to join this study.　　Of the respondents, it was found, 21.0% of the respondents were religious people, 14.5% had seriously considered their own death, 2.4% wanted to live as long as possible even with a life-limiting disease, 26.0% wanted to be informed of the terminal illness generally, 76.4% wanted to be precisely informed, 34.5% wanted family members being informed on a terminal diagnosis, 27.5% wanted to be informed alone without the knowledge of the family members, 90.1% wanted to be informed by doctors in charge, but not by family doctors, 60.3% wanted the use of a proper dose of opium to alleviate pain, 67.3% wanted to use hospice care, 7.8% wanted to see a man of religion at the terminal stage of life, and 39.6% wanted to die at their own home.　　Significant differences were found in the response to the questions depending on their sex, age and occupations (high school students, nursing school students, medical persons or people with other occupations).　　The findings of 22 other large-scale surveys conducted between 1987 and 2012 showed that the ratio of those who did not like to receive the information on terminal (IT) decreased (from 30-40% to blow 1%), and that the ratio of those who wanted to be informed of their incurable illness increased (from 55-65% to 75-85%), thus indicating that IT seems to have being accepted widely in Japan.

STUDY DESIGN: Retrospective case-control study, level 4. PURPOSE: To clarify the risk factors for late subaxial lesion after occipitocervical (O-C) reconstruction. We examined cases requiring fusion-segment-extended (FE) reconstruction in addition to/after O-C reconstruction. OVERVIEW OF LITERATURE: Patients with rheumatoid arthritis (RA) frequently require O-C reconstruction surgery for cranio-cervical lesions. Acceptable outcomes are achieved via indirect decompression using cervical pedicle screws and occipital plate–rod systems. However, late subaxial lesions may develop occasionally following O-C reconstruction. METHODS: O-C reconstruction using cervical pedicle screws and occipital plate–rod systems was performed between 1994 and 2007 in 113 patients with RA. Occipito-atlanto-axial (O-C2) reconstruction was performed for 89 patients, and occipito-subaxial cervical (O-under C2) reconstruction was performed for 24 patients. We reviewed the cases of patients requiring FE reconstruction (fusion extended group, FEG) and 26 consecutive patients who did not require FE reconstruction after a follow-up of >5 years (non-fusion extended group, NEG) as controls. RESULTS: FE reconstructions were performed for nine patients at an average of 45 months (range, 24–180 months) after O-C reconstruction. Of the 89 patients, three (3%) underwent FE reconstruction in cases of O-C2 reconstruction. Of the 24 patients, five (21%) underwent FE reconstruction in cases of O-under C2 reconstruction (p=0.003, Fisher exact test). Age, sex, RA type, and neurological impairment stage were not significantly different between FEG and NEG. O-under C2 reconstruction, larger correction angle (4° per number of unfixed segment), and O-C7 angle change after O-C reconstruction were the risk factors for late subaxial lesions on radiographic assessment. CONCLUSIONS: Overcorrection of angle at fusion segments requiring O-C7 angle change was a risk factor for late subaxial lesion in patients with RA with fragile bones and joints. Correction should be limited, considering the residual mobility of the cervical unfixed segments.
Arthritis, Rheumatoid ; Atlanto-Occipital Joint ; Case-Control Studies ; Decompression ; Follow-Up Studies ; Humans ; Joints ; Pedicle Screws ; Retrospective Studies ; Risk Factors

To investigate the effects of training focused on the movement velocity of the lower limbs (movement velocity training) on short sprint performance in young female non-athletes. Twenty-nine healthy young females (mean age: 20.1 ± 0.9 years) participated in this study. The subjects were randomized into a movement velocity training group (MV group, n=15) and a resistance training group (R group, n=14). MV group performed six lower limb exercises at high velocity (as fast as possible) with no load. R group performed five lower limb strength exercises using a resistance band. Both training programs were applied for 20 minutes per session, 5 days a week for 6 weeks. The following outcomes were measured at baseline and after 6 weeks of training: 30 m sprint time, 20- 26m running velocity, step length, step frequency, and muscle strength and movement velocity of knee extension. Significant group × time interactions were observed for the 30-m sprint time with the MV group exhibiting a significant improvement on simple main effect analysis. For the other parameters (step length, step frequency, and muscle strength and movement velocity of knee extension), group × time interactions were not observed and a significant main effect was observed. These findings suggest that training focused on the movement velocity of the lower limbs can be effective for improving sprint performance.

In 1991, the committee on postgraduate clinical training proposed revised behavioral objectives for basic clinical training in the initial two years. We present here a model for a clinical training program that should enable most residents to attain these objectives within two years.
The program begins with orientation for 1-2 weeks, including a workshop on team care, and nursing practice.
Basic clinical skills for primary care and emergency managements should be learned by experience during rotations through various clinical specialities. All staff members, even senior residents, should participate in teaching beginning residents in hospitals.

Ankle exercises are useful for preventing deep vein thrombosis, as they increase venous blood flow velocity. The cause for the increased venous blood flow velocity during ankle exercises may be the skeletal-muscle pump, but the mechanism is not clearly understood. The purpose of this study was to investigate the effects of the dorsiflexion angle and gastrocnemius muscle contraction on venous blood flow velocity during ankle exercises and to investigate the mechanism of the increase in venous blood flow velocity. The blood flow velocity in the popliteal vein, ankle joint angle, and surface electromyographic activity of the gastrocnemius muscle were measured at rest and during ankle exercises in the prone position in young healthy volunteers. The significant increase in venous blood flow velocity was observed during dorsiflexion phase, max dorsiflexion and during planter flexion phase. The peak venous blood flow velocity was different in each subject and classified into four types. The correlations of venous blood velocity to ankle joint angle and with the surface electromyographic activity of the gastrocnemius muscle were not statistically significant. These findings suggest that venous blood flow velocity increases not only during plantar flexion and dorsiflexion.