Objective : To explore the prevailing conditions in the childcare environment and to clarify the factors influencing the stress of parenting for Chinese mothers living in Japan, and to discuss the childcare support desired by these mothers.
 Methods : One hundred thirty-two Chinese mothers with 0～6-year-old children living in the Kanto area with their spouses participated in a questionnaire survey aimed at the childcare environment and parenting stress in Japan.
 Results : ①The proportion of Chinese mothers in employment was low, but most of those in work had part-time jobs. ②Those who had lived in Japan for longer periods had two or more children, although many Chinese women had only one child, and the birth interval was 4.9 years. ③Many of these mothers wanted to entrust their children to a day nursery in Japan.
 Conclusion : Mothers raising their children in Japan require childcare support including prompt and effective harmonization with Japanese society, easy-to-use child care facilities and the chance to study Japanese or a well-baby clinic conducted in Chinese.

 Our hospital comprises nine departments of internal medicine that specialize in different organs, and the Department of General Internal Medicine is one of these departments. The inpatient department has 30 beds for providing medical care, and education is provided for junior and senior residents. We examined the diagnoses in 593 cases (289 men, 304 women ; mean age, 64.2±21.2 years old) who were hospitalized in the Department of General Internal Medicine at this hospital between April 2007 and March 2008. The major diseases included pneumonia, 111 cases ; urinary tract infections, 44 cases ; infectious enteritis, 34 cases ; bronchial asthma, 24 cases ; fever of unknown origin, 12 cases ; heart failure, 11 cases ; viral infections 9 cases, diverticulitis, 8 cases ; malignant lymphoma, 7 cases ; infectious mononucleosis, 7 cases ; polymyalgia rheumatica, 6 cases ; and others. In order to provide diagnoses and treatments for cases in which no diagnosis could not be obtained on the first outpatient visit, for example, it is necessary to have a ward for general internal medicine as a location for providing medical care that is not limited to any specialized field.

 The Swedish primary care system has a long tradition : since 1790 it has been “provincial practitioner system”. District physicians, who are working as general practitioners in communal medical centers, run the modern primary care system in Sweden. The duties of these district physicians are treatment, rehabilitation, pain abatement and preventive care. All physicians are communal officers and have played an important part in primary care since 1970. Eighty percent of the population prefer to consult district physicians rather than specialists. The death rate decreases every year thanks to the primary care system. Medical consultation by telephone and self-medication supported by the national pharmacy system have contributed to reducing medical costs as a proportion of GNP since 1981.

Objective
The purpose of this study is to evaluate the differences in the reasons for visits to a Tokyo hospital before and after the changing of the name of the outpatient service from “internal medicine” to “general practice.”
Methods
The participants in this study were outpatients who visited the internal medicine department from September to October, 2006, and the general practice department from September to October in 2008, for their first medical examination at a hospital in Tokyo.
We encoded the reasons for the hospital visits using ICPC-2 (International Classification of Primary Care-2), and counted the number of reasons for each outpatient.
Results
In the internal medicine service, there were 362 outpatients participants (193 men and 169 women) with an average age of 48.6 years. In the general practice service, the participants consisted of 376 outpatients (206 men and 170 women) with an average age of 50.5 years. The difference between the total number of reasons for visits to the general practice service (1.7 ± 0.9 per visit) and to the internal medicine service (1.5 ± 0.8 per visit) was statistically significant. However, no significant differences were found between the two in terms of the proportion of the frequency for each category of reasons.
Conclusion
This study found that the changing of the name of the outpatient service from “internal medicine” to “general practice” led to a slight but statistically significant increase in the total number of reasons per visit. However, this change had no effect on the frequency for each category of reasons as a proportion of the total.

Purposes
The purposes of this study were to analyze the relationship between the discharge destinations of patients with cerebrovascular diseases (CVD) in our convalescent rehabilitation ward and their levels of activities of daily living (ADL), and also to consider the factors causing those patients difficulties upon discharge.
Methods
The subjects were 114 CVD patients in our Convalescent Rehabilitation Ward.
The investigation was conducted to examine their ADL score, both at hospitalization and at discharge, and to analyze the relationship between changes in their ADL scores and their discharge destinations.
Discussion
It was suggested that reduction of the ADL score from above 8 points at hospitalization, to less than 4 at discharge, contributed to improvement of the rate of discharge to the patients' own homes, and that four items in the ADL assessment scale, such as ‘transfer’, ‘ability to communicate’, ‘locomotion’ and ‘oral care’, had an effect on their discharge destinations.

Purpose
Long-term elderly care of the elderly (Jap. “Ro-ro Kaigo”) is a serious problem in Japan. The purpose of this study is to reveal the current state of Ro-ro Kaigo and to evaluate the factors affecting the burden on elderly caregivers.
Method
Ninety-three households of elderly subjects participated in this study. We conducted semi-structured interviews concerning the life styles of caregivers, the burden on caregivers and the condition of elderly subjects requiring long-term care.
Results
Eighty percent or more of the caregivers were spouses, and about 40 percent of the households were not supported by family members living separately.
Moreover, the burden of care borne by the caregivers was correlated with "hours spent daily providing care", "ADL of elderly requiring long-term care" (p<0.001), "hours of sleep" (p<0.01), "subjective feeling of wellbeing", "support from family living separately", and "behavioral disorders of dementia" (p<0.05).
Conclusion
These data suggest that supporting "health promotion", "reduction of hours of caregiving", "reduction of amount of assistance with toilet activity of care recipients", and "securing enough hours of sleep" were important for maintaining home care in Ro-ro kaigo.

