We examined ambulatory clinical training for patients with dementia conducted by residents at a university hospital and instructors at a psychiatric hospital who mainly treat patients with dementia in the General Internal Medicine Department of a regional hospital. Residents experienced dementia treatment in the context of primary care, and performed in-depth learning about dementia with the guidance of psychiatrists. It is hoped that dementia treatment will be provided by family doctors. Moreover, it is expected that doctors who have undergone this training will contribute to dementia treatment.

From 1998 to 2001, using questionnaires, we surveyed the use of travel vaccines among Japanese expatriates in developing countries. The percentage of those using more than one type of travel vaccine before departure increased significantly (45.6% in 1998 to 53.4% in 2001 (p<0.001)). In regions such as tropical Africa and South Asia, vaccination rates were high. But the increase was most noticeable in East Asia, the Middle East, and Latin America. Vaccinations against hepatitis A, hepatitis B, and tetanus were high throughout the developing countries. Vaccinations against yellow fever and Japanese encephalitis were high in endemic regions. Vaccination rates were slightly higher for typhoid fever in South Asia and tropical Africa than that in other areas. Vaccination rates for cholera, however, showed yearly declines. These trends seem to reflect a growing awareness among expatriates of the benefits of travel vaccines. Even so, nearly half of those living the countries have not received sufficient vaccination, indicating a need for further education.

Objective: With the accelerated population aging, multimorbidity has become an important healthcare issue. However, few studies have examined multimorbidity and its impact on the use of medical and long-term care services in Japan. Therefore, this study aimed to examine the association between multimorbidity and the use of medical and long-term care services among older adults living in the depopulated mountainous areas of Japan.Patients and Methods: A cross-sectional study was conducted using insurance claims data from late-stage medical insurance and long-term care insurance (April 2017 to March 2018) for older adults ≥75 years residing in a mountainous area in the Tottori prefecture. In addition to the descriptive analysis, multiple generalized linear regressions with family gamma and log-link functions were used to examine the association between the number of morbidities and total annual medical and long-term care expenditures.Results: A total of 970 participants ≥75 years were included in the analysis. Participants who had two or more morbidities constituted 86.5% of the total sample. Furthermore, participants with mental disorders were found to have more comorbidities. The number of comorbidities is associated with higher medical and long-term care expenditures.Conclusion: Multimorbidity was dominant among late-stage older adults living in depopulated mountainous areas of Japan, and the number of morbidities was associated with higher economic costs of medical and long-term care services. Mitigating the impact of multimorbidity among older adults in depopulated regions of Japan is an urgent challenge. Future research should investigate the degree and effectiveness of social protections for vulnerable older adults living in remote areas.