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This study used random allocation to separate out groups of students from four Taipei junior high schools, each of which underwent a different environmental-education program, in order to examine the effects of such programs on students' environmental behavior and related factors. Results indicate that Taiwanese junior high schools should coordinate the teaching of environmental programs with other school activities to obtain the most ideal results. [ABSTRACT FROM AUTHOR]

Breast cancer is a representative malignancy that is prone to brain metastasis. Recently, several studies have reported the efficacy of trastuzumab deruxtecan(T-DXd)in treating brain metastases. We have used T-DXd in 10 patients with brain metastases, and stereotactic or whole brain irradiation was performed in 9 of 10 patients. All patients had symptoms of brain metastases. Because T-DXd was administered in the late line in the early cases, symptoms due to brain metastases or meningeal dissemination worsened during T-DXd administration in a few cases. None of the four most recent cases showed worsening of brain metastasis or symptoms due to brain metastasis after T-DXd use. We would like to accumulate more cases and investigate whether T-DXd can be preferred over irradiation for asymptomatic patients with brain metastases.

A 46-year-old woman experienced bleeding from a large tumor in her right breast and was hospitalized after calling an ambulance. At first, we suspected breast cancer, but a core needle biopsy under ultrasound revealed a diagnosis of malignant phyllodes tumor. The bleeding was temporarily controlled using Mohs paste, so emergency surgery was not required. After mastectomy, skin grafting was not needed. Postoperative adjuvant therapy was not planned. 12 months after surgery, recurrence was detected in the lower lobe of the left lung, and we performed a laparoscopic-assisted left lower lobe lung resection. Future recurrences will be managed with chemotherapy and radiation therapy according to sarcoma treatment protocols, and surgery will be considered for operable sites.

The patient is a 45-year-old woman. She was aware of a right breast mass and consulted a referring physician. She was referred to our department for close examination and treatment. No axillary lymph node metastasis or distant metastasis was suspected on imaging examination, and a diagnosis of right breast cancer(cT2N0M0, Stage ⅡA)was made. The subtype was Luminal type with weakly positive ER. Preoperative chemotherapy was considered, but the patient underwent partial mastectomy and sentinel node biopsy. Histopathologically, the tumor cells were irregular with spindle-shaped nuclei, and the diagnosis of metaplastic breast cancer was made. The postoperative diagnosis was pT2, N0(sn), M0, Stage ⅡA. Metaplastic breast cancer is rare, accounting for approximately 1% of all malignant mammary tumors, and is considered to be a disease with a poor prognosis. There are reports that chemotherapy is ineffective, and there is no established treatment for this disease. We report the treatment course of this case with some discussion of the literature.

In March 2023, Trastuzumab deruxtecan(T-DXd)was added for the treatment of inoperable or recurrent breast cancer with low HER2 expression who has a history of chemotherapy. The patient was a 61-year-old woman who had undergone surgery for bilateral breast cancer, and was diagnosed with Stage ⅡA triple negative(HER2-IHC score 0)on the right and non-invasive ductal carcinoma of the breast on the left. Biopsy from metastases was triple-negative(HER2-IHC score 0, PD-L1 negative). Exacerbation of skin metastases was observed despite repeated regimen changes 3rd skin biopsy was diagnosed with low expression of HER2 for the first time, and T-DXd was started. The therapeutic effect of T-DXd was temporarily observed, such as a decrease in tumor markers. It is useful to repeatedly collect tissues from primary and metastatic lesions and re-evaluate biomarkers in order to develop an appropriate treatment plan.

A 56-year-old female was referred to our hospital for further examination and treatment because of her increasing right axillary mass for 1 year. Based on histological examination diagnosing the right axillary mass as carcinoma and radiological examination showing no evidence of distal metastasis, we decided to perform a radical resection. The patient underwent right axillary mass resection, axillary lymph node dissection, and latissimus dorsi musculocutaneous flap reconstruction. Right-sided breast cancer was diagnosed based on histopathological examination. The diagnosis was similar to that of breast cancer. The patient underwent adjunctive chemotherapy and is currently undergoing endocrine therapy. The incidence of accessory breast cancer is 0.2-0.6% among all breast cancers and is relatively rare. Postoperative adjuvant pharmacotherapy has no consensus. However, endocrine therapy, chemotherapy, and molecular target therapy are performed in cases of conventional breast cancer. Herein, we describe a case of right axillary accessory breast cancer with skin invasion successfully treated with radical resection.

