X-linked Severe Combined Immunodeficiency Syndrome: The First Korean Case with gamma c Chain Gene Mutation and Subsequent Genetic Counseling

X-linked severe combined immunodeficiency (X-SCID) is a rare, life-threatening immune disorder, caused by mutations in the gamma c chain gene, which encodes an essential component of the cytokine receptors for interleukin-2 (IL-2), IL-4, IL-7, IL-9, IL-15, and IL-21. A 13-month-old boy with recurrent infections who had reduced serum immunoglobulin levels and decreased numbers of CD3, CD16/56 cells was evaluated for gamma c chain gene mutation and protein expression. The patient had a C-to-T point mutation at nucleotide position 690, one of the hot spots, resulting in a single amino acid substitution of cysteine for arginine (R226C), as determined by direct sequencing and PCR-RFLP. The patient's mother was a heterozygous carrier. Percutaneous umbilical cord blood sampling was performed at the 6-month of gestation in a subsequent pregnancy. As the immunophenotype of the fetus showed an identical pattern, the pregnancy was terminated and genetic analysis of the abortus confirmed recurrence. This is the first report of the molecular diagnosis of X-SCID in Korea. Genetic analysis of the gamma c chain gene is useful for definite diagnosis and genetic counseling for X-SCID.

Housing Projects for Comfortable and Independent Life of Aged People. A Report Concerning Housing with Services for Aged People / 日本農村医学会雑誌

In Japan, the number of people 65 and over is increasing while the number of children is decreasing. A greater number of senior citizens live by themselves or husband and wife alone than before.<BR>To realize comfortable and independent life for aged people, it is important to prepare housing and environment which have special services for them.<BR>We would like to explain two housing projects which were planned and are being put into execution in Japan. One is ‘Silver Housing’ multiunit dwellings for the aged built by the Ministry of Construction and the Ministry of Health and Welfare since 1987. The other is ‘Silver Peer’ project which has been pushed forward by the Tokyo Metropolitan Government since 1987.

A Study on the Education Effects of Medical Team Care Practice at the University of Tsukuba: Analysis of Reports on the Practice / 医学教育

The need for medical team care is increasing because of advances in medical care and changing national needs. For more than 20 years medical students at the University of Tsukuba have participated in medical team care practice before bedside learning during the third trimester of their 4th year. The objective of this practice is to understand patients from the nurses' point of view and to learn cooperation between doctors and co-medical staff. We analyzed students reports to study what they had learned. A total of 326 items in 11 categories were specified in the free-response part of the reports. The largest category was “nursing/nurses” and the second largest was “communication/human relations.” The results show that the students learned points other than the General Instruction Objectives and that the practice was extremely effective.

Determination of Bone Mass for Diagnosis of Osteoporosis: Comparison of Computed X-Ray Densitometry(CXD) with Quantitative Computed Tomography(QCT) / 日本農村医学会雑誌

Measurement of bone mass (BM), especially in the lumbar vertebrae, is very important for diagnosis of osteoporosis. In this study, we compared BM values measured by computed X-ray densitometry (CXD) with those by quantitative computed tomography (QCT), and discussed differences between the two methods.<BR>The subjects were 90 women and 3 men, aged 42-86 years, who visited our outpatient department of osteoporosis. Metacarpal bone density (ΣGS/D) and metacarpal index (MCI) in the second metacarpal bone were measured by CXD. QCT was uesd for measurement of bone mineral density (BMD) in the lumbar trabecular bone, where pronounced osteoporotic changes occur early. The mineral values of L3 were expressed as mineral equivalent of CaCO<SUP>3</SUP> in mg/ cm<SUP>3</SUP>, and≤75 mg/cm<SUP>3</SUP> of L3 values were judged to be loss of lumbar BMD.<BR>There were negative correlations between age and ΣGS/D, MCI or L3 value, and positive correlations were found between ΣGS/D or MCI and L3 value. Based on the above criterion of lumbar BMD loss, sensitivity and specificity of ΣGS/D for lumbar bone loss were examined. If ΣGS /D of 2.30 (T score -2.7) was used as the cut-off point, the sensitivity was 69.8% and the specificity was 75.0%, and if ΣGS/D of 2.37 (T score -2.3) and 2.40 (T score -2.1) were employed, the sensitivity was 79.1% and 79.1%, while the specificity was 64.5% and 62.5%, respectively. We concluded that BM values of cortical bone and trabecular bone decrease with age, and that sensitivity and specificity of GS/D for diagnosis of lumbar BMD loss are not very high.

Towards the Completion of 'Fukushi no Mori'-The Comprehensive Health, Medical and Welfare System at Koga City / 日本農村医学会雑誌

Every local government in Japan is seeking to have an integrated health, medical and welfare system to take care of an increasing number of the elderly.<BR>An attempt to develop such a model system called ‘Fukushi no Mori’ was begun in 1987 in Koga City, Ibaraki Prefecture. It was not until 1993 that the land for the project was acquired and the final plans for the arrangement of facilities were drawn up. In March 1994 construction got under way.<BR>This paper discusses the strategies for developing an integrated health, medical and welfare system in this city. The results of a number of detailed research studies undertaken by the authors are also described and discussed.

Towards the Completion of 'Fukushi no Mori'-The Comprehensive Health, Medical and Welfare System at Koga City / 日本農村医学会雑誌

Every local government in Japan is seeking to have an integrated health, medical and welfare system to take care of an increasing number of the elderly.<BR>An attempt to develop such a model system called ‘Fukushi no Mori’ was begun in 1987 in Koga City, Ibaraki Prefecture. It was not until 1993 that the land for the project was acquired and the final plans for the arrangement of facilities were drawn up. In March 1994 construction got under way.<BR>This paper discusses the strategies for developing an integrated health, medical and welfare system in this city. The results of a number of detailed research studies undertaken by the authors are also described and discussed.

