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Background: With advances in medical technology, the number of children with medical complexity (CMC) has increased. Excursions with such children encourage their social participation and have been shown to have a positive impact on their caregivers. However, the first‐hand experience of the excursions has not yet been evaluated regarding the difficulties faced by CMC and their caregivers during preparation, transportation, and in the local area. Methods: Semi‐structured interviews were conducted with eight informal and eight formal caregivers of CMC who attended an excursion to Tokyo Disney Land (TDL) via video conference. We investigated challenges that they had experienced through the excursion, performing inductive thematic analysis. Results: Three themes were identified: the preparation stage (Theme 1), problems encountered while traveling to the theme park (Theme 2), and problems at the theme park (Theme 3). In the preparation stage, three subthemes, i.e. preparation for the trip, cooperation with related parties, and researching about the theme park and asking for help, are reported. Theme 2 includes four subthemes: activities of daily living, respiratory care, luggage, and weather changes. Theme 3 has three subthemes: activities of daily living, physical condition management, and issues for the theme parks. Conclusions: We found that securing the power supply, location, and time for daily procedures are challenges in realizing excursions for CMC, but with sufficient preparation, it is possible in Japan without major difficulty. [ABSTRACT FROM AUTHOR]

Aim: Since women with Turner Syndrome (TS) have various complications, they require comprehensive medical evaluation and multidisciplinary treatment. Although TS patients receive adequate care in childhood, many adults with TS do not. Since most TS adults attend gynecologists for hormone replacement therapy, we suggest gynecologists take primary responsibility for their management. In an attempt to provide TS patients with a comprehensive treatment regimen, we started multidisciplinary medical management in the Reproductive Health Clinic at Yokohama City University Hospital. To evaluate the efficacy of this medical care system, a retrospective analysis was conducted. Methods: The clinical profiles of 57 TS patients were examined. The past histories, complications and clinical data of these patients were extracted from their medical records and examined clinically. Bone mineral density measurements of lumbar vertebrae (L2–4), anti-thyroid antibody titer measurements, hearing tests and cardiovascular MRI were also performed. Results: Mean follow-up duration was 5.1 years (range, 1–8 years). At the time of transition, patients with complications developed in childhood, such as amenorrhea, osteopenia/osteoporosis, otitis media, thyroid dysfunction and cardiovascular disease were identified. All these complaints were successfully followed up in our adult care system. Several complications common to TS adults, such as glucose intolerance, liver dysfunction, hyperlypidemia and hypertension could be identified by our screening system. Patients were referred to specialists when necessary. Conclusion: Multidisciplinary health management in our Reproductive Health Clinic improved the status of medical care for TS adults. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to identify the prevalence of urinary, fecal and double incontinence among Japanese residents aged ≥65 years living in long-term care facilities. Furthermore, the association between baseline characteristics and changes in toileting activity after a 3-month comprehensive care among older individuals was investigated., Methods: We examined the prevalence of incontinence and its significant predictors. The association between the Functional Independence Measure score at baseline and each type of incontinence (urinary, fecal or double incontinence) was examined using a logistic regression model. Similarly, the association between the Functional Independence Measure score at baseline and improvement in toileting activity after a 3-month comprehensive care was examined., Results: In total, 2517 residents (670 men and 1847 women) were recruited. The prevalence rates of urinary, fecal and double incontinence were 66.9%, 42.8% and 41.1%, respectively. In multivariate analysis, the sum of the motor subscales after removing four continence items and the sum of the cognitive subscales of the Functional Independence Measure score at baseline were significantly associated with all types of incontinence. The sum of the motor subscales after removing four continence items of the Functional Independence Measure score was associated with improved toileting activity., Conclusions: This study presented the prevalence of urinary, fecal and double incontinence among residents living in long-term care facilities in Japan. The Functional Independence Measure items at baseline were associated with not only continence status, but also improved toileting activity after 3-month comprehensive care. Geriatr Gerontol Int 2020; 20: 285-290., (© 2020 Japan Geriatrics Society.)

