Aim: To describe the current use of percutaneous endoscopic gastrostomy (PEG) in long-term care national health insurance facilities (special nursing homes for the elderly, health service facilities for the elderly, and long-term health care facilities), and assess whether its prevalence increased or not between 2007 and 2010. Methods: Based on data from the "Survey of Institutions and Establishments for Long-term Care" by the Ministry of Health, Labour and Welfare, we calculated the prevalence of residents with PEG in each type of long-term care facility in 2007 and 2010. Results: The prevalence of residents with PEG in 2007 versus 2010 was 5.8% versus 8.1% in special nursing homes for the elderly, 3.9% versus 5.9% in health service facilities for the elderly, and 18.4% versus 26.1% in long-term health care facilities. Among residents requiring level 3 or higher care, the prevalence of PEG increased in all three types of long-term care facility. Conclusion: From 2007 to 2010, the use of PEG increased among residents of long-term care facilities requiring level 3 or higher care.

Background: Helicobacter pylori (H. pylori) infection has been reported to be associated with cardiovascular risk factors by inducing chronic low-grade inflammation and by influencing endocrine and metabolic systems, as well as the immunological response evoked by the host. This study investigated the association between H. pylori infection and high density lipoprotein cholesterol (HDL-C) in Japanese subjects.
Methods: The study subjects were 2,632 (1,061 men and 1,571 women) living in rural areas in Japan. We checked H. pylori serum immunoglobulin G (IgG), HDL-C and other cardiovascular risk factors in 1999.
Results: The overall prevalence of H. pylori seropositivity was 53.5% and increased with age. The prevalence was higher among men (58.3%) than women (50.3%). H. pylori seropositive women were more associated with decreased HDL-C than seronegative subjects (58.1±13.6 vs. 60.5±14.7, p<0.01). Multiple linear regression analysis with H. pylori seropositivity, age, body mass index (BMI), fibrinogen, blood glucose, and smoking and alcohol habits demonstrated that H. pylori seropositivity was a significant predictor of decreased HDL-C in women. In addition, there was a linear decrease in HDL-C with increments in the value of H. pylori antibody titer as a continuous variable in women. This association remained in H. pylori seropositive women aged ≥50 years. Moreover, H. pylori seropositive women with BMI <22 were associated with decreased HDL-C, whereas the association was not significant in women with BMI ≥22.
Conclusions: We show that H. pylori seropositivity is associated with decreased HDL-C, especially in women with a lower BMI in rural areas of Japan.

Abstract
Objective : To investigate the causes of fever of inpatients hospitalized in the Department of General Practice at Jichi Medical University Hospital.
Methods : We reviewed all medical records of the patients hospitalized in the Department of General Practice at this hospital between April 2003 and March 2004. Patients were selected as the “febrile group” by following criteria, 1) body temperature exceeded 37.5°C on admission, 2) fever and fever of unknown origin (FUO) were included in the clinical problems, and the causes of fever were described.
Results : A total of 464 patients were hospitalized and 221 patients (47.6%) were categorized as the “febrile group”. The most common cause of fever was infection (67.4%), followed by malignant disease (4.1%), collagen disease (3.2%), miscellaneous diseases (10.4%). 26 patients were classified as fever of unknown origin (FUO). Among FUO patients, collagen disease was the most common cause (34.6%), and undiagnosed cases was 26.9% that was similar to past reports. Although the rates of malignant disease and collagen disease were about sixteen percent in each generation from thirties to fifties as the cause of fever, only one patient met the criteria of classical FUO.
Conclusions : The most common cause of fever was infection. Systematic survey including hospitalization is needed early in case an outpatient doesn't cure fever unexpectedly. Noninfectious inflammatory diseases emerge as an important category of the causative disease of FUO.

[Purpose] This report examines the immediate effect of acupuncture treatment for subjective symptoms in competitive sailors.
[Method] The investigation was performed in the conditioning room at the national sports festival. Acupuncture treatment was performed for lumbago (n=108), dorsal pain (n=72). Acupuncture treatment was performed only on the area where players complained of pain. The variety of chief complaints, number of chief com-plaints, and visual analog scale (VAS) score were used for the investigation. Significance of differences in VAS score was compared by t-test.
[Result] There were numerous chief complaints involving lumbago, followed in orderby dorsal pain, and othercomplaints. Acupuncture treatment decreased the VAS score fbr lumbago (n=108) from 52.3±215mm to 21. 5±16.4mm. Dorsal pain (n=72) was also decreased from 48.0±18.7mm to 18.5±15.2mm. These values were both significantly different at p<0.01.
[Discussion] Acupuncture treatment was effective for lumbago, and dorsal pain of competitive sailors. As a result, it was suggested that the acupuncture treatment is an effective condition adjustment methods.

