[Purpose]To investigate the present use of medical expenses for acupuncture and moxibustion, and judo and massage therapies under the health insurance system in contracted nursing care plans prepared by nursing care managers.
[Methods]The subjects were 75 nursing care service providers who were registered in a certain municipally (B City) with an aging index of 27.7%. We investigated the experience and use of medical expenses for acupuncture and moxibustion therapy through a mail survey. The survey period was from July 10 to July 31 in 2006. The collection rate was 57.3%(43out of 75 nursing care service providers). We used simple adding, the Kruskal-Wallis test, factor analysis (principal factor method) and path analysis.
[Results]In simple adding, there were 3,535 total care receivers, 11.5%of the total aged population in B City. Users who took acupuncture and moxibustion therapy were 2.5%of the total care receivers in nursing care plans. However, 10 people could not take acupuncture and moxibustion therapy due to their economic conditions. Nine out of 41 nursing care service providers (22.0%) had users who could not take acupuncture and moxibustion therapy because their healthcare facilities would not sign the written informed consent. In factor analysis (principal factor analysis), "experience and recognition of acupuncture and moxibustion therapy using medical expenses"was extracted as the first principal component. In pass analysis, it can be explained that nursing care managers who planned acupuncture and moxibustion therapy using medical expenses had recognized that the therapy would maintain the capabilities for activities of daily living (ADL) and quality of life (QOL) of the users.
[Conclusion]When nursing care managers planned acupuncture and moxibustion therapy for maintenance of ADL and QOL in their care services using medical expenses, they were considered to have recognized that the therapy would keep the users'ADL and QOL.

To examine the personal space perception, measurements were conducted on both arms in 227 young men and women. Each subject, with his eyes closed, was instructed to stop the horizontal swing motion of his arm at the point he considered to be the middle of the range of possible motion on the horizontal plane, and this was repeated ten times.
Mean values of bisected angles were deviated from the middle points in the direction of the horizontal adduction, although there were large differences between the individuals. The deviation was larger in the right arms than that in the left, and it increased with the increasing range of motion of the horizontal abduction.
It was suggested that the gain of the personal space perception is higher in front of the body than in the side on the horizontal plane of the human shoulder.

Objective
 We examined the effects of acupuncture electrotherapy in young women with hie symptoms (excessive sensitivity to cold), presented in conjunction with vasomotor dysfunction as determined by the postural change test.
Subjects and Methods
 Subjects comprised 20 women (mean age, 20.6 years; range, 18-26 years) who exhibited symptoms of hie, evaluated as toe skin temperature after standing for 5 mins or a temperature difference between the right and left toes as compared to before standing. A stainless steel acupuncture needle (length, 40 mm; diameter, 0.2 mm) was inserted approximately 15 mm in SP6 (Shangqui). Acupuncture electrotherapy connected an acupuncture electrode to SP6 and a non-feeling electrode to lateral of the tibial tuberosity, and was undertaken at a frequency of 1 Hz for 20 mins. Therapy was provided as a total of 5 sessions, with 1 session each week, and the postural change test was performed before and after therapy. Thermal images from the medial aspect of the foot to the tibial aspect of the lower leg were captured using a medical thermography device, and mean skin temperature was calculated in selected regions of the toes, metatarsals, ankle, and tibial aspect of the lower leg. Therapy was evaluated using a questionnaire with two originally designed scales: a categorical scale of 14 symptoms including hie; and degree of hie on a visual analogue scale (VAS). Subjects completed the questionnaire every day during a period from 1 week before therapy sessions began until 1 week after completion of all 5 sessions. Scores for hie symptoms were calculated as mean values from the total score of the 14 symptoms and VAS each week. Changes in health-related quality of life with acupuncture were evaluated using the SF-8 Standard Edition.
Results
 Toe skin temperature just after standing was not significantly increased by therapy as compared to before standing. Skin temperature on the tibial aspect of the lower leg 20 mins after standing was significantly increased as compared to the adaptation period. In terms of hie, VAS and SF-8, no significant changes were seen before and after therapy, but total score for the 14 symptoms decreased significantly.
Conclusions
 Acupuncture electrotherapy to SP 6 did not appear to exacerbate hie symptoms after reductions in air temperature, while normalizing the postural vascular reflex and improving hie-related symptoms.