The patient is a 51-year-old female with comorbidity of schizophrenia. At the age of 41, she underwent surgery for bilateral breast cancer. Both sides were of the Luminal type, with Stage ⅢC on the right and Stage 0 on the left. She started to receive adjuvant chemotherapy but it was interrupted according to her wish. Approximately 3 years ago, she developed carcinomatous pleuritis, multiple liver metastases, and bone metastases. Despite receiving chemotherapy, her condition worsened. A BRACAnalysis revealed pathogenic variants in BRCA2. Upon initiating treatment with olaparib, both her liver metastases and carcinomatous pleuritis have shown reductions, and her tumor markers have also started to decline. Approximately 5 months after treatment with olaparib, it has been possible to continue without any side effects. Olaparib has shown good results in patients with germline BRCA1/2 mutation-positive HER2-negative advanced/recurrent breast cancer who have a history of receiving anthracycline and taxane-based therapies. It was considered that even in recurrent breast cancer, the presence or absence of BRCA1/2 mutations should be actively sought even in advanced cases, and the administration of olaparib should be considered.

The study subjects consisted of 54 patients with inoperable or recurrent breast cancer who were administered a combination of palbociclib plus endocrine therapy. We examined the onset of neutropenia during the first course of treatment and evaluated the influence that various risk factors had on treatment continuity. Patients with neutropenia Grade≥3 had significantly lower relative dose intensity(RDI) values during the first course of treatment than did patients with neutropenia Grade ≤2. Patients with neutropenia Grade≥3 showed significantly longer treatment to failure than did patients with neutropenia Grade≤2. These results suggest that the degree of neutropenia during the first course of treatment might contribute to treatment continuity and that it is important to improve the curative effect by maintaining appropriate RDI and by continuously administering palbociclib in patients with neutropenia Grade≥3.

Objectives　The purpose of this study was to identify elements that cancer peer supporters working in Japanese hospitals consider to be important in helping them perform their role.Methods　A qualitative inductive research was conducted. Introductions to potential participants were obtained from a patient association that agreed to help with the study. Interviews were conducted from July through October 2014, using an interview guide, with cancer peer supporters who consented to participate in the study. Elements they perceived as important to the performance of their role were inductively identified from interview transcripts. The analysis consisted of coding phrases in the text and organizing the codes generated into categories and subcategories.Results　The study participants consisted of 10 cancer peer supporters (2 men, 8 women), in the age range of 40 to 70 years, who provided private counseling and worked in cancer support groups in hospitals. The analysis generated 129 codes, 11 subcategories, and 5 categories. These 5 categories were: [1.Help service users determine their own paths by listening to and accepting what they say with a non-judgmental attitude]; [2.Offer a perspective distinct from that of the medical staff]; [3.Think of ways to achieve a good balance between one's personal life and cancer peer support work while maintaining a stable state of mind]; [4.Ensure that one maintains the necessary knowledge and skills, and continually improve oneself]; and [5.Build relationships of trust with medical staff and the hospital].Conclusion　Category [1] and category [2] were behaviors regarded as important when interacting with users. They were "matters regarded as important during the practice of cancer peer support working for users," and comprised the core of matters that were regarded as important. Next, as for matters regarded as important in relation to the supporters themselves, the categories were [3] and [4]. These were "matters regarded as important for continuity and qualitative improvement of cancer peer support working." Areas that call for improvement in relation to this are preparation of support systems and learning environments. Another matter regarded as important was category [5]. This was a "matter regarded as important to smoothen and facilitate cancer peer support working." Placing importance on relationships of trust with medical staff and hospitals could be considered a distinctive characteristic of cancer peer supporters working at hospitals.

