A Maternal and Child Health(MCH)handbook was introduced in Indonesia in 1993 to improve the quality of MCH services. BolMong district in the North Sulawesi province, a pilot area for the Japan International Cooperation Agency, started a user-fee system for distributing the handbook. The purpose of this study was to describe the policy-making process, management system, implementation, and outcome of this system. In June 2000, the Local Government instituted a user-fee system; price was set at Rp. 3,500(40 yen). Through continuous efforts of district health officers, all the money collected was used only for reprinting. Midwives collected the money from mothers and turned it in to their health center on a monthly basis, who then sent it to the district office. District health officers monitored and supervised the distribution of the handbooks to maintain the integrity of the system. Payment rate was calculated by dividing the number of pregnant woman paying the book by the number of books distributed. Considering a non-payment rate of 31.8% and an increase in printing cost of 30%, only 47.7% of the initial order could be reprinted. The remaining cost was subsidized by local government. The following three factors were critical in sustaining a user-fee system: strong political commitment by local government, proper supervision of distribution and funds, and simple distribution and management methods.

To consider what pharmacists can do to prevent patients from having leftover prescription drugs, we conducted a qualitative study about the various causes behind the unused drugs. We interviewed one male and four female home-care patients who had leftover prescription drugs that pharmacists detected via their home visiting service. The Grounded Theory Approach was used for analysis, and two types were identified as “exogenous factors that cause confusion for the patient” and “patient’s personal thoughts and feelings.” “Exogenous factors that cause confusion” involved eight factors, including unsuitable dosing schedule for lifestyle, complex timing for taking medicine, and inadequate support for enhancing patients’ compliance. These factors were divided into ［problems with prescription］ and ［difficult changes to manage］. In “patient’s personal thoughts and feelings,” 16 concepts were identified and their broader concepts comprised six categories: ［distrust of drugs］, ［taking a positive view about one’s own non-compliance］, ［psychological distance from medical staff］, and others. It was assumed that there would be a perception gap of compliance between patients and medical staff. Moreover, patients affirmed their poor compliance and they did not see the occurrence of leftover drugs as a problem. Additionally, psychological distance from medical staff prevents patients from consultation. Therefore, pharmacists should check patients’ compliance for each drug as well as any medical problems. Knowing patients’ inherent mind revealed by this study, the pharmacist can assist medication alongside patients and contribute to the early prevention of unused drugs.

Oral clefts, the most frequent congenital birth defects in humans, are multifactorial disorders caused by genetic and environmental factors. Epidemiological studies point to different etiologies underlying the oral cleft phenotypes, cleft lip (CL), CL and/or palate (CL/P) and cleft palate (CP). More than 350 genes have syndromic and/or nonsyndromic oral cleft associations in humans. Although genes related to genetic disorders associated with oral cleft phenotypes are known, a gap between detecting these associations and interpretation of their biological importance has remained. Here, using a gene ontology analysis approach, we grouped these candidate genes on the basis of different functional categories to gain insight into the genetic etiology of oral clefts. We identified different genetic profiles and found correlations between the functions of gene products and oral cleft phenotypes. Our results indicate inherent differences in the genetic etiologies that underlie oral cleft phenotypes and support epidemiological evidence that genes associated with CL/P are both developmentally and genetically different from CP only, incomplete CP, and submucous CP. The epidemiological differences among cleft phenotypes may reflect differences in the underlying genetic causes. Understanding the different causative etiologies of oral clefts is important as it may lead to improvements in diagnosis, counseling, and prevention.

Background A behavioral science-based approach is essential for constructing effective intervention programs to promote the shift from a sedentary to active lifestyle. Recently, the influences of social and physical environment on physical activity have been recognized as key factors for promoting physical activity. The present study attempts to identify the social and physical environmental influences associated with physical activity promotion.Methods We recruited volunteers from a 14,000 population of community-dwelling adults. Seventy-two adults (intervention group : n=35, control group : n=37) participated in the present study. The intervention consisted of 8 sessions for 2 months using The Waseda Walking Program. We assessed social support for exercise, perceived neighborhood environment for walking, stages of change in exercise behavior and physical activity outcomes at baseline and 2 months. Ffifty-seven out of 72 subjects (intervention : n=30, control : n=27) completed all of the intervention including the final questionnaire.Results There were significant intervention effects on physical activity outcomes, stages of change and perceived neighborhood environment. However, no significant improvement in social support was found. In addition, improvement of perceived physical environment was related to an increase in physical activity.Conclusion Perceived neighborhood environment for walking would be identified as a key factor to influence an effect of physical activity promotion. On the other hand, social support would be influenced to the earlier stages of change in exercise.