In order to examine the personal space perception, measurements were conducted on both elbows in 14 men and 46 women. Each subject, with his (or her) eyes closed and with his upper arm fixed horizontally, was instructed to stop the vertical and horizontal swing motion of his lower arm at the point he considered to be the middle of the range of possible motion on the front and side of plane at his shoulder, and this was repeated ten times. In various conditions, similar measurements were also done to study factors affecting the personal space perception in 14 men.
Mean values of bisected angles in percentage against range of motion were deviated from the middle points in the direction of the elbow extension, although there were large differences between the individuals. The deviation was smallest in the vertical. side of plane, and was larger in the horizontal plane than that in the vertical plane. The deviation was not so much affected by the various conditions.
It was suggested that the gain of the personal space perception is higher in the elbow extension than in the elbow flexion and its difference is larger in the horizontal plane than in vertical plane of the human elbow joint.

A 30-year-old woman who had no specific symptom was diagnosed with Turner syndrome at the age of 6 years. Subsequently, she was followed up at a hospital. However, she stopped going to the hospital when she was 18 years old. At 30 years of age, she underwent examinations involving echocardiography and enhanced chest CT at a hospital, which revealed severe aortic valve regurgitation and extreme dilatation of the aortic root. We performed the Bentall procedure through a median sternotomy following which she had an uncomplicated postoperative course. Aortic root enlargement increases the risk of aortic dissection in patients with Turner syndrome. However, no aortic events occurred before the surgery in this case. We considered the reason was related to the mosaic karyotype of this case.

Objective: Monitoring the incidence of atypical femoral fractures (AFFs) using medical claim databases is useful to assess the safety of long-term bisphosphonate exposure. Therefore, we aimed to validate the relationship between clinically-defined suspected AFFs and the candidate patients obtained from claims data at three hospitals in Japan.

Design: A cross-sectional study involving three hospitals that perform bone fracture surgery and from which electronic medical record databases of diagnoses and procedures are available.

Methods: Candidate patients were at the medical databases using two International Classification of Diseases, 10th Edition (ICD-10) codes (subtrochanteric fracture and fracture of shaft of femur) in the claims databases. These potential cases by claim-based definition were validated using clinically-confirmed information such as, the patient operation records, the discharge records, or radiographic imaging findings as suspected AFFs.

Results: Among fracture cases in the hospitals, and 9 cases with subtrochanteric fracture and 23 cases with femoral shaft fracture were identified based on the ICD-10 codes in the claims databases. Clinically confirmed subtrochanteric fracture had a sensitivity of 81.8% (95% CI: 48.2-97.7%), and a specificity of 100.0% (95% CI: 99.9-100.0%). For femoral shaft fracture, the sensitivity was 82.1% (95% CI: 63.1-93.9%), and the specificity was 100.0% (95% CI: 99.9-100.0%). In subgroup analyses, the sensitivities in patients over the age of 50 years with a single fracture site and with osteoporosis were relatively higher than in other subgroups.

Conclusion: The claims-based definitions of suspected AFFs are accurate, indicating the value of pharmacoepidemiological studies using the National Receipt Database.

Objective : To determine the effectiveness of acupuncture therapy on hiesho in maturate stage females.
Design : Multicenter, randomized, prospective, open blind, waiting list-controlled trial.
Setting : A clinical center attached to three universities and one vocational school.
Participants : Twenty two females between 18-39 years of age and with a level of more than four points on the “hiesho sensation scale” proposed by Kusumi et al for hiesho. Interventions : Participants were randomly assigned to receive therapies of either acupuncture or no therapy (waiting list controls). Acupuncture therapy was provided by needle retention to SP 6 and electro-acupuncture therapy to BL 32 at a frequency of 1 Hz for 20 minutes. One session per week of this therapy was provided for a total of four sessions. Method of Measurement : The primary outcome of change in hiesho intensity was measured using the visual analogue scale (VAS). Secondary changes were measured by an eight heading score and three component summaries of the standard edition SF-36 v 2.
Results : The statistical analyses used an intent-to-treat analysis that included two participants who dropped out, and the mixture of one participant targeted for exclusion who was censored from the analyses. As a result, 21 participants were classified as either in the acupuncture group (n = 12) or the control group (n = 9). Efficacy with acupuncture therapy was not found for effect size (Cohen d, point-biserial correlation r) for VAS and the scores of SF-36 between the two groups.
Conclusions : Effectiveness of the acupuncture therapy was not found, which suggests that it may be due to the smaller sample size, frequency of intervention, and symptoms associated with autonomic dysfunction.

