Four surgical operations were going on in our hospital when the 9.0-magnitude earthquake hit northeast Japan on March 11, 2011. To work out effective disaster prevention measures, we investigated how did nurses in the operating room acted immediately after the earthquake, and their psychological state. We distributed questionnaires to 17 nurses who had been in the operating room at that time. Our study showed that most nurses formed cool judgments on the safety and helped allay the anxiety of the patients, despite the fact that they themselves felt anxiety or were terrified at heart. On the other hand, several actions such as the protection from contamination of the operative field were not taken properly as prescribed in the Emergency Manual of the operating room. Full awareness of role-sharing flowcharts of emergency evacuation of the patient under operation, and periodical disaster drills are needed to plan for a crisis.

 Infertility in developing countries is important but neglected, while the issues of population growth control have been paid much attention. Female infertility rates in African countries were about 30 percent, which were three times higher than those of industrialized countries. It was reported that the most common cause of infertility was tubal dysfunction due to sexually transmitted infections, unhygienic delivery management, and unsafe abortion. The second common causes were male factors, which had been underestimated in developing countries. Thus, women were always blamed and often abused by their husbands and in-laws. Furthermore, infertile couples suffered from social discrimination and economic disadvantages.
 Infertilities were often treated without appropriate examinations of both husbands and wives. Inexpensive treatments were commonly applied: e.g., treatment of sexually transmitted infections, encouraging timing intercourse, hormonal therapies. Assisted reproductive technology (ART) would be effective in developing countries where main causes of infertility were tubal dysfunction and male factors. ART has been performed in urban areas in some developing countries. However, it is difficult to promote ART in developing countries, because of high costs and lack of sufficient technical and ethical regulations. To decrease the burden of infertility in developing countries, first, both developing and industrialized countries have to recognize the significance of the issue. Then, it is needed to evaluate accurate rates of infertility, causes of infertility, and effectiveness of current treatment, so that the countries could develop prioritized strategies and interventions.
 Infertility rates could be decreased with relatively low cost through building a system of proper diagnosis and treatment. International assistance might be required to negotiate the drug prices and to establish technical and ethical review mechanisms, which are the prerequisites of promoting ART. It is also important to provide people with knowledge and information regarding infertility, their causes and treatment.

Introduction
Health Sector Reform Program (HSRP) in Egypt started in 1997 to improve equity, efficiency, quality and sustainability of Egyptian health systems. This study aims to review reports and publications regarding HSRP in Egypt and to analyze its achievements and problems.
Methods
Documents of international organizations and other relevant agencies, such as reports of health sector reform programs and statistics, were reviewed and analyzed.
Results
HSRP aimed to improve quality of health services and equality of access, and to establish sustainable health financing mechanisms, while focusing on primary health care. Major components of HSRP were: health service delivery, health financing, and evaluation. It started in five pilot governorates. Based on the Family Health Model (FHM), each family registered to a physician or a health facility, and was provided with essential medical services called Basic Benefits Package (BBP). Family Health Fund (FHF), the newly established financing agency of FHM, provided health staff with incentives from a pooled fund. Against the original plan, FHF could not function as a health insurance fund, and was financially unsustainable. Mechanisms of health facility accreditation and health services performance evaluation with incentives were installed to ensure the quality of health services.In addition, health staff training programs were enhanced, health facilities and equipment in rural areas were improved, and referral systems were strengthened.
Conclusions
HSRP introduced a family health model for the first time in Egypt in pilot governorates. Focusing basic health service provision, HSRP succeeded to improve equity, efficiency and quality of health services. However, sustainable health insurance mechanisms were not established yet, and involvement of private health service providers were very limited. It is needed to bring in commitment of Egyptian government across the sectors and to develop health systems that secure good quality of health services for all Egyptians.

Constipation is one of the most common symptoms seen in elderly people, and is sometimes difficult to treat. Daikenchuto is a well-known Kampo formulation for treating ileus. Here, we report a case in which daikenchuto was not effective and constipation was effectively treated with kobokushokyohangeninjinkanzoto. The patient was an 81-year-old woman who had been hospitalized for treatment of a thighbone fracture. She was originally constipated, and her constipation had worsened over the course of hospitalization. Colonoscopy examination and abdominal computerized tomography showed no structural lesions. Her constipation improved after the administration of daikenchuto, but the improvement was transient. Since the constipation and abdominal distension worsened after she began eating again, we administered kobokushokyohangeninjinkanzoto. Subsequently, her condition improved remarkably. Eight days later, we changed the initial kobokushokyohangeninjinkanzoto to ninjinto and hangekobokuto. Her complaint did not recur, and she was discharged 17 days later. In case of deficiency pattern ileus, kobokushokyohangeninjinkanzoto may be considered as an alternative to daikenchuto. Furthermore, we believe that the combination of ninjinto and hangekobokuto is an effective alternative to kobokushokyohangeninjinkanzoto.