Objective　The purpose of this study is to redefine "Gojo" (mutual help) among residents and explore measures to develop it Gojo in the integrated community care system. In 2000, long-term care insurance accelerated Japan's movement toward an aging society, thus increasing the importance of Gojo. This study aims to clarify the conceptual definition it has come to acquire in recent years and explore ways it can be developed in comprehensive community systems.Methodology　Rodger's evolutionary concept analysis was utilized in the study. A keyword research was done using the term "Gojo" in the Japan Medical Abstracts Society (Ichushi Web) and CiNii Articles databases. The search period was from 2000 to 2016 (search date: August 30, 2016) and the database search formula was set to "Gojo/TA". Thirty documents were selected through random sampling and a total of 32 documents were selected for analysis, including landmark documents. A qualitative analysis was conducted on three frameworks: attributes (i.e., characteristics of Gojo), antecedents (i.e., factors affecting Gojo), and consequences (i.e., expected results for Gojo). These three frameworks represent how Gojo is used, the events occurring before it, and the events resulting from it, respectively.Results　The characteristics of Gojo were found to include "experiences of empathy toward residents' daily need for support," "awareness about the residents' efforts to support each other," and "interaction among residents who support other's daily needs." The factors affecting Gojo were identified to be "the need for daily life support beyond what self-help, social solidarity care, and governmental care can provide"; "interchange among residents"; "sharing needs for daily life support among residents"; and "a resident-led public system that promotes mutual support." Gojo's expected results were "a solution for residents' needs of daily support"; "promotion of self-help awareness"; "providing them with a role to enhance their purpose in life"; and "encouraging exchanges and relations between them."Conclusion　Gojo was defined as "the interaction between local residents who support their daily needs, have an empathic experience of the need for daily life support, and have the desire to support each other." In addition, the following points were suggested as measures necessary to expand Gojo. The residents must have sympathy for other residents who need daily life support, understand the benefits of supporting each other, and have a public support system, even if Gojo is led by the residents.

Objectives　To examine how parents of children with mental illness prepare for their children's lives in the community after their own death.Methods　Twenty-two parents living in the Kanto region, who have children with mental illness, were interviewed from December 2016 to February 2017. Through qualitative inductive analysis, codes were identified from the narrative data that showed the preparation of parents and compared their similarities and differences. Similar codes were collected and subcategories and categories were created with increasing abstraction levels. Each category was considered with respect to the purpose and the reason why each preparation was done.Results　Participants were 9 fathers (40.9%) and 13 mothers (59.1%). Their ages were as follows: in their sixties (n=9; 40.9%), seventies (n=10; 45.5%), and eighties (n=3; 13.6%).　Ten categories emerged regarding parental preparation for their children's life after their death: 1) Forecasting their own death and recognizing the limitations of support; 2) Trying to share with their children about their own death; 3) With consideration of after their own death, organizing the necessary information for their children and their own belongings; 4) Consulting with their relatives about the lives of their children and inheritance, and considering the use of the social resources; 5) Trying to secure a residence and living expenses for their children; 6) Connecting with social resources, searching for recovery methods for their children, and their own health maintenance; 7) Stabilizing and recovering disease conditions of their children, supporting to take medication and outpatient visits; 8) Assessing the ability of their children to live considering their independent life; 9) Developing their abilities to live and sociality, and making reliable supporters other than parents; 10) Encouraging to have fun in their children's lives and considering their employment. Parents were preparing to hope their child would cope with difficulties in their lives after their own death, and maintain a stable life in the community by him/herself.Conclusions　The results suggested that parents should recognize the need of an independent life for their children in the community, to promote concrete preparations toward their children living in the community after their own death.

ad hoc committee of Japanese Leprosy Association recommends revised standard treatment protocol of leprosy in Japan, which is a modification of World Health Organization's multidrug therapy (WHO/MDT, 2010). For paucibacillary (PB) leprosy, 6 months treatment by rifampicin and dapsone (MDT/PB) is enough. However, for high bacterial load multibacillary (MB) leprosy, 12 months treatment seems insufficient. Thus, (A) For MB with bacterial index (BI) > 3 before treatment, 2 years treatment by rifampicin, dapsone and clofazimine (MDT/MB) is necessary. When BI becomes negative and active lesion is lost within 2 years, no maintenance therapy is necessary. When BI is still positive, one year of MDT/MB is added (3 years in total), followed by maintenance therapy by dapsone and clofazimine until BI negativity and loss of active lesions. (B) For MB with BI < 3 or fresh MB (less than 6 months after the onset of the disease) with BI > 3, 1 year treatment by MDT/MB is necessary. When BI becomes negative and active lesion is lost within one year, no maintenance therapy is necessary. When BI is still positive or active lesion is remaining, additional therapy with MDT/MB for one more year is recommended. Brief summary of diagnosis, purpose of therapy, character of drugs, and prevention of deformity is also described.

