Mixed forests comprising multiple tree species with contrasting crown architectures, leaf phenologies, and photosynthetic activity, tend to have high ecosystem productivity. We propose that in such forests, differentiation among coexisting species in their spatial and temporal strategies for light interception, results in complementary use of light. Spatial differentiation among coexisting tree species occurs as a result of adaptation of crown architecture and shoot/leaf morphology to the spatially variable light conditions of the canopy, sub-canopy, and understory. Temporal differentiation occurs as a result of variation in leaf phenology and photosynthetic activity. The arrangement of leaves in both space and time is an important aspect of plant strategies for light interception and determines photosynthetic carbon gain of the plant canopy. For example, at the shoot level, morphological and phenological differentiation between long and short shoots reflects their respective shoot functions, indicating that spatial and temporal strategies for light interception are linked. Complementary use of light is a consequence of the spatiotemporal differentiation in light interception among coexisting species. Because coexisting species may show differentiation in strategies for resource acquisition (functional diversification) or convergence with respect to some limiting resource (functional convergence), the relative importance of various crown functions and their contribution to growth and survival of individuals need to be evaluated quantitatively and compared among coexisting species.

The objective of our study was to clarify the impact of adverse events associated with the initial course of outpatient chemotherapy on the quality of life of breast cancer patients. We conducted a survey to assess the quality of life in 48 breast cancer patients before and after receiving their first course of outpatient chemotherapy at Gifu Municipal Hospital. Patients completed the European Quality of Life 5 Dimensions and Quality of Life Questionnaire for Cancer Patients Treated with Anticancer Drugs before and after 1 course of outpatient chemotherapy. European Quality of Life 5 Dimensions utility value and Quality of Life Questionnaire for Cancer Patients Treated with Anticancer Drugs total score decreased significantly after chemotherapy (p<0.001 and p = 0.018, respectively). The mean scores for the activity, physical condition, and psychological condition subscales of the Quality of Life Questionnaire for Cancer Patients Treated with Anticancer Drugs decreased significantly after chemotherapy (p = 0.003, p<0.001, and p = 0.032, respectively), whereas the social relationships score increased significantly (p<0.001). Furthermore, in the evaluation of quality of life according to individual adverse events, the decrease in quality of life after chemotherapy in terms of the European Quality of Life 5 Dimensions utility value and the Quality of Life Questionnaire for Cancer Patients Treated with Anticancer Drugs total score was greater in anorexic patients than in non-anorexic patients (p = 0.009 and p<0.001, respectively). This suggests that anorexia greatly reduces quality of life. Our findings reveal that anticancer drug-related adverse events, particularly anorexia, reduce overall quality of life following the first course of outpatient chemotherapy in current breast cancer patients. These findings are extremely useful and important in understanding the impact of anticancer drug-related adverse events on quality of life.

In the field of occupational health services, productivity loss can be expressed by absenteeism (i.e., employees being absent from work and taking leave due to health problems) and presenteeism (i.e., a reduction in the ability to perform one’s tasks at work). Similar to absenteeism, it is important to assess presenteeism because it can severely reduce productivity. Despite numerous reports about the impact of disease and medical treatments on presenteeism, there is a lack of data regarding the influence of medication side effects. In this study, a prospective analysis was conducted via questionnaire survey to clarify the influence of the side effects of anticancer drugs on presenteeism in workers receiving outpatient chemotherapy for breast cancer. Between December 2012 and November 2013, the influence of side effects on the quality of life, absenteeism, and presenteeism was investigated via a questionnaire conducted before and after 1 course of chemotherapy in 19 currently employed breast cancer patients receiving outpatient chemotherapy for the first time at Gifu Municipal Hospital, Japan. The rate of absenteeism was 24.7 %, resulting in financial losses of 2002 yen/day (national statistical data) and 881 yen/day (our questionnaire data). The rate of presenteeism was 33.7 %, resulting in financial losses of 1354 yen/day (national statistical data) and 1263 yen/day (our questionnaire data). Furthermore, a significant positive correlation was observed between absenteeism and presenteeism (r = 0.687, p = 0.001), suggesting that the productivity losses associated with presenteeism due to the side effects of anticancer drugs in breast cancer patients are large and similar to that associated with absenteeism in these patients. Our results may be useful for improving the occupational health of workers receiving chemotherapy for cancer.

Information on ethical drugs is managed by medication notebooks but information on over-the-counter (OTC) drugs and dietary supplements is hardly covered. Therefore, it is important to understand the awareness about medicationnotebook use on the purchase of OTC drugs and dietary supplements and to take measures to improve awareness. In our study, in order to understand the awareness and situation of medication-notebook use and clarify the effect of group instructions for improving the awareness, we gave a lecture about medication-notebook use and investigated items such as awareness about medication notebooks before and after the lecture. We conducted a questionnaire survey in 80 participants in a public lecture in Gifu Municipal Hospital on April 19, 2014. The lecture explained about medication notebooks and their usefulness for ethical drugs, OTC drugs and dietary supplements, etc. The items of the questionnaire were, for example, awareness about medication-notebook use for ethical drugs, OTC drugs and dietary supplements (Likert scale, evaluation 1-5). The recovery rate of questionnaires was 80.0％. Regarding the awareness about medication-notebook use for OTC drugs and dietary supplements, the rates of evaluations 4 and 5 before the lecture were low (30-50％) regardless of ways of purchasing them, but the evaluations increased significantly after the lecture (P < 0.05). Our study clarified that awareness about using medication-notebooks for OTC drugs and dietary supplements is insufficient at present and suggested that group instructions about medication-notebook use improve awareness.

The merit of outpatient chemotherapy is that patients can continue their daily life in their house and at their job, while the demerit is that patients sometimes experience severe adverse effect because they cannot prevent and treat adverse effects in their house. Therefore, investigated the impact of outpatient chemotherapy-related adverse effects on patient's daily life and work productivity. Subjects were 48 breast cancer patients receiving first outpatient chemotherapy in Gifu Municipal Hospital between December 2012 and November 2013. We performed a questionnaire survey on quality of life (EQ-5D and QOL-ACD), adverse effects and time loss before the 1st and the 2nd course. No significant decrease in EQ-5D utility was observed, but a significant decrease in QOL-ACD score was observed. The average hour when an adverse effect influenced patient's daily life was 3.63 hours/day, and the average work productivity was 2,359 yen/ day. The work productivity in the patients who answered "I suppose that I could have prevented this adverse effect if I had taken the drugs as the doctor directed." were 1,545 yen/day in malaise and tiredness and 534 yen/day in nausea and vomiting. Regarding "I suppose that I could have prevented this adverse effect if I had been more careful in my daily life.", the work productivity were 1,883 yen/day and 1,827 yen/day, respectively. The results suggest that the loss of work productivity caused by adverse effects would decrease if pharmacists instruct patients and improve their adherence, then prevent the adverse effects.