Objective: The purpose of this study was to clarify burnout and the characteristics of mental health of caregivers of elderly dementia patients, which have been little studied.Methods: The subjects of this study were 107 caregivers who were engaged in the care of dementia patients at 12 facilities in northern Kyushu. We examined age, sex, status of nursing-care related qualifications, kinds of nursing care-related qualifications, years of working experience, physical health (Present state of health and Presence of perceived ill health), status at work (Problems at work and Job stress) and satisfaction with life using the Maslach Burnout Inventory (MBI) and WHO Subjective Well-Being Inventory (SUBI). The period of survey was five months, between June 1 and October 31, 2006.Results: The most severe level of burnout was found in 27.1% of the subjects. When subjects were classified into the burnout and nonburnout groups, the burnout group represented 53.3% of the subjects. In a comparison of the scores of the SUBI subscales between the burnout and nonburnout group, significant differences were observed in almost all subscales without "Deficiency in Social Contacts."Conclusion: This study clarified that self-care of physical and mental health, family support and social support were very important in maintaining mental health and preventing burnout in caregivers of dementia patients. Improvement of working conditions was considered particularly important for social support.

Objective: The purpose of this study was to assess the treatment outcome in patients with chronic hepatitis C (CHC) using the current standard antiviral therapy when patient were treated in collaboration between hepatologists and primary care physicians (PCPs).Patients and Methods: One hundred and ten patients with CHC were treated with a combination therapy of peginterferon-alpha 2b and ribavirin. Among them, 25 patients were treated by a collaboration between hepatologists and PCPs (collaboration group), whereas 85 patients were treated with exclusively by hepatologists (noncollaboration group). The duration of the therapy was 48 weeks for 58 'difficult- to-treat' patients (genotype 1 with a high load of HCV-RNA; 1H patients) and 24 weeks for the remaining 52 patients (non-1H patients). In the collaboration group, antiviral therapy was initiated and adjusted, if needed, by hepatologists (visits every four weeks), whereas the weekly administration of peginterferon-alpha 2b was performed by PCPs. Clinical characteristics and the treatment outcome were compared between these two groups.Results: The two groups had similar baseline characteristics. By intention to treat, the two groups showed similar rates of treatment-related serious adverse effects (0% vs. 1%, respectively) and dropout rates for adverse effects (8% vs. 13%, respectively). Sustained virologic response rates were also similar between the two groups, being 42% vs. 39% in the 58 1H patients (NS) and 62% vs. 64% in the 52 non-1H patients (NS), respectively.Conclusions: Collaboration between hepatologists and PCPs may be a valid treatment alternative to treat patients with CHC using the current standard antiviral therapy.

Objective: Tamsulosin is often administered at a dose of 0.2 mg in Japan, Korea, and elsewhere in Asia, while a dose of 0.4 mg is more common in the West. In order to determine the higher dose might also be appropriate in the North-East Asian setting, we studied whether the effect of increasing the dose to 0.4 mg in Japanese patients who had dysuria associated with benign prostatic hyperplasia.Patients and Methods: Twenty-two cases with a voiding volume ≥ 100 ml assessed by uroflowmetry out of 31 patients with benign prostatic hyperplasia and an IPSS (International Prostate Symptom Score) ≥ 8 whose symptoms were controlled with 0.2 mg of tamsulosin were entered into this study. We evaluated IPSS and QOL (quality of life) score, urinary flow parameters and residual urine volume before and 4 weeks after increasing the dose of tamsulosin.Results: Statistical analyses performed using the Wilcoxon test showed no significant alteration in IPSS total score or QOL score with the increased dose, but Qmax (maximum urinary flow rate) improved from 10.1 ± 5.5 ml/s to 12.1 ± 6.5 ml/s (p = 0.013), and residual urine volume improved from 37.6 ± 26.4 ml to 22.2 ± 24.3 ml (p = 0.012). Two of the 31 patients complained of new symptoms; 1 complained of breast pain and the other complained of dizziness.Conclusions: From the lack of side effects of more than moderate grade in the present study, increasing the dose of tamsulosin might be recommended before switching patients to other drugs.

