The medical insurance system was reformed in 2008. A new program was introduced to detect metabolic syndrome in the early stages with the aim of reducing lifestyle-related diseases such as diabetes and hypertension, and the specific medical examination and specific health instruction became incumbent on the medical insurers. The primary purpose of the medical examination was not only to discover metabolic diseases but also to provide the people an opportunity to reconsider their lifestyle. The specific health instruction was to raise health consciousness. Our hospital started the specific medical examination in the first year. Based on the screening outcome data, the specific health instruction, the specific health instruction was implemented.　　This year marks the fifth anniversary of the introduction of the new medical insurance system. We investigated how the effect of the health instruction lasted based on the results of the medical examination that we carried out in 2012. The average weight decreased 1.0 kg (P<0.001) and the mean girth of the abdomen decreased 1.5 cm (P<0.001). Those who successfully lost weight and maintained that success accounted for 60%, as compared with women’s figure of 66% for women. There were people who lost weight temporarily, but regained all or more than they lost in four years. Compared to women, men showed a strong tendency to regain weight lost. The level of the specific health instruction has been improved. The effects of the health instruction would last longer. However, to ward off rebound weight gain, it is necessary for us to keep careful watch over area residents and work out more effective prophylactic measures.

　　We often experience difficulty supporting the pediatric social work because, under the present social welfare system, support services change as patients grow. Recently, studies aimed at establishing practice models have increased in the pediatric social work region. With a view to establishing practice models, we reviewed our experience in the neonatal and pediatrics departments.　　Our investigation found that almost all support requests in the neonatal cases were from our medical staff. For inpatients, request were mostly concerned with hospital discharge support. Requests in behalf of outpatients were consultation about physical examination. Most of the support processes ended up in liaison and coordination or providing information.　　In the pediatric department, the most common route of requests for inpatients was from our medical staff, but for outpatients, the requests came from public institutions and private facilities concerned. Most requests for inpatients were related to the use of the social welfare system. Meanwhile, requests in behalf of outpatients were centered on support of consultation about physical examination.　　From the above, we concluded that in the pediatric social work region, social workers should approach not only patients and their family members but also medical staff and community institutions. We deemed it necessary to coordinate social-welfare services based on a long-term plan, taking into account the growth of children.

　　Traumatic cerebellar hemorrhage is a rare condition. This paper reports a case of traumatic cerebellar hemorrhage associated with supratentorial acute subdural hematoma due to a fall from a persimmon tree, who underwent emergency surgical evacuation of supra- and infratentorial hematoma, leading to an excellent outcome.　　The patient is a 65-year-old male. He was transferred to our emergency room, since he had a transient episode of loss of consciousness after the fall and hit his occiput on the ground. CT scans of the brain disclosed traumatic hemorrhage in the cerebellum and bilateral frontal area. On admission, he was alert and oriented. He complained of slight numbness on his right hand. Four hours after admission, he became comatose, and CT scans showed enlargement of supratentorial acute subdural hematoma with midline shift and brain swelling around the cerebellar area where hemorrhage occurred. Emergency surgery for evacuation of hematoma in both supra- and infratentorial region was performed. Postoperatively, he made an uneventful recovery and was discharged from the hospital without any neurological deficit.　　Prompt surgical treatment to prevent neurological deterioration in traumatic intracranial hemorrhage is essential for achieving a good outcome. The branches of the persimmon tree are prone to be broken off. Methods of preventing falls or minimizing the risk of injuries should be developed.

