To examine relationship between the family composition and medical expenses for circuration diseases in the elderly people who were 65 or more, we analysed the 1982 and 1983 data of medical expenses of national health insurance in the rural area of Fukuoka Prefecture.
The elderly people were classified into five groups according to whether they were living with their children and whether their spouse was alive.
The results were as follows:
1) In the elderly people who were living with their children, the medical expenses were low among those living with their spouses and high among those living without.
2) In the elderly people who were not living with their children, the medicalexpenses were low among the elderly men with their spouses and high among the eldrly women without.
3) In the elderly people who were living alone, the elderly men and women had low medical expenses in hospital services and ambulatory services.
4) The medical expenses for circulation diseases were more influenced by the presence of spouses than living with their children.

To evaluate training methods for basic clinical skills before bedside learning, we used questionnaires to ask students and instructors their opinions about the fixed-instructor system, in which one instructor teaches the entire course, and the rotation system, in which instructors share responsibilities for teaching according to their specialty. Students had positive impressions of training with both systems. Many students felt that communication with in structors was good inthe fixed-instructor system and that the specialized education provided by multiple instructors was good in the rotation system. However, students expressed dissatisfaction about differences in educational content between the systems. Instructors believed an advantage of the fixed-instructor system was that skills learned could be applied to all medical fields, whereas the rotation system made teaching easier because it was specialized. On the basis of this investigation, we conclude that training should establish good communication between instructors and students and should include the required educational contents. We also found that unifying educational contents is difficult, regardless of the training system. Few reports about educational methods used to teach basic clinical skills have been published in Japan, but studies focusing on this issue are becoming increasingly necessary.

The most important factors in determining the outcomes of patients with traumatic brain injury (TBI) is the degree of severity and types of primary brain damage, and the secondary damage to the brain such as low-oxygen and low-blood pressure et al. For severe TBI patients, prompt and appropriate decompression to reduce intracranial pressure (ICP) and ICU management are commonly required. The second edition of "Guidelines for the Management of Severe Head Injury" was published by the Japan Society of Neurotraumatology (JSNT) in 2006. These guidelines include a wide range of topics in the management for severe TBI, from prehospital care, primary care, ICU management and surgical treatment. The essence of extended decompression and neuroprotection for TBI is also focused in the JNST Guidelines. The pathophysiological event in the acute stage of severe TBI is quite variable ; therefore, an appropriate individual based approach in ICU management is necessary under experienced medical teams.

1) We investigated the patients'evaluations of the students, our management of the medical training, and the patients' recognition of our outpatient clinic education. We then requested the patients to give their opinions regarding such interviews.
2) The patients'evaluations of the outpatient clinic and the patients'recognition of our outpatient clinic education were relatively good, but some patients complained about the short duration of medical care and also expressed anxiety over the students'medical interview.
3) Many patients expressed the desire to positively participate in medical education because the patients had high expectations of the medical students.In addition, this interview training fulfilled the patients'desire to be listened to and have their concerns acknowledged.

BACKGROUND: In general practice, though patients often stop visiting ambulatory clinics of their own vo-lition despite the need for ongoing medical treatment, there is little reported research on the reasons for nonattendance in Japan. In this study, we investigated whether the patient/doctor relationship influences nonattendance rates in general practice. In addition, we investigated the reasons why patients stopped visiting the hospital.
METHODS: We collected data from 115 patients (58 males, 57 females; age range: 16 to 94 years old, median age: 52 years old) whose initial diagnoses were made in our department from June to July 2000. We classified the patients into five groups based on the level of their complaints concerning the initial consultation (‘A’ representing the highest degree of complaint, ‘E’ representing the lowest) and determined the relationship between the strength of complaints and the non-attendance rate. Furthermore, we investigated the reasons for non-attendance concerning 28 patients who stopped visiting the hospital from April 2000 to November 2001.
RESULTS: The non-attendance rates were 0% (014) for group A, 14.3% (2114) for group B, 5.6% (5189) for group C, 33.3% (216) for group D, and 50% (1/2) for group E. The rate tended to be higher in groups with fewer complaints. The reasons for non-attendance were the following: remission of symptoms (9 patients), request for another hospital or department (6 patients), relief due to consultation at the university hospital (6 patients), and lack of time to come to the particular hospital (5 patients) . In contrast, the most common reason for satisfaction at the time of consultation was ‘enough explanation and listening to complaints well’ in 7 of 11 patients who were satisfied with the consultation.
CONCLUSIONS: The level of patient's complaints at the time of consultation is related to the non-attendance rate. However, sufficient explanation about symptoms and careful listening to complaints are important for establishing a good patient/doctor relationship.

