1) As medicine matures, a more balanced management of human resources, medical skills and technology, and finance is required. Therefore, the importance of business administration as a subject of lifelong learning by physicians is increasing.
2) Japanese medical students and physicians have few opportunities to learn business administration. A distance-learning programme for a masters of business administration (MBA) degree provides a learning opportunity that does not interrupt careers.
3) For both providers and learners, much effort is needed to avoid leaving school without completing the MBA course: while learners need more time management and motivation, providers need to develop a better management system and provide virtual reality situations.

1) The number of newly employed medical residents per 100,000 persons and Gini coefficients were calculated using 2005 census data and the numbers of newly employed medical residents from 2003 through 2008.2) The maximum/minimum number of medical residents per 100,000 persons decreased from 9.3 in 2003 to 3.6 to 4.7 from 2004 through 2008. Gini coefficients also decreased from 0.21 in 2003 to 0.17 to 0.19 from 2004 through 2008.3) The interprefectural inequality was large before the introduction of the new system but decreased slightly after its introduction.

The demand-supply status of manipulative therapies for muscle-skeletal complaints in Japan were observed and analyzed using data published in 1995.
The results were as follows.
1. In Japan, the average prevalence rate was 69.6 for shoulder stiffness, 71.8 for lower back pain, and 46.1 for joint pain as of 1995 (per 1, 000 population). The prevalence rates were higher in women than in men and higher in prefectures located in the west part than in the east part of Japan. Differences in prevalence rates of the three complaints of several times were seen among the 46 prefectures.
2. On average, there were 66.6 massagers/chiropractors, 45.0 acupuncturists, 44.0 moxibustionists, and 20.2 bonesetters as of 1995 in Japan (per 100, 000 population). These numbers were higher in prefectures located in the west part than in the east part of Japan.
3. The rate of outpatients attending massagers, chiropractors, acupuncturists, moxibustionists, or bonesetters as of 1995 in Japan was 23.7per 1, 000 population. The rate of outpatients was higher in women than in men and higher in prefectures located in the west part than in the east part of Japan.
4. The rate of outpatients in each prefecture showed a significant correlation with the prevalence rates of muscle-skeletal complaints (r=0.51 for shoulder stiffness, r=0.44 for low back pain, and r=0.68 for joint pain) and with the numbers of manipulative therapists (r=0.31 for massagers/chiropractors, r=0.36 for acupuncturists, r=0.35 for moxibustionists, and r=0.57 for bonesetters).
5. Based on multiple correlation analysis showing the correlation of the rate of outpatients with the number of therapists, the prevalence rate of shoulder stiffness (partial correlation coefficient: PCC=0.61) and the number of bonesetters (PCC=0.65) showed significant correlation with the number of outpatients visiting therapists, and its multiple correlation coefficient was 0.76 (<0.001).

Objectives: To determine the relationship between obesity and cardiac autonomic nerve activity in healthy children. Methods: 16 healthy male children comprising of 9 nonobese and 7 obese subjects (body mass index > 19.1 kg/m2) aged 8−9 years were selected. Electrocardiograms were measured for 10 min. under controlled ventilation (0.25 Hz) in the supine position. Consecutive 256-second RR interval data were transformed by the Fast Fourier Transform method into power spectral data. Very low frequency (VLF; 0.003−0.04 Hz), low frequency (LF; 0.04−0.15 Hz), high frequency (HF; 0.15−0.40 Hz), and total power (TP; 0.003−0.40 Hz) were calculated and transformed into a natural logarithm (ln). Normalized units (nu) were also calculated as follows: LFnu = LF / (TP - VLF) x 100. HFnu = HF / (TP - VLF) x 100. Low/high-frequency ratio (LHR) was calculated as LF divided by HF. Unpaired t test was performed to compare the 2 groups. Results: TP ln and HFnu, reflecting cardiac parasympathetic nerve activity, in obese children were significantly lower than those in nonobese children. In contrast, LFnu and LHF, reflecting cardiac sympathetic nerve activity, in obese children were significantly higher than those in nonobese children. Conclusions: These findings suggest that obese children have higher sympathetic nerve activity and lower parasympathetic nerve activity than nonobese children.
Child ; Hz ; Cardio- ; Nerve ; With frequency

Sand bathing is a method of Uighur medical treatment that use natural conditions to treat diseases at Turpan, China. Its effects on heart rate, blood pressure, body temperature, body weight and rheumatoid arthritis were discussed in various patients. Reduction in body weight (absolute decrease 1.46±3.8kg) was observed one hour after completing at 50-60°C sand bathing. The heart rate (absolute increase 16.33±7.5/min), systolic blood pressure (absolute increase 4.05±16.6mmHg) and body temperature (absolute increase 1.02±0.2°C) inceased gradually after 10 minute sand bathing and decreased gradually in 10 minutes after the sand bathing in 91 patients. Since heart rate and blood pressure could not recover after completing the sand bathing in a small part of patients, we considered that hypertensive patients should pay attention to taking the sand bathing. For 21 patients (70.0%) of 30 rheumatoid arthritis patiens treated by serial sand bathing for 15 days, joint pain was relieved signifcantly. However, for 5patients (16.7%) treated by the serial sand bathing, joint pain was not changed. For 4 patients (13.3%) treated by the sand bathing joint pain was worsened. From the above results it was considered that sand bathing may exert rather benfcial effects on rheumatoid arthritis patients.