　　Serious aggravation of de novo hepatitis B caused by revitalization of the hepatitis B virus in HBs antigen negative, HBs antibody or HBc antibody positive patients has recently been reported. The incidence of de novo hepatitis B infection which occurs in patients undergoing immunosuppression or chemotherapy develops at times into a medical lawsuit. To cope with the situation, the Ministry of Health, Labour and Welfare (MHLW) issued the guideline for the management of hepatitis B infective occurring in patients treated with immunosuppressive therapy or chemotherapy (the revised edition). In our institution, the Chemotherapy Committee discussed our measures against de novo hepatitis B, and determined to carry out the in-hospital examination of the HBc antibody to provide reliable safe and speed medicine.　　During the investigation period, HBc antibody was examined for confirmation of anamnesis of Hepatitis B in patients receiving chemotherapy, immunosuppressive medicine, examination of infectious disease before blood transfusion and examination of viral hepatitis. In our institution, the number of cases which are adapted for the MHLW guideline (the revised edition) was 15 of 218 examples, and as a result HBs antigen negative, HBs antibody or HBc antibody positive patients, who could not be found in the routine screening for HB infection turned out to be not a few.　　Since it was expected that the number of patients undergoing immunosuppression and chemotherapy would continue to increase in the future, the necessity for observance of guideline was suggested to provide relief, safety in medical treatment.

　　[Purpose] This study was carried out to examine the effects of the locomotive syndrome prevention program implemented by our hospital. [Subjects] Thirty-four individuals (3 males and 31 females; mean age, 72.2±6.9 years) who participated in the exercise class held under the program from 2010 to 2011 were enrolled in the study. [Methods] We examined their bodily functions and the self-assessment checklists for locomotion and exercise habit at the beginning of, at the end of, and six months after the class, and made a comparison between the results obtained on the three occasions. The bodily function examinations included tests of grip strength, 10-m fast-paced walk, tandem gait, 30-sec chair-stand (CS-30), timed “up and go” and one-leg stance with their eyes open. The lower limb length to height ratio was calculated in percentage. [Results] A good deal of improvement was observed in all of the bodily functions tested except for the grip strength. The follow-up survey which was taken six years after the class ended showed a significant improvement in the 10-m fastest walk, lower limb length ratio, and CS-30. The average number of locomotion-syndrome-positive items on the locomotion checklist decreased from 2.5 at the beginning of the exercise class to 1.7 at the end of the exercise class, though the difference was not so significant. The number further decreased six months after the class ended. It was also shown that an increasing number of subjects took exercise more frequently. [Conclusion] The abovementioned results suggested that our program was effective in preventing locomotive syndrome.

　　Clinical cases of pesticide poisoning from 2010 through 2012 were analyzed based on data collected from the hospitals affiliated with the Japanese Association of Rural Medicine.　　One hundred and thirty-seven cases of pesticide poisoning were reported from 37 hospitals. By gender, males and females made up almost the same number. By age group, those in the 70-79 age band accounted for 22% of the total number of the cases, followed by those in their 60s (18%) and those in their 80s (18%). By month, the incidence peaked in May, accounting for 16%. When it comes to occupational poisoning, the majority of the cases occurred in spring and summer, when pesticides were used frequently.　　By type of pesticide exposure, suicide accounted for 71%, followed by accidental ingestion (13%) and occupational exposure (12%).　　By type of clinical manifestation, acute poisoning was most frequent (83%), followed by dermatitis (6%) and ocular disorders (5%). When it comes to occupational exposure, the rate of acute poisoning decreased to 42%, and dermatitis and ocular disorders increased to 47% and 11%, respectively.　　Amino acid herbicides topped the list of agricultural chemical compounds causing poisoning (29%), followed by and organo-phosphate insecticides (29%) and bipyridilium herbicide (8%).　　As regards main ingredients, glyphosate was the most frequent inducer (38 cases), followed by fenitrothion (18 cases) and paraquat (12 cases).　　Twenty-two death cases were reported, of which eight cases were by paraquat and three cases by fenitrothion. The death rate from paraquat poisoning was far higher than those from any other pesticides. The death number has been decreased gradually, which was correlated with the downward trend of paraquat sales.

