Objective: To determine the seasonal differences in instrumental activities of daily living (IADL) and objective physical activity among older adults residing in non-urban areas in snowy and cold regions according to sex.Patients and Methods: Fifty older adults aged ≥65 years were included in the present study. IADL was assessed using the revised Frenchay Activities Index (FAI), and physical activity was measured using a triaxial accelerometer. Comparisons were made between the snowy and non-snowy seasons based on sex.Results: Compared to the non-snowy season, the female participants exhibited significantly lower scores for outdoor housework, outdoor activity, and overall scores on the FAI during the snowy season. In terms of physical activity, a decrease in the number of steps and light-intensity physical activity, accompanied by an increase in sedentary behavior, was observed in both sexes. High light-intensity physical activity decreased in the snowy season, especially in the female participants. In addition, the total moderate-to-vigorous physical activity (MVPA) and short-bout MVPA (intermittent and lasting <10 minutes) also decreased.Conclusion: Considering the significant changes in lifestyle and physical activity during the cold snowy season, women should consider performing alternative physical activities other than indoor household chores. Furthermore, men should be encouraged to participate in indoor household chores they typically do not engage in, irrespective of the season.

Objectives: A refill-prescription system startedin April, 2022 in Japan. Refill-prescriptions can be usedrepeatedly, but pharmacists are required to check patients' medication and determine whether refills are appropriate. This study aimed to clarify the actual status of community pharmacies' treatment of prescription refills and pharmacists’ concerns about them.Design: Questionnaire survey.Methods: A self-administered questionnaire survey was conducted for pharmacists at community pharmacies from June to July, 2022, shortly after the refill-prescription system was launched, focusing on handling of prescription refills in community pharmacies, and concerns and challenges about refill-prescriptions.Results: Responses were obtainedfrom 377 pharmacists in 34 prefectures throughout Japan. Among them, 30.8% had received refill-prescriptions. Many pharmacists checked medical histories, changes in patients' symptoms, and medication and medical examination status when determining the appropriateness of refills, but few reviewed past laboratory values or laboratory values measuredby patients themselves at the time of their pharmacy visit. Moreover, 34.8% of the pharmacies had internal rules for dealing with refills, and 39.8% had equipment to measure laboratory values. Many pharmacists were concerned about how to share patients’ information with other pharmacies. Challenges that were identified included “Determining whether the refill is appropriate for the patient” and “Establishment of a pharmacy system to receive refill-prescriptions”.Conclusion: This study clarified the actual status of community pharmacies handling of prescription refills, and pharmacists' concerns or challenges about them. Potential improvements include increasing the number of devices that can measure laboratory values at pharmacies, improving home-use measuring devices, creating guidelines to determine the appropriateness of prescription refills and improving pharmacists' skills.

  Introduction  This study aimed to clarify social networking and help seeking behaviors in relation to the health of pregnant and puerperal Brazilian women in Japan, using unanalyzed data collected in the article titled “Socio-cultural factors affecting the health of pregnant and puerperal Brazilian women in Japan” published in this journal.Methods  We conducted semi-structured interviews of pregnant and puerperal Brazilian women aged ≥20 years in their homes in Prefectures A and B during 2013-2014. We used the Japanese version of the interview guide based on the cultural determinants of help seeking developed by Arnault. The analysis was guided by analytic ethnography, and core themes were derived.Results  The interviews were conducted with 18 women. Their mean age was 32.4 years (5 women in their 20s and 13 women in their 30s). The average length of stay was 12.6 years (6 women: <10 years and 12 women: ≥10 years). Regarding residential status, 12 women were permanent residents. Two categories for social networking were derived: (1) limited social interaction and (2) reliance on family and trusted others. Two categories for help-seeking behaviors were derived: (1) reliance on informal resources close to them and (2) self-reliant problem solving.Conclusions  The social networking and help-seeking behaviors of pregnant and puerperal Brazilian women in Japan were related to their way of cultivating relationships in their transnational life as migrant workers. Their behaviors were also related to their perception on the family, their religion, and their self-reliant problem-solving behaviors.

Background / Purpose: The aim of this study was to analyze the relationship between metacognition and mental health among first-year Japanese medical students at several months after admission.　Method: A questionnaire survey was conducted on first-year medical students at a private medical university. We used the Adults' Metacognition Scale to measure metacognition and the Japanese version of the 12-item General Health Questionnaire (GHQ-12) to measure mental health status.　Results: The data from 80 students were analyzed. The total metacognition score and the subscale monitoring score were negatively correlated with the GHQ-12 total score and were significantly different between the poor mental health group and the good mental health group. 　Discussion: The results suggest that students in poor mental health status were considered to have weak metacognition, especially monitoring.