Objective: The aim of this study was to assess the "Health Care Town in Kyoto" project designed to promote health and safety for health conscious people in a small community. We conducted a survey involving the users of the salon and local residents to examine the effects of the activities in the salon.Methods: We recorded the activities of salon and conducted semi-structured interviews with ten local residents to ask their opinions about the salon. The data from the interviews were analyzed using the Grounded Theory Approach. We distributed a questionnaire and collected 215 valid responses (valid response rate: 67.8%).Results: 1) Purpose of using the salon was categorized into health consultation, conversation with others, rest and other purpose. 2) The significance of the salon for users was categorized into usability, acquisition of useful information, changes in daily habits and their maintenance, diversion, interaction with other people and acceptance by the shopping center. 3) The results of the questionnaire survey showed marked relations between Well-Being Index (WHO-5), age, employment and family budget, self-rated health and ability to perform daily activities (TMIG), whereas use of the salon was not associated with Well-Being Index (WHO-5). On the other hand, there were marked relations between loneliness (LSO), educational background and use of the salon, demonstrating that the facility helped its users reduce loneliness (LSO).Conclusion: In this town, the salon has served as a place providing effective preventive support for the health of individual users.

Objective: The objective of this study was to verify the recognition of dangers and obstacles within a house in the elderly when walking based on analyses of gaze point fixation.Materials and Methods: The rate of recognizing indoor dangers was compared among 30 elderly, 14 middle-aged and 11 young individuals using the Eye Mark Recorder.Results: 1) All of the elderly, middle-aged and young individuals showed a high recognition rate of 100% or near 100% when ascending outdoor steps but a low rate of recognizing obstacles placed on the steps. They showed a recognition rate of about 60% when descending steps from residential premises to the street. The rate of recognizing middle steps in the elderly was significantly lower than that in younger and middle-aged individuals. Regarding recognition indoors, when ascending stairs, all of the elderly, middle-aged and young individuals showed a high recognition rate of nearly 100%. When descending stairs, they showed a recognition rate of 70-90%. However, although the recognition rate in the elderly was lower than in younger and middle-aged individuals, no significant difference was observed. 2) When moving indoors, all of the elderly, middle-aged and young individuals showed a recognition rate of 70%-80%. The recognition rate was high regarding obstacles such as floors, televisions and chests of drawers but low for obstacles in the bathroom and steps on the path. The rate of recognizing steps of doorsills forming the division between a Japanese-style room and corridor as well as obstacles in a Japanese-style room was low, and the rate in the elderly was low, being 40% or less.Conclusion: The rate of recognizing steps of doorsills as well as obstacles in a Japanese-style room was lower in the elderly in comparison with middle-aged or young individuals.

We report a case of idiopathic thrombocytopenic purpura (ITP) accompanied by steroid-induced avascular necrosis of the femoral head in a 68-year-old woman. Extremely low platelet counts of ITP patients prohibit any surgical interventions. Her platelet count was 25,000/μL. We performed a total hip arthroplasty with high-dose immunoglobulin therapy and transfusion of platelet concentrates. Her platelet count increased to 94,000/μL just before the operation. No hemostatic complications were encountered perioperatively, and the postoperative course was uneventful. She left the hospital 20 days after the operation with a T-cane. Her platelet count decreased to 34,000/μL on the day she left the hospital. Three years after the operation, she had no groin pain and could walk without ambulatory assistive devices. We did not observe implant loosening.

Objective: The aim of this study was to implement self-care support for leglymphedema patients using mobile phones and to investigate the effects thereof.
Patients and Methods: A total of 30 patients with lymphedema followingfemale genital cancer surgery (stages I to II) who were referred from a nearbygynecologist were randomly divided into groups for routine self-care support (controlgroup) and mobile telephone-assisted support (intervention group) and received theself-care support appropriate to their group. The (total) circumference of the leg withedema, FACT-G (cancer patient QOL), MHP (mental health status), and self-careself-assessment were comparatively investigated at three months after the initialinterview.
Results: No significant reduction in the (total) circumferences of legs withedema was confirmed in either the control or intervention group. The intervention groupwas significantly better than the control group in terms of the activity circumstances andFACT-G mental status at three months after the initial interview. The intervention groupwas also significantly better in psychological, social, and physical items in the MHP. Theintervention group was significantly better than the control group in terms ofcircumstances of self-care implementation at three months after the initial interview.Additionally, comparison of the circumstances of implementation for different aspects ofself-care content showed that the intervention group was significantly better at selectingshoes, observing edema, moisturizing, self-drainage, wearing compression garments, andimplementing bandaging.
Conclusion: Compared with routine self-care support, mobiletelephone-assisted support is suggested to be effective for leg lymphedema patients’ QOLand mental health status as well as their self-care behaviors.