Towards the Completion of 'Fukushi no Mori'-The Comprehensive Health, Medical and Welfare System at Koga City / 日本農村医学会雑誌

Every local government in Japan is seeking to have an integrated health, medical and welfare system to take care of an increasing number of the elderly.<BR>An attempt to develop such a model system called ‘Fukushi no Mori’ was begun in 1987 in Koga City, Ibaraki Prefecture. It was not until 1993 that the land for the project was acquired and the final plans for the arrangement of facilities were drawn up. In March 1994 construction got under way.<BR>This paper discusses the strategies for developing an integrated health, medical and welfare system in this city. The results of a number of detailed research studies undertaken by the authors are also described and discussed.

Towards the Completion of 'Fukushi no Mori'-The Comprehensive Health, Medical and Welfare System at Koga City / 日本農村医学会雑誌

Every local government in Japan is seeking to have an integrated health, medical and welfare system to take care of an increasing number of the elderly.<BR>An attempt to develop such a model system called ‘Fukushi no Mori’ was begun in 1987 in Koga City, Ibaraki Prefecture. It was not until 1993 that the land for the project was acquired and the final plans for the arrangement of facilities were drawn up. In March 1994 construction got under way.<BR>This paper discusses the strategies for developing an integrated health, medical and welfare system in this city. The results of a number of detailed research studies undertaken by the authors are also described and discussed.

The evaluation of twelve years experiences of the practice of medical team care at the university of Tsukuba, school of medicine / 医学教育

For the purpose of learning the comprehensive medical team care. we tried for the fourth year medical students at University of Tsukuba to exercise the nursing service and the team care system in the Hospital of University of Tsukuba.<BR>These practice were already undergone during past twelve years.<BR>In this practice, students are expected to comprehend about the significance of team work in medical care, to understand the meaning of medical care, to learn especially the roles of nursing and rehabilitation medicine (in total medical care system), to practice in the work of nurses and co-medical workers for understanding their roles, to study the basic science and contribution in medical team care of rehabilitation medicine, to comprehend about the outline of the health, medical care system, and medical economics.<BR>As the items of this practical exercise, all students must work as follows:<BR>1. collection of venous blood and check of vital signs.<BR>2. practical work of nursing service.<BR>day time service: 8:00 a.m.-11:30 a.m.(fourtimes)<BR>1:00 p.m.-4:30 p.m.(once)<BR>early night service: 5:00 p.m.-0:00 a.m.(once)<BR>midnight service: 0:00 a.m.-8:30 a.m.(once)<BR>Moreover 15 corelative lectures are prepared.<BR>For these twelve years, we researched motivating effects and impression of this exercise about both medical students and nurses by method of using questionnaire. We hope to grow kindly doctors having the mind of humanity.

The role of the practice of medical team carc and introductory medical training system / 医学教育

This paper discussed the introductory medical training system and medical team care problems at University Hospital of Tsukuba.<BR>The characteristics of this training system are that the duration of training is the fourth year medical students at the University of Tsukuba and to exercise the roles of nursing service at University Hospital.<BR>In this practice, medical students are expected to comprehend about the significance of team work in medical care, to practice in the work of nurses and c-medical workers for learning their roles. We introduce our purpose and practice of this medical team care. Problems of this trial are discussed in this paper. But we have confirmed that this experimental. Trial is useful experience to all medical students and the items of this practical exercise are one of the most effective training method for them.

Public health activities for the prevention of cerebrovascular diseases at Oho-machi, Ibaraki / 日本農村医学会雑誌

With an aim at reducing the incidence of cerebral apoplexy to half in three years, the Institute of Community Medicine, the University of Tsukuba, worked out a community health program for the inhabitants of Oho-machi, a predominantly rural community in Ibaraki Prefecture.<BR>A cerebrovascular disease prevention council was set up in the town to map out plans to execute health care services. An expert committee was set up to formulate health examination standards and health guidance. The governance of the health grogram is to be transferred from the Institute to the town council.<BR>Initially, considerable effort was exerted to encourage inhabitants to participate in the mass health screening. With importance placed on livelihood and health guidance, effort was made to increase the efficiency as well as the quality of the self-governing health care delivery.<BR>As a result, the health examination attendance has been increased and health conditions improved remarkably. Particularly, the cardiovascular disease death rate has gone down ward among the inhabitants at the prime of life.

Studies on the Difference of the Roles of Two Tertiary Care Hospitals from the Aspects of Consulting Behaviours of Outpatients / 日本農村医学会雑誌

For the purpose of clarifying the different roles of two tertiary care hospitals, namely the Tsukuba University Hospital and Tsuchiura Kyodo Hospital, we researched for the consulting behaviours of out patients in these two hospitals.<BR>As Results:<BR>1) About the classification of the diseases and the morbidity rate, there was slight degree of differences between the out patients in these two hospitals.<BR>2) The motivations of consulting both of these two hospitals were seen in a large number the items of “confidence to the scientific medical arts” and “excellent medical instruments”.<BR>3) The majority of out patients of both hospitals take about within one hour coming to hospital, in spite of various transport methods.<BR>4) Specific functions and different roles were seen only a little between these two tertiary care hospitals in the same region.<BR>We hope to make more propaganda and education, not only to patients but also to medical staffs, concerning with the regional activities of comprehensive health and medical planning and resources.