Background: Chronic infections, such as Helicobacter pylori (H. pylori) and Chlamydophila pneumoniae (C. pneumoniae), are known to contribute to atherosclerosis. However, the relationship of the infections to cerebral infarction is still controversial. Methods: The Jichi Medical School (JMS) Cohort Study, a prospective population-based study, investigated the risk factors of cardiovascular disease in Japanese community-dwelling populations. In 1999, we measured serum H. pylori IgG, C. pneumoniae IgG and IgA levels in 2,632 subjects. Logistic regressions were used to analyze associations between H. pylori and C. pneumoniae seropositivities and cerebral infarction. Results: A total of 2,243 subjects were followed up and, during 10.7-years, 64 developed cerebral infarctions, whose prevalence of H. pylori IgG, C. pneumoniae IgG and IgA seropositivities were 51.6%, 71.9%, and 67.2%, respectively. Among seropositive subjects, adjusted odds ratios (ORs) for cerebral infarctions were 1.04 (95% confi dence interval (CI), 0.58-1.87, P=0.89), 2.02 (1.03-3.95, P=0.04), and 1.35 (0.73-2.49, P=0.34) respectively, after adjusting for sex, age, body mass index, total cholesterol, high-density lipoprotein cholesterol, fasting blood sugar, smoking, alcohol, and fi brinogen. C. pneumoniae IgG seropositivities in subjects aged > 65 years were associated with cerebral infarctions, whereas those in subjects aged < 65 years, were not. Conclusions: C. pneumoniae IgG was associated with cerebral infarction, C. pneumoniae IgA and H. pylori IgG were not.

Introduction : The appropriate size of the regional coverage area for primary care in Japan has been unclear. The aim of this study was to determine the geographical distribution of primary care clinics for elderly ambulatory diabetic patients.
Methods : Using an insurance claims database, we extracted data of patients aged 75 years and older requiring ambulatory diabetic care in May 2010 in Ibaraki prefecture. The geographical distance from each municipal office to the clinics was analyzed.
Results : A total of 17,717 data points were extracted from the database. Data points that could not be mapped due to coding errors were eliminated, resulting in 17,144 (96.8%) data points that were ultimately analyzed. The median [25th-75th percentile] geographical distance was 5.5 [2.3-9.9] km. The distance was not related to municipal population, aging rate, or area size.
Conclusion : The coverage area for diabetic care in this primary care setting was estimated. For most elderly ambulatory diabetic patients, clinics are distributed within a 10-km radius area. Further investigation is needed to clarify primary care coverage areas that result in the most efficient use of medical resources.

Objective: We investigated the relation between fasting insulin (FI) and risk of cerebral infarction in a Japanese general population. Methods: The subjects were 2,610 men and women without past history of stroke or myocardial infarction and under treatment for diabetes, examined between 1992 and 1995 as part of the Jichi Medical School Cohort Study. The FI level was measured once at the baseline. Subjects were divided into quintiles by FI levels, and Cox’s proportional hazard model was used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for cerebral infarction. Results: During an average of 11.1 years of follow-up, 87 participants developed cerebral infarction. Crude incidence rates of FI quintiles 1-5 were 4.69, 2.35, 1.85, 2.77 and 3.30 per 1,000 person-years, respectively. The multivariate-adjusted HRs for cerebral infarction were 2.33 (95% CI, 1.10 – 4.96) in quintile 1 (Q1), 1.25 (95% CI, 0.55 – 2.84) in Q2, 1.68 (95% CI, 0.76 – 3.70) in Q4 and 2.06 (95% CI, 0.94 – 4.47) in Q5, using Q3 as the reference. Conclusions: The lowest FI level was associated with increased risk of cerebral infarction and the association between FI and risk of cerebral infarction appeared to be a U-shaped relationship.

Objective : To analyze and reveal the contents of medical questionnaires distributed to nationwide general practice outpatients prior to their initial medical consultations.
Method : An observational study was conducted, based on questionnaire format. Sample questionnaires were collected from 85 hospitals registered with the Japan Primary Care Association.
Results : No standard format was found among the samples. A4 size forms (210 mm×297 mm) averaging 19.7 questions were in the majority, accounting for 68%. The distribution frequency of questionnaires reported by research cooperation centers listed 28 items (31.8%) concerning medical history, 19 items (21.6%) related to lifestyle, and 7 items (8.0%) referring to social and reproductive status.
Conclusion : This research assessed the qualitative value of medical questionnaires used in General Practice Clinics in Japan. The results indicate the nature of the medical information required by physicians prior to medical consultation.

PURPOSE: To examine the effects of conservative and surgical treatments for nocturnal leg cramps in patients with lumbar spinal stenosis (LSS). Nocturnal leg cramps is frequently observed in patients with peripheral neuropathy. However, there have been few reports on the relationship between nocturnal leg cramps and LSS, and it remains unknown whether conservative or surgical intervention has an impact on leg cramps in patients with LSS. MATERIALS AND METHODS: The subjects were 130 LSS patients with low back and leg pain. Conservative treatment such as exercise, medication, and epidural block was used in 66 patients and surgical treatment such as decompression or decompression and fusion was performed in 64 patients. Pain scores and frequency of nocturnal leg cramps were evaluated based on self-reported questionnaires completed before and 3 months after treatment. RESULTS: The severity of low back and leg pain was higher and the incidence of nocturnal leg cramps was significantly higher before treatment in the surgically treated group compared with the conservatively treated group. Pain scores improved in both groups after the intervention. The incidence of nocturnal leg cramps was significantly improved by surgical treatment (p=0.027), but not by conservative treatment (p=0.122). CONCLUSION: The findings of this prospective study indicate that the prevalence of nocturnal leg cramps is associated with LSS and severity of symptoms. Pain symptoms were improved by conservative or surgical treatment, but only surgery improved nocturnal leg cramps in patients with LSS. Thus, these results indicate that the prevalence of nocturnal leg cramps is associated with spinal nerve compression by LSS.
Adult ; Aged ; Aged, 80 and over ; Decompression, Surgical ; Female ; Humans ; Leg/*pathology ; Low Back Pain/epidemiology/etiology ; Male ; Middle Aged ; Pain/*epidemiology/*etiology ; Prospective Studies ; Questionnaires ; Spinal Stenosis/*complications/*physiopathology/surgery