Background: The allocation of outcome of suicide attempters is extremely important in emergency situations. Following categorization of suicidal attempters who visited the emergency room by outcome, we aimed to identify the characteristics and potential needs of each group., Methods: The outcomes of 1348 individuals who attempted suicide and visited the critical care center or the psychiatry emergency department of the hospital were categorized into 3 groups, "hospitalization in the critical care center (HICCC)", "hospitalization in the psychiatry ward (HIPW)", or "non-hospitalization (NH)", and the physical, mental, and social characteristics of these groups were compared. In addition, multiple logistic analysis was used to extract factors related to outcome., Results: The male-to-female ratio was 1:2. The hospitalized groups, particularly the HICCC group, were found to have biopsychosocially serious findings with regard to disturbance of consciousness (JCS), general health performance (GAS), psychiatric symptoms (BPRS), and life events (LCU), while most subjects in the NH group were women who tended to repeat suicide-related behaviors induced by relatively light stress. The HIPW group had the highest number of cases, and their symptoms were psychologically serious but physically mild. On multiple logistic analysis, outcome was found to be closely correlated with physical severity, risk factor of suicide, assessment of emergent medical intervention, and overall care., Conclusion: There are different potential needs for each group. The HICCC group needs psychiatrists on a full-time basis and also social workers and clinical psychotherapists to immediately initiate comprehensive care by a medical team composed of multiple professionals. The HIPW group needs psychological education to prevent repetition of suicide attempts, and high-quality physical treatment and management skill of the staff in the psychiatric ward. The NH group subjects need a support system to convince them of the risks of attempting suicide and to take a problem-solving approach to specific issues.

Diagnosis of genetic and metabolic disorders is usually made in childhood. Key issues for adult patients have shifted from children with these disorders to treatment of the symptoms and complications which appear in adulthood, and to the problems related to pregnancy and delivery, since pediatricians have less knowledge regarding these problems. With the development of new treatment, the numbers and problems of transitioned patients have been increasing. To achieve better medical care for these patients, pediatricians should play an important role in organizing the medical team and in establishing the medical network with key specialists including genetic counselors, dieticians and social workers for taking care of adult patients with those disorders.

A significant number of patients with childhood-onset epilepsy continue to be treated by child neurologists after reaching adulthood. In this article, the issue of these so-called carry-over cases is discussed based on the results of two studies: our previous study on carry-over patients at the Department of Child Neurology, Okayama University Hospital, and a questionnaire survey on carry-over cases by the Japan Epilepsy Society. These two studies revealed that child neurologists currently treat many carry-over epilepsy patients in Japan, and that these patients, even those who have low seizure frequencies or are in remission, suffer from many problems such as comorbidities and socioeconomic difficulties. To ameliorate these problems, a comprehensive care system should be established, based on cooperation between various kinds of doctors and comedical staff members.

Aim and Methods: The cooperation of general practitioners and specialists is crucial to establish comprehensive medical services for demented older adults. In the current study we conducted a survey regarding the attitudes towards referrals between general practitioners and specialists by sending a questionnaire to 1,176 general practitioners., Results: The 39.1% of the general practitioners returned the questionnaire. Of the respondents, 68.8% answered that they did not want referrals of demented patients from specialists, however, when analysis was limited to those who had an internal medicine background, only 26.3% did not want referrals. Difference of subspecialties within internists did not affect the preference for referrals. Regarding the reasons for referring the demented patients to specialists, more than 70% of the general practitioners chose "accurate diagnosis of the cause of dementia" and "decision of therapeutic plans"., Conclusion: The majority of general practitioners in Japan may still be reluctant to follow patients with dementia mainly because they regard the practice of seeing demented patients as the subject outside of their specialty. Therefore providing general practitioners with opportunities to receive training programs regarding the practice and care of demented patients, as well as establishing support from specialists is necessary.

The role of certified specialists in geriatric medicine in Japanese University Hospitals is discussed in this section. First, they should act as geriatric general physicians to provide a comprehensive medical care for elderly patients against a background complicatedly divided medical departments in university hospitals. Second, they should create attractive undergraduate programs for geriatric education in medical schools and training programs in geriatric medicine for doctors to develop certified specialists in geriatric medicine in the future. Finally, they should perform clinical research to provide an evidence to construct better social policies to keep older people healthy.

The Japanese long term care insurance has started since 2000. After 5 years' experience, it is scheduled to change in 2006, the most important point is preventive care which means to stop the deterioration of ADL or cognitive function. Prevention is thought to be best way to cut the cost of care services. The preventive care system will start in April, 2006, over 1 million people with supportive care needs will receive muscle training or oral care and nutritional support from care workers in the community. New comprehensive community centers will open and these should which make assessments for preventive care, and provide consultations for care givers and families, and comprehensive care management in the community, and protect the dignity of the elderly will newly start. To improve quality of care services is important, and each prefecture has to evaluate all services and to publish the data with internet, so that everybody can see it and select the most appropriate care or company. Also, the government will start a new system of community based services including group homes, small and multifunctional care services, and day care services for people with dementia. These services should have one room available for each individual.