Objective: The purpose of the present study was to investigate employees’self-assessments of their occupational risks and health awareness as well as theirperception of preventive methods. We also aimed to collect data on employees’ perceptionof some selected alarming signs and symptoms that may encourage them to take furtheractions (such as separation and calling an ambulance).
Participants and methods: Between April and June 2013, an anonymousquestionnaire survey was conducted with the participation of 70 employees working withmigrants (both health-care and non-health-care staff) in 10 Hungarian settlements: 4border crossing points along the eastern Schengen borderline, 3 asylum detention centersand 3 reception centers.
Results: Our results demonstrated an increased perception of certainbiological and mental health hazards at work among those working with migrants: 63.7% ofthe health-care workers and even 37.3% of the non-health-care staff come into contact withhuman secretions (feces, urine, saliva) “frequently” or “sometimes”. Self-assessedawareness of the signs and symptoms of infectious diseases was poor: only 12.8% ofparticipants evaluated their awareness as “good” or “very good”. Threat of verbal violencemay be considered a common mental risk at work for participants: 35% “sometimes” or“frequently” and 5% “always” face verbal violence during their work. The most commonlyused preventive measures against infectious diseases included the use of gloves, masks anddisinfectants; these were generally available to 70 to 80% of the workers and properlyapplied.
Conclusions: Our results indicate considerable deficiencies in theparticipants’ preparedness in respect to their occupational health-related issues. Sinceit is essential for those having daily physical contact with migrants during their work tobe properly informed about the occupational health hazards and consequences that may beassociated with international migration, their training programs urgently require furtherdevelopment. More comprehensive knowledge may improve the preventive attitudes ofemployees, and conscious application of preventive measures may contribute to betterpublic and occupation health safety.

Objective: Despite the fact that the total energy intake of Japanese peoplehas decreased, the percentage of obese people has increased. This suggests that the timingof meals is related to obesity. The purpose of the study was to investigate therelationship between the timing of meals and obesity, based on analyses of physicalmeasurements, serum biochemical markers, nutrient intake, and lifestyle factors in thecontext of Chrononutrition.
Participants and Methods: We analyzed data derived from 766 residents ofToon City (286 males and 480 females) aged 30 to 79 years who underwent detailed medicalexaminations between 2011 and 2013. These medical examinations included. (1) physicalmeasurements (waist circumference, blood pressure, etc.); (2) serum biochemical markers(total cholesterol, etc.); (3) a detailed questionnaire concerning lifestyle factors suchas family structure and daily habits (22 issues), exercise and eating habits (28 issues),alcohol intake and smoking habits; (4) a food frequency questionnaire based on food groups(FFQg); and (5) a questionnaire concerning the times at which meals and snacks areconsumed.
Results: The values for body mass index (BMI) and waist circumference werehigher for participants who ate dinner less than three hours before bedtime (<3-hgroup) than those who ate more than three hours before bedtime (>3-h group). TheChi-square test showed that there was a significant difference in eating habits, e.g.,eating snacks, eating snacks at night, having dinner after 8 p.m., and having dinner after9 p.m., between the <3-h group and the >3-h group. Multiple linear regressionanalysis showed that skipping breakfast significantly influenced both waist circumference(β = 5.271) and BMI (β = 1.440) and that eating dinner <3-h before going to bed onlyinfluenced BMI (β = 0.581).
Conclusion: Skipping breakfast had a greater influence on both waistcircumference and BMI than eating dinner <3-h before going to bed.

An 85-year-old malnourished man was admitted with ischemia-induced necrosis of the rightleg and high-risk factors, including chronic obstructive pulmonary disease, pneumonia, andinfection of the necrotic leg. We controlled the infection and provided proper nutrition.Using light general anesthesia and a nerve block, we amputated the leg above the knee. Thepatient could eat and drink the same day following the surgery, and respiratoryrehabilitation was begun the next day. His postoperative course was uneventful. Our casesuggests that maintenance of good nutrition may play a key role for high-risk eldersundergoing leg amputation.