[Objectives]We investigated the behaviour factors in Hiesho (excessive sensitivity to cold symptoms), a summary score of Health-related QOL (SF-8) and Body Mass Index (BMI) in subjects who feel Hiesho (hereinafter referred to as Hiesho Subjects), in relation to sex, and showed the future direction of acupuncture therapy on Hiesho.
[Methods]After approval by the Ethics Committee, we obtained written informed consent from the participants in this study. Participants were 753students in a vocational college. The study was performed with questionnaires, which were delivered by hand to the participants in September, 2008. We analyzed 629 subjects (538 males and 91 females, mean age of 27.4 ± 6.8) whose responses were valid. The questionnaire consisted of age, sex, height, weight, subjective Hiesho, 24 behaviour patterns of Hiesho according to a previous study, and Health-related QOL (SF-8, Japanese version). We used two summaries -physical component summary (PCS) and mental component summary (MCS) -which are derived from standard values (scores) in the nation on eight scales of SF-8 calculated using the special scoring software. Total scores of behaviour patterns of Hiesho subjects (HIE Scores) and summary scores and BMI in male and female subjects were statistically analyzed using covariance structure analysis technique in multiple populations (Amos Ver. 7).
[Results]In our model, the Comparative Fit Index (CFI), Akaike's Information Criterion (AIC) and Root Mean Squares Error of Approximation were 1.00, 75.886 and 0.00, respectively, which showed a high degree of compatibility. We found the relations from Hiesho Scores to PCS (β=-0.175, p < 0.01) and MCS (β=-0.179, p < 0.001) and from PCS to MCS (β=-0.089, p=0.038) in male Hiesho subjects. In contrast, in female Hiesho subjects, there were relations from Hiesho scores to MCS (β=-0.601, p < 0.001) and from PCS to MCS (β=-0.244, p < 0.05).
[Discussion]From the results of our investigation, Hiesho was considered not to be associated with Health-related QOL in male Hiesho subjects but to be associated with mental factors in female Hiesho subjects.
[Conclusions]It was shown that we should consider the patient's sex in acupuncture therapy on Hiesho.

The purpose of this study was to examine the association between the pedometer-determined steps per day and physical fitness in order to evaluate the usefulness of the pedometer-determined physical activity to help individuals meet the recommended exercise target level of the Ministry of Health, Labour and Welfare (MHLW). The subjects consisted of 222 men and 172 women aged 71 years in community-dwelling elderly. The subjects wore a pedometer for 7 consecutive days to measure daily steps. The functional capacity was assessed based on the Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG-IC) and self-reported performance of tasks (stair-climbing and chair-rising). Physical fitness tests included handgrip strength, knee extensor strength, leg extensor power, stepping, one-leg standing time with eyes open and maximal walking speed at 10 m. The men and women took on average 6,561±2,907 and 6,329±2,451 steps/day, respectively. Our subjects seemed to be highly functioning elderly, because the total scores of TMIG-IC (maximum : 13 scores) were on average 12 for men and women. The average of steps/day was significantly correlated with stair-climbing, chair-rising and knee extensor strength in men and women, and with body weight, body mass index (BMI), percent body fat (%Fat) and leg extensor power in women. The BMI and %Fat levels were significantly lower while the handgrip strength and knee extensor strength were significantly higher in women who attained to the level of the pedometer-determined physical activity as recommended by the MHLW.The present study suggests that both men and women who take a lot of steps on a daily basis tend to demonstrate excellent leg strength and thus have a good ability to perform the tasks of daily living. In addition, the degree of obesity tends to be lower in women who regularly take a lot of steps. In addition, the number of daily steps taken has been recognized to be linked to gender, and such a link has also been suggested to be stronger in women than in men.