Background/Aims: Endoscopic submucosal dissection (ESD) for residual or recurrent colorectal lesions after incomplete resection is challenging because of severe fibrosis. This study aimed to compare the efficacy of the pocket-creation method (PCM) with a traction device (TD) with that of conventional ESD for residual or recurrent colorectal lesions. Methods: We retrospectively studied 72 patients with residual or recurrent colorectal lesions resected using ESD. Overall, 31 and 41 lesions were resected using PCM with TD and conventional ESD methods, respectively. We compared patient background and treatment outcomes between the PCM with TD and conventional ESD groups, respectively. The primary endpoints were en bloc resection and R0 resection rates. The secondary endpoints were the dissection speed and incidence of adverse events. Results: En bloc resection was feasible in all cases with PCM with TD, but failed in 22% of cases of conventional ESD. The R0 resection rates for PCM with TD and conventional ESD were 97% and 66%, respectively. Dissection was significantly faster in the PCM with TD group (13.0 vs. 7.9 mm2/min). Perforation and postoperative bleeding were observed in one patient in each group. Conclusions PCM with TD is an effective method for treating residual or recurrent colorectal lesions after incomplete resection.

We report three cases of patients with mental illness suffering from symptoms associated with menstruation, which were improved with Kampo treatment. Case1: A 39-year-old female had been in a depressive state after delivery and diagnosed with persistent mood disorder in the Neuropsychiatry Department of Fukushima Medical University (FMU). During treatment for the disorder, she developed premenstrual dysphoric disorder (PMDD) and was immediately hospitalized. After she was introduced to the Obstetrics/Gynecology Department, we treated her with Kampo medicine such as tokakujokito considering the meaning of the pattern (sho), and then she recovered from PMDD. Case2: A 29-year-old female with schizophrenic disorder treated in the Neuropsychiatry Department of FMU was referred to the Obstetrics/Gynecology Department due to PMDD. We administered Kampo medicine such as kamishoyosan, nyosinsan and saikozai when yang pattern was observed, and ninjinto and daikenchuto in yin sho. Then, her condition then gradually improved. Case3: A 37-year-old female diagnosed with borderline personality disorder and attention deficit hyperactivity disorder was hospitalized in the Neuropsychiatry Department of FMU. She was introduced to the Obstetrics/Gynecology department due to dysmenorrhea and PMS. After she was treated with keishibukuryogan and hangekobokuto, her symptoms improved. In conclusion, Kampo treatment appears to be effective for symptoms associated with menstruation in women with mental illness.

Engaru-Kosei General Hospital expanded its pharmacist duties in hospital wards in April 2018 following the nationwide switch to out-of-hospital prescriptions. The purpose of this study was to examine the effect of pharmacists’ ward duties on nursing duties. Pharmacists expanded their duties to cover drug distribution management, infusions of total parenteral nutrition (TPN) mixed with drugs, and aseptic preparation of 24-h infusions (including peripheral parenteral nutrition). The effects were compared between April 2018 before the expansion of duties and May-September 2018 after the expansion, and we compared the number of meetings set up to discuss nurses’ overtime hours and patient problems. In addition, interviews were conducted about the changes experienced on site. Drug distribution management averaged 3,150 cases/month. The number of TPN mixed infusions was 25 cases/month before expansion and this increased to 88 cases/month after expansion. The number of mixed injections of 24-h infusions was 296/month. Nurses' overtime hours did not decrease significantly, but the number of meetings increased from 47/month to 79.4/month. In the interviews, positive responses were obtained about, for example, the increased number of meetings held and more time for patient care. The pharmacist and the nurse collaborated to improve work by using their expertise, we think that the results obtained from work improvement contributed to the improvement of medical quality and medical safety.

Purpose: This study investigated the current state of critical hemorrhage during home palliative care for terminally ill cancer patients. Methods: We conducted a retrospective medical chart review of 7 cancer patients (1.4%) who received home palliative care from our clinic and died of critical hemorrhage at home from October 2007 to December 2014. Results: Four patients were male, the mean age was 70±11 years, and underlying diseases were different. None of the patients were accompanied by medical staff at the onset of bleeding. Six patients died at home and one patient was admitted to hospital for hemostasis. Six patients had a pre-hemorrhage episode more than 24 hours before critical hemorrhage occurred from the same site. One patient was administered a hemostatic agent, hemostasis was attempted in one, and one was given sedation. Six patients wanted to die at home, and did die at home. Discussion: If terminally ill cancer patients have critical hemorrhage at home, our options are limited. The results of this study suggest the importance of hemorrhage risk assessment and advance care planning.

Purpose：This study investigated the current state of medical care and home palliative care for terminally ill cancer patients in Japan. Methods：We conducted a retrospective questionnaire study of 352 cancer patients who received home palliative care from 6 specialized home care clinics and discontinued home care or died from January to June in 2012. Results：The questionnaire was answered by 290 patients〔165 men（57％）, mean age：72±13 years〕who started home palliative care after completing cancer treatment. Home visits from nurses were used by 238 patients（98％）and 95 patients（39％）used home care workers. Within a month before discontinuation of home care or death, 72 patients（30％）received fluid therapy and 127 patients（52％）received strong opioids. The outcome of home palliative care was death at home in 242 patients（83％）and discontinuation of home care in 48 patients（17％）. The reason for discontinuation was family physical and mental problems or physical problems of the patient. Conclusion：This study demonstrated the current state of home palliative care by specialized home care clinics.