The purpose of this study was to investigate the effect of individual feedback intervention (IFB) or general video intervention (GV) on promoting daily physical activity. One hundred and thirty-six community-dwelling people volunteered as subjects and participated in the 2-month walking program provided as a correspondence course. The subjects were randomly allocated to one of four groups, which consisted of either IFB or GV. Each of the groups was based on behavioral science. The stage of change in exercise, self-efficacy for exercise and daily physical activity were measured before and after intervention 4 months later during the follow-up period. There were statistically significant effects of both ‘time’ (F=3.71, p=0.026) and ‘time’בIFB’ (F=3.76, p=0.025) in self-efficacy for exercise; while there was no significant effect of interaction between ‘time’בGV’. As for daily physical activity, there was no significant effect of the interaction both of ‘time’בIFB’ and ‘time’בGV’. These results suggest the IFB of promoting self-efficacy for exercise.

OBJECTIVES: The aim of this study was to evaluate the effectiveness and sustainability of educational interventions to encourage incident reporting. METHODS: This was a quasi-experimental design. The study involved nurses working in two gastroenterology surgical wards at Fukuoka University Hospital, Japan. The number of participants on each ward was 26 nurses at baseline. For the intervention group, we provided 15 minutes of education about patient safety and the importance of incident reporting once per month for six months. After the completion of the intervention, we compared incident reporting in the subsequent 12 months for both groups. Questionnaires about reasons/motives for reporting were administered three times, before the intervention, after the intervention, and six months after the intervention for both the intervention group and the control group. RESULTS: For the intervention group, incident reporting during the 6 months after the intervention period increased significantly compared with the baseline. During the same period, the reasons and motives for reporting changed significantly in the intervention group. The increase in reported incidents during the 6- to 12-month period following the intervention was not significant. In the control group, there was no significant difference during follow-up compared with the baseline. CONCLUSIONS: A brief intervention about patient safety changed the motives for reporting incidents and the frequency of incidents reported by nurses working in surgical wards in a university hospital in Japan. However, the effect of the education decreased after six months following the education. Regular and long-term effort is required to maintain the effect of education.
Education* ; Follow-Up Studies ; Gastroenterology ; Japan* ; Patient Safety ; Risk Management ; Surveys and Questionnaires

Objective: To develop a label comprehension study (LCS) of package inserts for over-the-counter medications in Japan, we evaluated whether it would be possible to detect differences in the level of understanding due to layout, and font size of different types of package insert using the interview method for LCS we developed previously.
Design: A face-to-face questionnaire investigation.
Methods: Two different types of package insert (including layout, and font size) for H₂-antagonists (package insert groups A and B) were used.  Study participants (≥18 years old) comprised consumers who visited a drugstore with a dispensing service in Saitama Prefecture.  They were randomly assigned to group A or B and divided by age range (young, 18-39 years; middle-aged, 40-59 years; eldely, ≥60 years).  First, the volunteers read the package insert with no time limitation and then answered 14 scenario-type questions during an interview to determine the level of understanding of the insert.  When both the correct answer and correct reason were given, the response was judged as correct.  The level of understanding of the package insert was calculated as the number of persons giving correct responses divided by all respondents.
Results: Questionnaire responses from 86 consumers (43 in each group) were obtained.  The mean age in groups A and B was 46.5 years and 47.0 years, respectively.  The mean level of understanding of the package insert (14 questions) in groups A and B was 50.2 and 38.1%, respectively.  By age range, the mean level of understanding of the package insert in groups A and B in the young group was 60.6 and 56.9%, respectively, and there was no statistically significant difference between the two groups.  However, the mean level of understanding in groups A and B was 56.9 and 35.0% in the middle-aged group and 26.3 and 14.5% in the elderly group, respectively.  The mean understanding in group A was therefore higher than that in group B in both age ranges.  The association between understanding and age within groups indicated that with increasing age, understanding was lower in both groups (group A, p=0.001; group B, p<0.001).  There was no difference in the level of understanding between the young and middle-aged in group A, but the difference in group B was greater than 20%.
Conclusion: By comparing two package inserts of products in a similar pharmacological category using our LCS method, it suggested that font size and layout influenced consumers’ understanding of package inserts.  It might be able to evaluate the difference in the understanding of the package insert by using our LCS method.

