Community discharge of patients with schizophrenia: a Japanese experience

In Japan, admission to a psychiatric facility for people with schizophrenia is usually for life. We developed a rehabilitation program aimed at discharging these patients into the Tokyo community. This paper describes the results for the 224 patients. Using an inpatient ward at the Tokyo Musashino Hospital, patients were enrolled in the program and subsequently discharged into the community with an assigned worker. The results indicate for the majority (79%) re-integration into the community was successful. The success of this program in a metropolitan city like Tokyo argues for the efficacy of such programs.     

Elder care in Japan

The social and health care issues surrounding the elderly in Japan have been described focussing on the long-term care issues and the LTCI System. Because the Japanese have traditionally held a strong sense of family, they have believed that the family should look after a family member. The burden of caregiving had become so serious to many families that the situation has been called "caregiving hell". In those situations, the LTCI System seems to be succeeding in releasing the families from the unbearable burden of caregiving. However, there are many problems associated with the LTCI System. The system adopted the social insurance system because of its clearly defined relationships between the provision of services and the insured persons' share of the costs of services. Keeping with the system's principle, the insured persons' rights must be respected and the system must continually be improved so that they could choose the necessary and the most appropriate services to meet their needs. Japan has been experiencing the aging of its society at an unprecedented rate, which no other nation in the world has experienced. The world is watching Japan with interest to see how it responds to the grave issues of an aged society. The necessary systems and services should not be provided because the funding is available. Rather, the funding should be arranged so that the necessary systems and services can be provided. It is said that some countries intend to study the merit of Japan's strong sense of family ties and to utilize the strength of family ties to enhance their elder care. Considering such an idea it is hoped that, with collective efforts, the health care and the social welfare services for the elderly in Japan will continue to improve in the future.     

Adenovirus-mediated gene transfer of ICOSIg fusion protein ameliorates ongoing experimental autoimmune myocarditis

Experimental autoimmune myocarditis (EAM) has been used as a model for human myocarditis. We previously demonstrated that blockade of B7/CD28 or CD40/CD40 ligand (CD40L) had a potential preventive effect on EAM, but less therapeutic effect on ongoing EAM. Thus, we searched for the involvement of other costimulatory molecules in EAM. We demonstrated the expression of inducible costimulator (ICOS)/ICOSL molecules in the lymph nodes, spleen, and heart in the EAM rat. We constructed adenovirus vectors containing ICOSIg (Adex1CAICOSIg) to achieve effective inhibition of ICOS/ICOSL interaction, and examined the effects of Adex1CAICOSIg on EAM. Adex1CAICOSIg treatment shortly after the immunization did not inhibit the onset and severity of EAM compared to control rats. On the other hand, delayed treatment with Adex1CAICOSIg significantly inhibited ongoing EAM. The survival rate in rats treated with Adex1CAICOSIg was significantly higher than that of the control group. Furthermore, the affected area ratio of the Adex1CAICOSIg treatment group was significantly lower than that of the control group. This study indicates that ICOS/ICOSL costimulation makes an important contribution to the progression of EAM and that the blockade of this pathway by gene transfer has therapeutic potential for ongoing autoimmune myocarditis.     

Musculoskeletal disorders among female nurses in a rural Japanese hospital

Abstract The present research investigated the prevalence of musculoskeletal disorders (MSD) among a previously understudied group of Asian nursing professionals in a rural setting. A total of 305 female nurses (84% response rate) were recruited from a university teaching hospital in Yamanashi prefecture, central Japan. Data were gathered by means of a self-reporting questionnaire. Lower back pain (LBP) was the most commonly reported MSD, affecting 59% of all nurses. This was followed by MSD of the shoulder (46.6%), neck (27.9%), knees (16.4%) and upper leg (11.8%). Working in the surgical department was shown to increase the risk of any MSD 2.7 times when compared to nurses in the other departments (odds ratio 2.7, 95% confidence interval 1.2–6.7, P = 0.0202). Overall, our study shows that MSD are reasonably common among registered nurses in a rural Japanese hospital. These staff may also be at greater risk of suffering MSD than their city-based nursing counterparts and foreign colleagues, particularly with respect to LBP.