Aims: There have been some reports about the efficacy of trauma team activation. In November 2015, we implemented a trauma call system, wherein a general surgeon, neurosurgeon, and orthopedic surgeon are called to the emergency department when severe trauma patients are transferred to our emergency department. In this study, we evaluated the efficacy of this trauma call system., Methods: The purpose of the present study was to evaluate the efficacy of a trauma call system for trauma cases with an Injury Severity Score ≥16. We compared the mortality of trauma cases and the time from arrival to the start of the examination and intervention before and after implementing this trauma call system., Results: There was no significant difference in the mortality rates before and after the implementation of the trauma call system. The median time from arrival to the start of contrast-enhanced computed tomography or transcatheter arterial embolization improved from 54 to 19 min ( P  = 0.015) and 171 to 84 min ( P  = 0.030), respectively, after the implementation of the trauma call system., Conclusion: Our trauma call system did not significantly improve the mortality of trauma patients with an Injury Severity Score ≥16. However, it was effective for reducing the time from the arrival to the start of contrast-enhanced computed tomography or transcatheter arterial embolization.

Rationale: Kawasaki disease (KD) is an acute febrile illness predominantly affecting children less than 5 years of age and characterized by systemic inflammation in all medium-sized arteries. Adult-onset KD (AKD) is rare with only 105 case reports published. Recently, the efficacy of infliximab (IFX) for patients with refractory KD has been demonstrated., Patient Concerns: A previously healthy 24-year-old man was admitted because of a persistent fever, and elevated serum level of AST, ALT, LDH, and CRP., Diagnosis: The patients met the diagnostic criteria for KD based on the findings of persistent fever, polymorphous exanthema, unilateral cervical lymphadenopathy, non-purulent palpebral conjunctivitis and membranous desquamation. Echocardiogram revealed the dilatation at the proximal sites of the right coronary artery (7.9 mm) and left anterior descending artery (5 mm). The patient was treated with high-dose intravenous immunoglobulin (1 g/kg/day for 2 days) and ASA (100 mg daily). However, his fever and arthralgia persisted., Interventions: He was administered single 5 mg/kg doses of IFX., Outcomes: He became afebrile the next day and his arthralgia improved., Lessons: We report the first case of administration of IFX in a patient with AKD refractory to intravenous immunoglobulin (IVIG), and successful reduction of systemic inflammation. However, the effectiveness of IFX in the regression of coronary artery aneurysm remains to be determined.

Objectives　This research aims to ascertain the kinds of support cancer peer supporters at medical institutions currently receive and the support they actually need.Methods　Participants in the study were ten cancer peer supporters who were recommended by a patient association and who agreed to participate in the study. Using a qualitative descriptive method, interviews were conducted using an interview guide from July to October 2014. Codes were extracted from the interview transcript and divided into categories and subcategories. Accuracy was ensured by checking the data with the participants. The study was conducted with the approval of the Ethics Committee of Mejiro University.Results　Research participants consisted of two men and eight women aged forty to seventy years, who were private counselors, telephone counselors, or members of cancer salons at hospitals. Four categories were generated on the basis of the support that cancer peer supporters are currently receiving: mutual learning and support among peer supporters, learning and encouragement from patients, self-improvement in peer supporters, and cooperation with hospitals and the government. Seven categories were generated on the basis of the support that cancer peer supporters need: opportunities for peer supporters to learn from and support each other, further studies on cancer peer support, reliable and up-to-date information, society's understanding and cooperation regarding cancer, financial support for support activities and patient associations, improvement of cancer peer support system, and quality assurance of peer supporter training courses.Conclusion　Cancer peer supporters were supporting each other, gaining encouragement from patients, improving themselves, and gaining support from others. However, they also needed additional assistance such as opportunities for supporters to learn from and support each other and reliable and up-to-date information. Moreover, peer supporters needed advice and emotional support from hospital staff as they experienced difficulties during consultation. Various other types of support were needed, such as society's understanding and cooperation regarding cancer, financial support for support activities and patient associations, institutionalization of peer supporter placement in hospitals, and quality assurance of peer supporter training courses. Overall, support for cancer peer supporters is still not sufficient; thus, further help is necessary.

