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.

Objective: With the recent aging trend in the Japanese population, dysphagia appears to be increasing. However, few epidemiologic surveys have been conducted to determine the prevalence of dysphagia in local inhabitants. Ohkuma et al. prepared a highly reliable questionnaire using a simple test and safe examination method. We investigated the presence/absence of symptoms of dysphagia in local inhabitants, evaluated their association with subjective symptoms, and examined whether the inhabitants were following a particular diet, which is the most important factor in management of dysphagia.
Methods: A cross-sectional study involving 743 inhabitants (age: over 20) of an isolated island was performed. Each subject was asked basic questions (awareness about the presence/absence of dysphagia and dietary habits), and the data was analyzed by chi-square test. Based on their responses, dysphagia incidence was determined and rated on a 3-category scale (severe, mild, and no dysphagia).
Results: Responses were recollected from 368 subjects (response rate, 49.5%). The percentage of subjects aware of dysphagia in the severe, mild, and no dysphagia groups was 13.8%, 3.2%, and 0%, respectively and the percentage of subjects who changed their dietary habits was 17.2%, 2.6%, and 0%. These percentages were significantly higher in the severe group than in the mild and no dysphagia groups, though the value was less than 20% in the 3 groups.
Conclusion: Most subjects in the present study were unaware of dysphagia, suggesting that patients with dysphagia tend to be unaware of the key symptoms of dysphagia.

Introduction : With the increase in proportion of female physicians in Japan, breaks in their career associated with life events have become more apparent. We are making efforts to improve the program of work-life balance for female students at Jichi Medical University (JMU) who have a 9-year obligation to practice in a rural area following graduation. The purpose of this study is to research the needs for career development and work-life balance programs desired by female students at JMU.
Methods : A questionnaire was distributed to all 187 female students enrolled at JMU.
Results : The proportions of those wanting to marry and give birth during their 9-year obligation term were 71% and 68.6%, respectively. The proportions of those feeling anxious about childbirth and work-life balance after graduation were 80.0% and 78.1%, respectively. Over 80% of subjects answered that they wanted to attend lectures by female physicians and group meetings with such physicians, and to receive information regarding support systems and career development.
Conclusion : Female students at JMU tend to have greater concerns about life-events, but have an advantage in having opportunities for contact with female physicians who have contributed to rural practice. Clarifying role models for female medical students appears to be an expectation that our students have from our work-life balance programs.

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.

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.