　　This study was conducted with a view to improving medication management service by reviewing renal excretory drug prescription practices in our hospital for patients with decreased kidney function without intervention of pharmacists. The subjects were the outpatients to whom the doctors had prescribed drugs containing digoxin, cibenzoline, bezafibrate, levofloxacin, valaciclovir or dabigatran. We retrospectively reviewed their serum creatinine levels, sex, age, height, weight and the amount of the drugs prescribed. It was found that there are cases in which medication had been prescribed without serum creatinine testing or prescribed in excess of the amount needed. Furthermore, there were cases in which the renal function had been judged in all probability by age and serum creatinine levels alone. Based on these findings, we concluded that pharmacists should intervene in pharmacotherapy using renal excretory drugs. For the realization of this, it would be necessary to build a system within the Department of Pharmacy to support the pharmacotherapy.

　　To educate patients with diabetes mellitus, we use a clinical pathway. Pharmacists hold the chair of instruction on the use of drugs and insulin self-injection during the course of the pathway. Until now, teaching contents have been left to discretion of attending pharmacists. Therefore, we draw up a brochure to set standards for instruction.　　By using this brochure, it has become possible to instruct patients without relying only on the knowledge and experience of pharmacists in charge. Additionally, we have become able to share teaching contents of pharmacists with nurses.　　By publishing the brochure, intervention of pharmacists in the pathway has become smoother. For better and more efficient instruction on the use of drugs in a limited time frame in the clinical pathway, we need to overhaul of the brochure and to develop a method to evaluate patient’s understanding.

　　We made assessment sheets to gauge the ability of patients in Ward A to instill eye drops, because there had been no data indicating how the patients were using eye drops properly or improperly. We carefully watched inpatients using eyedroppers. We interviewed some patients when they were admitted into the hospital for cataract surgery and asked them about the use of eye drops. These surveys found that the patients had difficulties dipping liquid drug into the eye at one try and keeping the distance between dropper and eye. To solve these problems, we turned to a certain ophthalmic administration method. It was known as “genkotsu-ho” (literally, a fist method), which was thought to be easy to use even for the elderly. We told them how to use this method.　　To make certain whether this method was effective or not, we had 28 elder patients, age 65 and up, assess their own ability to dip a liquid drug into the eye using the assessment sheets at the time they were admitted to the hospital and at the time they were discharged. Those who had not been able to instill eye drops correctly because they couldn’t hold the eye droppers steady became good at it after they were taught how to use the fist. Actually, all of the six items in the assessment sheet showed a remarkable improvement in the ability of the elderly subjects. Being simple and easly acquired, the fist method proved to be helpful to the aged people. We thought it necessary to continue teaching this method to patients so as to be able to administer eye drops correctly after they are discharged from the hospital.

　　Catamenial pneumothorax (CP) is defined as a form of thoracic endometriosis syndrome (TES) and the clinical manifestations and management of this disease are not consensual. Successful treatment depends on how closely pulmonary specialists and gynecologists work together. Such being the circumstances, we reviewed our experience with CP in terms of treatment and follow-up. We treated surgically many patients with pneumothorax during the period from 1989 to 2014, of which eight cases had endometriosis on the diaphragm, lung or pleura histologically. The median age at the time of operation was 37 (range, 17 to 41). CP was right-sided in seven of the eight patients (87.5%). Six patients underwent an examination with diagnostic laparoscopy and five had positive findings. The median period of follow-up after surgery was 33.5 months (range, 4 to 129 months). Two patients had no recurrence without hormonal therapy. Six other patients experienced a recurrence of pneumothorax, although two patients received dienogest after surgery. The use of only dienogest or both GnRHa and dienogest prevented recurrence in all patients. CP is a critical condition that requires prompt action, so after surgical treatment, the choice of hormonal therapy with a high rate of patient compliance are needed. No recurrence occurred in young patients who had only surgical treatment, suggesting that there were some associations between age and recurrence. Since we succeeded in preventing recurrence after using GnRHa in all cases, we recommend GnRHa or dienogest following GnRHa for the first choice of hormonal therapy after surgery. However, treatment with only dienogest could achieve successful results with no recurrence, so more case studies need to be done to make the best treatment choice for each case.