Acidification of the lumen of intracellular organelles is important for post-transcriptional processing, endosomal maturation, receptor recycling, and vesicle trafficking, being regulated by an intricate balance between H+ influx through vacuolar-type H+-ATPase and efflux through ion channels and transporters, such as the Na+/H+ exchanger (NHE). The eukaryotic NHE family comprises two major subgroups, one residing in the plasma membrane and the other in intracellular organelles. While mammalian intracellular NHE isoforms are localized to various organelles, including the mid-trans-Golgi compartments, early and late endosomes, and recycling endosomes, Nhx1p, the sole NHE in yeast, has been reported to be localized predominantly to the late endosomal/prevacuolar compartment. Here, using live cell imaging, we demonstrated that Nhx1p is localized to the trans-Golgi network compartments, late endosomes, and recycling endosomes, similar to mammalian intracellular NHE isoforms. Loss of Nhx1p led to accumulation of components of the retromer and endosomal sorting complex required for transport complexes, but not trans-Golgi compartments, in aberrant prevacuolar compartments. Importantly, Nhx1p was also required for recycling of the plasma membrane vesicle SNAP receptor Snc1p. These observations suggest that Nhx1p plays an important role in regulation of the luminal pH of various intracellular organelles, and that this regulation is critical for the protein recycling pathway as well as the endocytic pathway., (Copyright © 2011 Elsevier B.V. All rights reserved.)

The aim of this study was to clarify the factors influencing the dietary behavior of patients with diabetic nephropathy. One hundred twenty-two patients with type 2 diabetes were recruited from the outpatients of Okayama University Hospital in Okayama, Japan. We performed a cross-sectional study using a questionnaire including 206 items among 18 categories as follows: background factors, coping behavior (coping scale), degree of uncertainty in illness (uncertainty scale), and dietary behavior. The data were analyzed by correlation analysis, t-test, one-way analysis of variance, Pearson correlation analysis, and multiple regression analysis. We found that those patients with microalbuminuria alone tended to recognize more mild about their kidney status than those with macroalbuminuria and chronic renal failure. We also found that common factors influencing the dietary behavior of diabetic patients with and without nephropathy are as follows: 1. coping with the problem (beta = 0.342, p < 0.01); 2. anxiety about prognosis (beta = -0.344, p < 0.01); 3. sex (beta = -0.234, p < 0.05); 4. uncertainty regarding treatment (beta = 0.377, p < 0.01); 5. negative coping (beta = -0.354, p< 0.01); and 6. employment status (beta = 0.367, p < 0.01). Coping and uncertainty in illness had a significant relation to positive support and lack of support. To maintain appropriate dietary behavior in diabetic patients, medical staff need to determine what the social supports are important for the patient, and also to ensure good communication among healthcare personnel as well as positive support for patients and families.

Foreign workers face many difficulties in obtaining health care in Japan. To clarify the sociodemographic factors that determine health care access for foreign workers, qualitative and quantitative studies were conducted. The respondents of this study were Filipino workers, who are one of the major ethnic groups in Japan. Quantitative survey (N = 276) was performed by delivering questionnaires to attendants at mass at 12 churches in the Greater Tokyo Area. To obtain a clearer understanding of what factors are associated with health care access, logistic regression analysis was conducted. Independent variables were gender, age, length of stay in Japan, type of job in Japan, whether they sent money periodically to family, Japanese proficiency, whether they were uninsured, and whether they belonged to an informational and/or tangible network. The independent variables were standardized before the analysis to isolate the contribution of each variable. The logistic regression results indicate that having support from a network (either informational or tangible or both) has the largest contribution to the healthcare access (beta = .780, P < 0.01), followed by length of stay in Japan (beta = .534, P < 0.01) and being female (beta = .356, P < 0.05). There was no significant association between Japanese proficiency and health care access. This study indicates that providing a social support network is an effective method of helping foreign workers to overcome the obstacles preventing them from obtaining health care access. This applies particularly to women and to those who are new comers to Japan.