Sand bathing is a method of Uighur medical treatment that use natural conditions to treat diseases at Turpan, China. Its effects on heart rate, blood pressure, body temperature, body weight and rheumatoid arthritis were discussed in various patients. The heart rate (absolute increase 16.33±7.5/m), systolic blood pressure (absolute increase 4.05±16.6mmHg) and body temperature (absolute increase 1.02±0.2°C) increased gradually after 10 minute sand bathing and decreased gradually in 10 minutes after the sand bathing in 91 patients. Since heart rate and blood pressure could not recovery after completing the sand bathing in a small part of patients, we considered that hypertensive patients should pay attention to taking the sand bathing. Reduction in body weight (absolute increase 1.46±3.8kg) was observed one hour after completing at 50-60°C sand bathing. For 21 (70.0%) of 30 rheumatoid arthritis patients treated by serial sand bathing for 15 days, though joint pain was relieved significantly. However, for 5 patients (16.7%) treated by the serial sand bathing, joint pain was not changed. For 4 (13.3%) treated by the sand bathing joint pain was worsened. From the above results it was considered that sand bathing may exert rather beneficial effects on rheumatoid arthritis patients.

The comfortability and safety on resort were investigated in terms of resort environments focusing on atmosphere temperature.
With regard to the comfortability, first, a discomfort index (DI) defined with atmosphere temperature and relative humidity was demonstrated to be associated with indicators of autonomic nerve activities derived from heart beat variability at the level around DI-70 which was classified into the category of “comfortable for most of people”.
Secondarily, it was suggested that the index could be available to evaluate comfortability for given time courses at different resort points with an example of its hourly average in 24 hours a day for a representative month in each season. With regard to the safety, first, stroke incident rate of each month was associated with monthly average atmosphere temperature when the relationship was analyzed using around ten thousands patients data for 7 years from the community-based stroke registration for in Toyama prefecture. On top of that, it has been demonstrated that the atmosphere temperature on one and two days prior to the stroke development was independently effective on the risk of cerebral hemorrhage and subarachnoidal hemorrhage development with the adjustment for patient's sex and age, calendar year, season, relative humidity and atmosphere pressure. Secondarily, morning raise in blood pressure was affected by the room temperature (10°C and 25°C). The lower temperature the more raise in blood pressure.

Objective:
A rapid rise in blood pressure (BP) in the early morning is called morning BP surge and is known to be related to the onset of cerebrovascular or cardiovascular diseases. Exposure to cold temperature aggravates this condition. However, few studies have investigated the relationship between morning BP surge and bedroom temperature (BT). This study examined the effectiveness of a comfortable BT for mitigating morning BP surge.
Methods:
In this study, five healthy male university students (22.8±0.4 years old with BMI 21.7±1.3Kg/m²) volunteered to be subjects. The relative humidity in the bedroom was controlled to 50%, and the BT was set at 10°C and 250°C for two test conditions. From 0:00 to 8:00am, a Portapres Model-2 was used to measure BP continually at each beat. The average BP and heart rate (HR) from 2:00 and 4:00am were used as the baseline BP and HR. The changing rates of BP and HR from 4:00 to 7:30, the time and the BP value when BP started to rise, the time and the BP value when the BP reached the maximum, the BP value at the time of waking, and the time and rate of increase of BP until it reached the peak at temperatures of 10°C and 25°C were compared by means of the Wilcoxon signed ranking test.
Results:
The BP before waking started to rise later at 25°C than that at 10°C. BP rose more slowly at the higher BT than at the lower BT, especially 30 minutes after waking. At the lower BT, BP rose almost linearly, and the maximum rising rates were 37% (153.3mmHg) for systolic BP and 54% (97.6mmHg) for diastolic BP. At the higher BT of 25°C, however, BP reached the first peaks about 20 minutes after waking/getting up, and then remained stable. The maximum rising rate was 30% (14.2mmHg) for systolic BP and 33% (86.5mmHg) for diastolic BP. At the higher BT, BP reached the maximum value 40 minutes later for systolic BP and 60 minutes later for diastolic BP. At the lower BT, systolic BP exceeded the normal range, reached 140mmHg 35 minutes after getting up, remained stable for 55 minutes, and then rose to the maximum value of 153.3mmHg. In contrast, at the higher BT, the first peak of BP was significantly lower than that at the lower BT. Furthermore, the differences in BP between the first peak of BP and the BP value at the time of staring to rise and between the first peaks and the BP value at the time of waking up were significantly lower at the higher BT than those at the lower BT. The rising rates of BP from the time when BP started to rise and from the time of waking until reaching the maximum value were significantly lower at the higher BT than those at the lower BT.
Conclusions:
These results suggest that the margin of the rise in BP, the rising rate of BP, and the peak value of BP in the early morning are significantly lower at a BT of 25°C than those at a BT of 10°C. They also suggest that sleeping at a comfortable BT, especially during winter, may suppress morning hypertension or morning BP surge and indirectly prevent the onset of cerebrovascular and cardiovascular disease as well as related deaths. Although the subjects in this study were healthy young men, it was considered that the benefit of sleeping in warm bedroom for preventing morning BP surge may be increased for the elderly who are highly likely to have already suffered from such underlying diseases as hypertension.

In recent times, an ingestible capsule sensor for the measurement of core body temperature has become available. This equipment was used to measure the relationship between core body temperature and daily living activities such as eating, exercise and bathing etc.
The main findings were as followings:
1. With respect to daily living activities, the core body temperature during bathing showed higher values in comparison with eating and light-grade exercise etc.
2. For the same-grade of exercise (HRmax60%) either in an environmentally controlled room at either constant temperature (25°C) and humidity (50%) or in water (36°C; 50%humidity), the core body temperature showed almost identical changes for peak value and the rise and fall ever time.
3. Atypical work at midnight was associated with a continuous decrease in core body temperature.
4. Atypical sleep in the daytime was associated with a continuous decrease in core body temperature.
5. For daily living activities inducing an increase in core body temperature, the correlation coefficient between core body temperature and heart beats/min was 0.87 (p<0.01).