With the advancement and complexity on present society it has been called the “age of depression”. One gets the feeling that depression, following a singular path of increase in recent years is one sort of “sickness of the era”. This time we conducted a screening test for masked depression, selected those showing such a tendency, and here report the remarkable improvement in a short period of time the condition of depression using acupuncture.
Method: Nakajima's test for masked depression (abbr MD test) was carried out on students from Meiji special school of Oriental Medicine and Meiji Junior College of Acupuncture and Moxibustion and screened 65 subjects with depression tendencies. Twenty-seven of these 65 subjects were randomly selected and divided into two groups of 16 in “actual group” and 11 in “placebo group”. Acupuncture method: In the actual group six acupoints that commonly applied on the psychic disease were used as follows; HYAKUE (GV 20), SHINCHU (GV 12), SHIN-YU (BL 15), KOKETSU (CV 14), SHINMON (HT 7) and SAN-INKO (SP 6) and the other hand in the placebo group five acupoints close to these in the former group but which are not directly related to psychic disease were applied as follows; TOH-DO (GV 13), FU-MON (BL 12), SUIBUN (CV 9), GEREN (LI 8) and KENSYO (GB 39). Acupuncture was performed for 10 minutes stationally by using gold needle (0.20mm wide, 40mm length) and was undertaken three times in a week for four weeks. Its clinical effect was evaluated by the MD test and the CMI test every two weeks.
Results: 1) In the actual group the score on the MD test averaged out to a return to normal range within two weeks whereas in the placebo group even after four weeks the score still remained in the sphere of depression.
2) In the actual group a 80% of the subjects showed in area IV (the sphere of neurosis) on the CMI test was resistant to the therapy. Even they did not relieve into the sphere of normality.
3) The acupuncture therapy indicated a tendency to the improvement of both physical and psychic symptoms in the actual group.
Conclusion: It was demonstrated that the acupuncture therapy applying acupoints suitable for psychic disease brought rappydly improvement of not only psychic symptoms but also physical symptoms and then gave a relief from the condition of depression.

　　In Japan, few reports have discussed adverse events and safety after simultaneous vaccination during infancy. The purpose of this study was to elucidate adverse events after simultaneous vaccination of inactivated vaccines in infants in comparison with those after single vaccination. Selected for this study were infants aged ≥2 months who received subcutaneous injections of inactivated vaccines between July 2012 and June 2013. These subjects were divided into two groups: a single-vaccination group (46 subjects) and simultaneous-vaccination group (42 subjects). The presence or absence of severe adverse events that required hospitalization was investigated. We also checked up on subject background and systemic [fever (transitional and highest body temperature)] and local (dermatological, respiratory, gastrointestinal, neurological, and other organs’ symptoms) adverse events. Questionnaires to investigate if adverse events occurred during one week after simultaneous vaccination, questionnaires were distributed to the parents of all the subjects. “We performed vaccination in 162 subjects, and the collect rate of questionnaires was 57% (97/162).” The percentage of effective answers to the questionnaire survey was 91% (88/97). Among simultaneous-vaccination group subjects, 14 (32%) received Haemophilus influenzae type b (Hib) + 7-valent pneumococcal vaccine (PCV7) and 12 (27%) received Hib + PCV7 + Diphtheria-Pertussis-Tetanus vaccine. No subject developed severe adverse events that required hospitalization. The body temperatures taken on the day following the injection in the simultaneous-vaccination group were significantly higher than those in the single-vaccination group (p=0.049). However, the incidence of other systemic and local adverse events in the simultaneous-vaccination group was not significantly different from that in the single-vaccination group. Compared with single vaccination, simultaneous vaccination of inactivated vaccines in infants resulted in a significant rise in body temperature on the day following vaccination; however, no severe adverse events occurred.