Clients taking HIV antibody tests at public health centers (PHCs) in Japan were surveyed in autumn of 1995 centered on 17 PHCs selected by a snow-ball sampling method in domestic PHCs. The anonymous self-administered questionnaires were given out by PHC's medical doctors or public health nurses after receiving informed consent of this survey's objectives following HIV post-test counseling. A total of 250 questionnaires were collected (71.8%). Valid questionnaires were 233 (67.0%) and 62.7% (146 people) were male, 37.3% (87 people) were female, with differences in mean age by sex being significant (p < .001). The greatest motivating factor for getting HIV testing was concerning secondary infection to partners and extreme anxiety relating to one's own possible infection. This motivating factor was greater than having experienced previous HIV infectious high-risk behavior (i.e. condomless sex). Repeat (more than twice) visitors totaled 49 (21.0%), with 75% having experienced HIV infectious high-risk behavior since the last HIV test. "Having being advised or having received from partners or friends" affected decision making to get tested. About half of subjects vacillated before coming to the PHC for taking anonymous the HIV antibody test. Through multiple-logistic regression analysis factors causing vacillation were: greater self-awareness of possibility of having HIV infection and the fact that HIV infected people must retire from their work (or studies) despite their current health condition being fine. While HIV medical/clinical treatment progress continues, the stigma toward HIV/AIDS and the resulting discrimination is not changing in terms of the general citizen's knowledge and attitudes. This result will likely curtail HIV antibody testing behavior.

In order to highlight factors leading to problems in parenting, a survey of 450 mothers with children aged three or younger was conducted. Data from 370 respondents who completed the questionnaire were used for the analysis. The results were as follows: 1) From factor analysis, a concept of parenting-strain was formed comprising: a) anxiety about children and child-raising; b) irritation towards the children; c) feelings of burden or denial; d) feelings of discontent or insufficiency. 2) The results from multiple regression analysis were as follows: a) Feelings of burder or denial, feelings of discontent or insufficiency in working mothers were significantly lower than those in the housewives. b) Anxiety about children and child-raising, irritation towards the children, and feelings of discontent or insufficiency were negatively associated with a positive image towards the family where the mothers themselves had been raised. c) Received support from the husband lowered feelings of burden or denial, feelings of discontent or insufficiency with statistical significance.

To estimate the change in health-promoting activities among elderly people affected by community organizing environments, we examined the relationships among health-promoting activity, going out and perceived transportation problems. A questionnaire was sent to 567 men and women aged 60 years old and over living in a small town in Kanagawa prefecture between July 27 and August 12 in 1995. The questionnaire consisted of 42 items concerning health, social ability of daily living (including the desire to participate in social activities), attitude toward health-promoting activities, and perceived transportation problems. A total of 397 people responded and the answers from 368 people were analyzed after excluding responses from those unable to go out by themselves and those who seldom went out. Single regression analysis and multiregression analysis were used with the sum of responses for each question representing factors related to health-promoting behavior. A probability level of 5 percent was considered significant. The reliability of the data was examined with Cronbach's coefficient alpha. Coefficients of determination for health promoting behavior were 42% in men and 48% in women. In both men and women, age, social ability of daily living and attitudes toward health-promoting behavior were related to health-promoting activity. In women, more actively going out was related to more active health-promoting activity. Higher perception of transportation problems had a negative effect on going out. In men, neither of these factors had any relationship with health-promoting activity. In men, poorer health conditions were related to more active health-promoting activity, but in women, there was no relationship between those factors. These results show that there are gender differences in the relationships among the factors related to health-promoting activities in elderly people. In women, a higher perception of transportation problems restrained actively going out and health-promoting activity.