Cerebral palsy is associated not merely with impairments of posture and locomotion, but also with various other problems. Medical illnesses should be treated by an adequate system. Emotional disturbances require a psychological support. Communication disorders may be overcome with proper modern equipments Perceptional deficits and sensory impairments should also be addressed. Care systems for physically handicapped children in Japan were established by the concept of ryoiku, a term in Japanese created about fifty years ago by K. Takagi, Professor of the Department of Orthopedics, University of Tokyo. This term can hardly be translated into English, bot in my view stands for a comprehensive approach comprising orthopedic treatments, educational programs and vocational trainings. Based on this concept, Dr. Takagi founded an institution for the physically handicapped in 1942; followed by establishment of similar institutions in all areas of Japan after World War II. Despite its historical role, ryoiku does not meet any more the current standard of care for cerebral palsy. We need now a new comprehensive term and management systems. A novel medical subdivision "medicine for developmental handicaps" may also be necessory. In this paper I made an overview of current problems of children and adults with cerebral palsy. I proposed a new concept of ryoiku and emphasized the need for the new medicine to treat developmental handicaps.

One of our objectives in establishing the Hemophilia Center was to create a model of a total care system for chronic diseases which develop in the childhood and continue through adulthood. We also believe that the comprehensive medical care system should be introduced not only for the care of hemophiliacs but also for those with every chronic refractory disease. It may be a surprise that in a university hospital, which is likely to lack cooperation between departments, this kind of cross sectional support system, even extending to activities outside the hospital, has been continued. This success owes much to the understanding and consideration by successive Directors of the Hospital and the Professors (Directors) of every department, the enthusiastic efforts by members of the Center who have continued their volunteer work for the purpose of improving the QOL of patients, and the cooperation by students of the Volunteer Study Club. We also have to mention the advice and guidance by Dr. Minoru Inagaki (now at the National Children's Hospital) who established the first substantial hemophilia center in Ogikubo Hospital, and Dr. Kaneo Yamada, present Visiting Professor in the Faculty of Medicine, St. Marianna University. We would like to thank every one who has supported the activities of the Center. Finally, we strongly hope that this total care system will become popular among those responsible for caring of patients with other chronic refractory diseases.

The improvement of quality of life (QOL) is now widely accepted as an important goal of health care. Underlying the acceptance of QOL is the unspoken assumption that therapies and practices associated with QOL are inherently beneficial. The uses of QOL in the treatment of epilepsy need scrutiny. Close attention must be given to the effects of policies instituted in the name of QOL, as significant social consequences may result from these policies.

To study quality of life in school children with epilepsy, we surveyed families of 443 elementary and junior high school children with epilepsy, as well as their school teachers. Approximately 80% responded. Seizures were controlled in 70% of the children. Of the children with epilepsy, 27% received education for disturbed children. Main family concerns were the future of their child, seizures, and school performance. Main concerns of the children were medication and seizures. The majority of both families and teachers agreed that children should participate in all physical education and school events based on individual considerations. Many teachers expressed the opinion that correct information about epilepsy and close communication between teachers and physicians are necessary. To establish comprehensive medical care that satisfies the needs of children with epilepsy and their families, further training of medical specialists in epilepsy, establishment of more hospitals specializing in epilepsy, and enhancement of the network among relevant organizations are needed. For children with intractable epilepsy, special considerations include associated handicaps and antiepileptic drug side effects.

The desire of people to receive the best health care services without difficulty is an instinctive one. However, defects in public health education and the irresponsible or sometimes sensational medical information released by the mass media are causing an excessive increase in the population's demand for health care services. As a result, so-called "worried well" patients are increasing and health care institutions are crowded with such patients, who play a major role in increasing national medical spending. On the other hand, it is difficult to say that health care institutions are providing satisfactorily continuous, consecutive and comprehensive health care services. Needless to say, in dealing with worried well patients, the health care institutions should make efforts towards early detection of disease, if any, but at the same time, a psychosomatic approach should be made, considering patients as holistic people with both a mind and body. To this end, interdepartmental and interhospital liaison becomes very important. From the viewpoint of comprehensive health care services, the author presents in this paper such cases where the health care services provided are regarded as defective in terms of continuity and points out the importance of systematized health care information and systematized health care services at all health care levels from primary to tertiary.