 In recent years, workers have shown a tendency to suffer increasing amounts of stress, and over 60% claim to feel much anxiety towards their jobs. Problems of psychological health are having an increasing impact on workers, their families and their communities. Furthermore, regular health checks are uncovering health problems in more workers each year, indicating an urgent need for measures to promote psychological and physical health. The aim of our research was to assess current job-related lifestyle behaviors, eating behaviors and stress response and to examine the relationships between them. In August 2006, 980 employees from retail business Company A were given self-assessment surveys (response rate: 63.7%). Excluding those which were left mostly incomplete, a total of 624 usable responses were received and examined. Examination of the relationships between stress response and various lifestyle behaviors showed significant correlations of stress response with eating behavior, exercise and body image satisfaction. The variables that had high correlations with psychological stress responses were psychological workload, interpersonal relations at work, relationship with superiors, lifestyle satisfaction, cognitive restraint and emotional eating. On the other hand, the variables whose correlations with physical stress response were high were psychological workload, amount degree of skill use, lifestyle satisfaction, uncontrolled eating and emotional eating. Not only is there a need for behavior modification support to improve lifestyle behaviors, but assistance for increasing support from superiors in the workplace is also essential for stress management. In addition to the clear need for effective supervisor training, various long-term education and consultation programs for employees and their families should also be considered.

Introduction
This study aims to clarify how patients and local residents regard physicians and medical care in light of the ongoing nationwide tendency of internists to unexpectedly abandon their posts in local community hospitals.
Methods
The subjects of this study were citizens who chose to continue visiting a community hospital in X City after some of its internists recently left their posts in order to return to their previous hospitals. A questionnaire survey was conducted by focus-group interviews of two patient groups.
Results
Three hundred and ninety-nine responses were judged valid. The causative factors cited by the respondents for the internists’ abandonment of their jobs were: the college or university system (81%), the national institutions (79%), and the nation’ s hospital system (72%). Eighty-eight percent of the respondents observed that internists had done the best they could, while 88% pointed out that internists could not avoid changing their workplaces, 96% wanted internists to exert their utmost efforts for their patients, and 85% found internists trustworthy.
Conclusions
Patients affected by internists' job changes were actually inconvenienced by these, and considered it a matter of course that the results should have meant some loss of freedom for themselves. Moreover, it was suggested that that the physicians had lost their trust in the medical organizations, and the patients were left with very mixed emotions about the physicians. Many patients considered that the practice of medicine is a vocation, and, even though they experienced the physicians' withdrawals from their posts, they still expected a humane attitude in the doctors and communication with them, and they trusted them. However, there were some patients who regarded medicine as a service industry, so that it was suggested that there may be a change in the nature of the trust that patients have in doctors.

OBJECTIVE: To describe gender differences in job satisfaction, mental health and work conditions of Japanese hospital internists
METHODS: A self-administered, mailed survey was conducted among hospital internists throughout Japan. The survey included questions such as job satisfaction, time allotted for an ambulatory patient, and work environments.
RESULTS: Two hundred thirty-four hospital internists were eligible (59 women). Female internists allotted more time for each patient in an ambulatory care setting than their male colleagues (new patient/consultation: P<0.01, routine follow ups: P=0.046). Female internists worked continuously for as long as their male colleagues when they were on night duty (average: 31.1 hours), but their replies indicated that they were not able to maintain continuous high-quality care for as long as the male internists (-4 hours, P=0.02).
CONCLUSIONS: Female internists allotted more time for each ambulatory patient, and their replies showed that they were able to maintain quality care continuously for less time than were the males.

Introduction
There are about 3,000 facilities for the elderly (elderly facilities, EFs) where physicians are employed to manage the health of the elderly in Japan. To date, neither a system nor a continuing educational program has been developed for certifying or supporting physicians in the management of EFs. Hitherto, various medical problems have been reported in EFs. Physicians serving in them are required to maximize the safety of the elderly with limited financial support and medical costs.
Methods
Continuing educational needs for EF physicians were elucidated by qualitative methods, with reference also to their practical needs and preferred learning styles, via questionnaires distributed in 35 EFs in Hyogo Prefecture (response rate: 31%).
Results
The results showed that relevant and complementary educational needs were required for: (i) diagnosis of dementia, (ii) management of the behavioral psychological symptoms of dementia, and (iii) familiarization of the medical staff involved in elderly care. The most favored learning styles involved lectures, textbooks and journals. In contrast to those 40% of physicians who preferred to use educational web sites, those with more than 40 years of experience in medicine tended not to.
Conclusion
Relevant complementary and supporting educational programs based on the results of this study should be developed for physicians at EFs to facilitate provision of health care.