The purposes of this study were to estimate the prevalence of drug use, to examine the correlation between drug use and drinking/smoking in Japan, and to test a developmental model of adolescents' drug use based on three basic theories of deviance: Strain, Social control, and Differential association. The survey was conducted from April to May, 1996, in 14 public high schools in Tokyo, using anonymous self-reporting. A total of 4,171 (99.45%) students responded to our questionnaire. It included central concept items in the three deviant theories, beliefs about the ill effects of drugs, sex, grades, etc. The following findings were obtained: 1) Among the subjects, 255 students (6.1%) reported drug use within the past year. Of these drug users, 73.3% used drugs soon after being "tempted" by friends. Responding to "When was it.", as a first year junior high school was the most common first experience, and the next most common was during the sixth year of elementary school. 2) Drinking and smoking appeared to be gateway drugs for adolescents in Japan as has been shown in the United States. 3) Multiple regression and logistic multiple regression analyses suggested that differential association variables were far more powerful predictors of adolescent drinking, smoking and drug use than either the control or strain variables. Results provided modest support for the Differential Association Theory as an explanation of drug use. 4) LISREL's goodness-of-fit statistic indicated a much better fit between the model and the data. (CN: 282, GFI: 0.967, AGFI: 0.941). These findings show two processes by which adolescents become involved in drug use. Strain and Social Control do not directly affect drug use. However, Social Control is important because it works indirectly, through Differential Association resulting in drug use. Second, though weaker, Differential Association appears to lead to dangerous beliefs in drug use followed by actual drug use.

We examined sex and age differences in health promotion behavior, participation in social activities, and perceived transportation problems of elderly people living in a small town far from the nearest train station. A questionnaire was sent to 567 men and women aged 60 years old and over living in a small town in Kanagawa prefecture. A total of 397 people responded. The questionnaire consisted of 42 questions concerning their health, daily activities (including their desire to participate in social activities), the frequency with which they went out, their attitude toward health promotion behavior, and their perceived transportation problems. They were also asked why they acted in ways that promote their health. The reliability of the data was examined with the coefficient kappa and with Cronbach's alpha. Chi-squared tests were used to examine sex and age differences. Women reported more health problems and more transportation problems, and said that they were less active in social activities than did men. Women become inactive in daily life with increasing age earlier than do men. Contrary to our hypothesis, women tended to have medical examinations more often than did men. More women under 75 years old than men answered that they acted in ways that promote their health because they did not want to give others trouble when they became ill, fewer women than men said that they wanted to enjoy their intended activities. These results seem to show that women lead less active social lives than do men and have less motivation for promoting their health because of a desire to lead an active life.

A person is believed to choose a health related behavioral alternative based on his/her perception of the health risk. This survey tried to clarify the structure of perceptions relating to risk of death, which seems to be the most fundamental among various health risks. A survey was performed in 1995 on 350 employees of two major companies. Subjects were shown two paired causes of death and asked which diseases caused deaths more frequently in the Japanese. Diseases included cancer, cerebral apoplexy, heart disease, traffic accident, tuberculosis, and lung cancer. The results obtained were as follows: 1. Generally, the order of perceived risk for each cause of death was similar to the real death numbers. 2. While traffic accidents tended to be overestimated for its risk, the risk perception for heart disease and cancer tended to be underestimated. 3. Young people tended to overestimate the risk of traffic accidents more than older people. Based on these results, it is suggested that people tend to overestimate current risks, and to underestimate future risks. This may contribute to the improvement of risk communication between health care providers and residents/patients.

Social activities such as visiting friends or participating in community groups have been shown to correlate positively with active health promotion, more frequent physical exercise, and maintenance of activities of daily living in older people. Social inactivity may result from personal factors such as physical condition and from environmental factors such as limited means of transportation. To study the latter factors, we focused on perceived transportation difficulties and on the influence of those perceptions on the daily activities of elderly people. We sought to test the hypothesis that perceived transportation problems restrict health promotion or social activities and accelerate the decline in activities of daily living, and also to determine how transportation can be improved. A questionnaire was sent to 238 people (a fifth of the population) aged 60 years or older who were living in a small town in Kanagawa prefecture. Buses are the principal mode of public transportation from their residences to the nearest train station and the trip takes about 50 minutes. Responses were received from 190 persons (83.3%, excluding those who had died, moved, or were in the hospital). Of the respondents, 166 (74 men and 92 women) went out by themselves and their responses were subjected to logistic regression analysis. The results revealed the following points. (1) For both men and women, riding buses to the hospital was associated with a greater perception of problems with respect to convenience, physical exertion, or anxiety when crossing the road. (2) Among women, greater perceived inconvenience of transportation correlated with a lower frequency of going out for daily shopping; a higher frequency of visiting friends correlated with greater perception of physical exertion. (3) Among women, the main desire was to visit friends. Men indicated that they wanted to be more active in hobbies. The women indicated that the main reason they do not fulfill their desires was that transportation is inconvenient. These findings indicate that perceived transportation problems can prevent elderly people, especially women, from going out for health promotion and social activities. This indicates that to support social activities of elderly people, the means of transportation should be made more convenient and more physically accessible, and local circumstances should be taken into consideration.