We describe two cases of cardiac failure in elderly patients successfully treated with shimbuto. Case 1 was that of an 84-year-old man with severe aortic stenosis and liver cancer. His cardiac failure led to repeated hospitalization. After taking shimbuto, his pleural effusion decreased and cardio thoracic ratio improved. Case 2 was that of an 84-year-old man who was hospitalized because of cardiac failure and aspiration pneumonia after undergoing an operation for lung cancer. After taking shimbuto, his urine volume increased and cardiac failure improved. No notable adverse events were observed in any of the abovementioned cases. It is important that kanzo is not included in shimbuto to demonstrate risui action, hence the use of other “ho” formulations should be avoided. These cases suggest that shimbuto is indicated for elderly patients with cardiac failure under terminal care.

A forties year-old female visited our hospital on March 2011, complaining chest discomfort. Computed tomography (CT) revealed a huge mass in the anterior mediastinum combined with multiple masses in the lungs, the uterus and the bone. Since no abnormal shadow had been noticed on the chest radiograph on January 2011,they seemed to have grown very rapidly in a short period. The pathological diagnosis following needle biopsies of mediastinal and uterine cervix tumors was undifferentiated carcinoma of the thymus metastasizing to the uterus. She was also suffering from the pain on the right femur and intermittent hypogastralgia due to metastases to the bone and uterus. Although NSAIDs and oxicodone relieved the pain on the right femur, they could not significantly reduce the hypogastralgia. Judging from the nature of the frightful hypogastralgia, the cause was estimated to be not somatalgia but splanchnodynia. Ritodorine hydrochloride, which was then adnimistered for the purpose of inhibiting the contraction of the uterine, was remarkably effective in reducing the pain. According to the literatures reviewed concerning metastases of the extrapelvic malignant tumors to the uterus, the median survival period after occurrence of metastases was 14 months. This report suggests that the administration of Ritodorine hydrochloride can keep the quality-of-life of these patients without suffering from the pain due to metastatic tumor to the uterus.

Background: Socioeconomic status (SES) is correlated with morbidity and mortality rates, in addition to people of a lower social status. Many of such people have health-related problems and do not undergo a regular health checkup or consult a medical practitioner. We investigated whether a correlation exists between SES, psychological state and the number of weeks of gestation at the time of the first examination. We clarified the influence of SES on the subjects’ life events (e.g. pregnancy and childbirth), in order to understand appropriate support measures.
Methods: A total of 151 female study subjects were selected from among women hospitalized for postpartum care, who underwent prenatal checkups, and delivered their children in the study center. Questionnaire surveys, one of which involved an interview, were conducted in a cross-sectional manner for the subjects’ during their pregnancy and in the postpartum period.
Results: The results show that women who perceived financial constraints showed a significantly stronger tendency to develop depression. Multiple logistic regression analysis showed that women whose partners had an educational background of junior high school level underwent their first gestational examination at week 12 or later of pregnancy (odds ratio of 10.99, P = 0.001; 95% confidence interval, 3.15–86.79).
Conclusion: The present study suggests the importance of observing the correlation between SES and health among pregnant women, such that strategic interventional services can be provided to such persons.

The effectiveness of the Kampo medicine shakuyakukanzoto extract for patients with muscle cramp is well known, but recently side effects related to pseudoaldosteronism have also been reported. To avoid this issue, Kampo medicines without Glycyrrhizae Radix are needed for treatment of muscle cramp. We investigated the therapeutic effect of shimotsuto extract, which has traditionally been used to treat anemia, in 26 patients (mean age : 70.7 ± 12.1 years) with muscle cramp. Improvement of the symptom was noted in 18 patients (69%), with no change in 8 patients (31%). The abdominal muscle tension of the former patients was significantly lower than the latter. Here, the cases of four representative patients in whom muscle cramp was improved by shimotsuto are described. The response rate to shimotsuto was similar to that of shakuyakukanzoto. Our results suggest that shimotsuto extract is a suitable alternative to shakuyakukanzoto for treatment of muscle cramp in older non-robust type patients not in need of emergency care.

We reported 2 cases of plantar keratosis (59 years of age, female/39 years of age, male) successfully improved by intake of hot water extract of Coix lacryma-jobi L. var. ma-yuen Stapf with Husks. Both subjects were administered coix seed extract containing food for 20 weeks. The lesions improved gradually after 12 weeks, and almost cured by 20 weeks of administration. Although the food seemed to be effective in these cases, further studies are needed to define the optimal dose and duration.