No abstract available.
Breast* ; Female ; Mammaplasty*

Background/Aims: Diarrhea-predominant irritable bowel syndrome (IBS-D)-like symptoms frequently occur in patients with quiescent Crohn’s disease (CD). To investigate the factors underlying IBS-D-like symptoms in patients with quiescent CD, we performed a comprehensive analysis of the clinical features and intestinal environment in those patients. Methods: We performed a prospective observational study of 27 patients with quiescent CD (CD activity index [CDAI] ≤ 150; C-reactive protein ≤ 0.3 mg/dL). The presence and severity of IBS-D-like symptoms, health-related quality of life, disease-specific quality of life, andstatus of depression and anxiety were evaluated. The level of intestinal permeability, fecal calprotectin and organic acids and the profiles of gut microbiome were analyzed. Results: Twelve of the 27 patients with quiescent CD (44.4%) had IBS-like symptoms, and these patients showed a significantly higher CDAI, IBS severity index and anxiety score than those without. The inflammatory bowel disease questionnaire score was significantly lower in the patients with IBS-D-like symptoms. There were no significant differences in small intestinal/colonic permeability or the levels of organic acids between the patients with and without IBS-D-like symptoms. Fusicatenibacter was significantly less abundant in the patients with IBS-D-like symptoms whereas their fecal calprotectin level was significantly higher (384.8 ± 310.6 mg/kg) than in patients without (161.0 ± 251.0 mg/kg). The receiver operating characteristic curve constructed to predict IBS-D-like symptoms in patients with quiescent CD using the fecal calprotectin level (cutoff, 125 mg/kg) showed a sensitivity and specificity of 73.3% and 91.7%, respectively. Conclusion Minimal inflammation is closely associated with the development of IBS-D-like symptoms in patients with quiescent CD.

Background/Aims: Thiopurines are key drugs for inflammatory bowel disease (IBD), including ulcerative colitis (UC) and Crohn’s disease (CD). Recently, NUDT15 polymorphism (R139C, c.415C > T) has been shown to be associated with thiopurineinduced adverse events in Asian populations. In patients with the C/T genotype, low-dose thiopurine treatment is recommended, but its long-term efficacy and tolerability remain unclear. This study aimed to uncover the long-term efficacy and appropriate dosage of thiopurine for IBD patients with the C/T genotype. Methods: A total of 210 patients with IBD (103 UC and 107 CD) determined to have NUDT15 R139C variants were enrolled. Clinical data were retrospectively reviewed from medical records. Results: Of 46 patients (21.9%) with the C/T genotype, 30 patients (65.2%) were treated with thiopurines. Three of whom (10.0%) discontinued thiopurine treatment due to adverse events and 27 of whom continued. The median maintenance dosage of 6-mercaptopurine was 0.25 mg/kg/day (range, 0.19–0.36 mg/kg/day), and 6-thioguanine nucleotides level was 230 (104–298) pmol/8 × 108 red blood cells. Cumulative thiopurine continuation rates for 120 months for patients with the C/C and C/T genotypes were not significantly different (P= 0.895). Cumulative non-relapse rates in the patients with UC treated with thiopurine monotherapy and surgery-free rates in CD patients treated with combination therapy (thiopurines and anti-tumor necrosis factor-α agents) for maintenance remission were not significantly different at 60 months (C/C vs. C/T, P= 0.339 and P= 0.422, respectively). Conclusions Low-dose thiopurine treatment is an effective and acceptable treatment for patients with C/T genotype.