To study travel outside the home by elderly people and perceived problems with such travel, a questionnaire was sent to 238 men and women aged 60-year-old and over living in a small town in Kanagawa prefecture. Public transportation in this town consists mainly of buses, and the bus ride from the nearest train station takes about 50 minutes. A total of 190 people responded (83.3%, after exclusion of those who had died, moved away, or were in the hospital). Of those 190 people, 166 (74 men and 92 women) went out by themselves and their responses were analyzed. About 50% of both men and women said that they go to the hospital once or twice a month and go out for hobbies less than several times a year. The means of transportation differed according to sex and age: 80% of men in their 60s said that they drive alone, but many men in their 70s and older said that they ride buses or walk. Women in all the age studied said that they ride buses or drive with others. More than 50% of men and women reported problems with transportation: men reported anxiety about driving alone and women reported difficulties with the poor means of transportation or when walking upstairs or uphill. Many men and women in their 80s said that they would rather not be driven places by others or be helped by others while riding trains or buses. These findings show the patterns of travel outside the home by elderly people of different ages, and the problems these people perceive with regard to various modes of transportation. They should be useful in the design of transportation suitable to older people.

In Japan, about 97% of diabetic patients suffer from non-insulin dependent diabetes. Because of its insidious onset, public education with regard to diabetes is very important. According to a survey in 1989, approximately 87% of diabetic patients were treated at hospitals. Considering the difficulty of organizing an educational team targetting small clinics, diabetes education should be provided with close cooperation between hospitals and local clinics. Since 1967, National Diabetes Week is annually held in the second week of November; in more than 150 cities and towns, lecture meetings, screening tests and consultation by physicians and health professionals are performed under the sponsorship of the Japan Diabetes Society and the Japan Association of Diabetes Care and Education. The Japan Diabetes Society has edited 'Diabetes Treatment Guide' and 'Meal Exchange List' since 1961 to provide the minimum requirement of knowledge and skill in the diabetes treatment regimen. More than 850 hospitals and clinics now have a particular educational program. Admission for the education of diabetic patients is provided by 366 hospitals. In 1991, summer camps for children were held at 37 sites, where about 1200 patients participated. For the training of the educators, the Japan Diabetes Society and several other organizations offer many lecture meetings and courses with experiential format; the curriculum for diabetes educators is expected to be much improved in the near future.

The relationship between the type of job and/or position of male white-collar workers to their working life, life style, health behavior, and health condition was examined based on data obtained from a survey of 1129 male workers in a major computer manufacturing company in 1988. The results were as follows: 1. Work, life style, health behavior, and health condition of male white-collar workers are strongly affected by type of job and position when adjusted for education, income, and age. 2. Workers in the sales department and engineering department appeared to have the most problems associated with working life, life style, health behavior, and health condition. Workers in sales, especially, displayed Type A behavior and their job was characterized by a lot of business transactions in a working environment that requires them to work until late at night. This leads to an irregular diet, late bed time, and makes their family relationships worse. Workers in the engineering department had work loads that were heavy because they have the longest working hours, and the content of their jobs is a mixture of both research and sales. Consequently their health is not good. On the other hands, workers in the laboratory had the best situation, and with general workers about average in terms of working life, life style, health behavior, and the state of health. 3. The department heads have the best conditions of life and health over all, except for their diet. The chiefs of sections are generally in the middle between the department heads and ordinary workers in terms of life and health. They drink and smoke heavily and show Type A behavior characteristics. Ordinary workers appear to have the most problems in working life, life style, health behavior, and health condition. From these results it may be concluded that this is associated with the difference in work type and position of these workers compared to managerial class and also with a low level of morale.