The Japanese Association of Rehabilitation Medicine (JARM) is developing a Rehabilitation Patient Database (DB). The accumulated number of registered patients exceeded 10000 by March, 2011. The purposes of this article are to describe the process and procedures of secondary analysis and to consider potentials and limitations of the DB to promote the research activities of JARM members. JARM Members who submitted patient data or cooperate with JARM in the secondary analysis are regarded as eligible to use the combined data submitted by many hospitals. A suitable patient dataset should be derived from the DB including stroke, hip fracture, and spinal cord injury, and also patient data from the acute to recovery phase of rehabilitation. Additionally, before paper drafts can be submitted, a reviewing process is needed. The DB holds much potential, because the sample size is large and data were submitted from many hospitals. Since there are inherent limitations in all observational research, many issues such as endogeneities and confounders should be considered carefully to ensure high quality evidence is obtained with validity and reliability using the DB.

This study sought to elucidate the relationship between units of rehabilitative training time and Functional Independence Measure (FIM) at time of discharge in femoral neck fracture patients. The subjects were 795 patients with femoral neck fracture from 19 hospitals registered in the Japan Rehabilitation Database who satisfied the inclusion criteria. Separating these into 15 hospitals (371 cases) where surgery was performed at outside institutions and 14 hospitals (424 cases) where surgery was performed in-house, multiple regression analysis was performed using six explanatory variables including hospital dummy and training time units, and motor FIM score at discharge as an objective variable. In the outside surgery group, whose training time units ranged from 0.8 to 8.6, the coefficient was not significant. However, it became significant when narrowed to two hospitals comprising more than 50 cases (B=2.187). The in-house surgery group's training time units represented a significantly positive coefficient (1.427). It is thought that if the number of training time units used for patients with femoral neck fractures increases by one unit, then the patient's motor FIM score at discharge will rise about 1.4 to 2 points.

We report a relatively rare case of syphilitic aortic aneurysm that was treated by reconstruction with interposition of a prosthesis. The patient was a 72-year-old woman who presented with an abnormal shadow on chest radiograph and an abdominal pulsatile tumor. Aortography revealed double aneurysms in the descending thoracic and infrarenal abdominal regions, combined with a left common iliac artery aneurysm. Microscopic examination revealed an inflammatory infiltrate within the adventitia and destruction of the elastic fibers in the media, classical features of syphilitic aortitis. The incidence of double aortic aneurysm is expected to increase in the future, and one of the many problems involved in the management of this disorder is the correct timing for safe surgery. We prefer simultaneous surgery to secondary surgery, since this rules out the possibility of rupture of the remaining aneurysm. In order to perform this operation safely, it is necessary to treat the patient's general condition with regard to the surgical procedure and possible adjevant therapy.

A 49-year-old man who had no history of cardiac disease or intravenous drug abuse was referred to our hospital complaining of fever despite antibiotic chemotherapy. Blood culture was positive for Streptococcus agalactiae, and transesophageal echocardiography revealed vegetation attached to the tricuspid valve and moderate tricuspid regurgitation. Two-thirds of the anterior leaflet and a part of the posterior leaflet of the tricuspid valve were excised with the vegetation, and the remaining anterior leaflet was sutured to the posterior leaflet after annular plication. DeVega's annuloplasty was added to a diameter of two fingers. Following this procedure tricuspid regurgitation was minimal.

  Background: The traditional Japanese style of soaking in a hot bath is a lifestyle custom for many citizens, no study had ever investigated the association between bathing as a lifestyle practice and the onset of long-term depression. Through a large-scale six-year longitudinal study, we aimed to determine whether tub bathing as a lifestyle custom plays a role in preventing the onset of long-term depression.  Methods: Of 11,882 individuals who responded to surveys conducted in 2010 and 2016 as part of the Japan Gerontological Evaluation Study (the JAGES) project, we analyzed 6,452 and 6,465 individuals for whom information was available regarding summer bathing frequency and winter bathing frequency, respectively; all of these individuals were independent, had a Geriatric Depression Scale (hereafter, “GDS”) score of ≤4, and did not suffer from depression. The cohort study involved dividing participants into a group of those who bathed 0-6 times a week and a group of those who bathed ≥7 times a week and determining the percentages of individuals who developed depression based on their GDS scores six years later. Multiple logistic regression analysis was performed to determine odds ratios for the association between depression onset and tub bathing.   Results: For individuals who tub bathed ≥7 times a week, the odds ratios for depression onset versus individuals who bathed 0-6 times a week in summer and winter were 0.84 (95% confidence interval, 0.64-1.10) and 0.76 (95% confidence interval, 0.59-0.98), respectively. Tub bathing ≥7 times a week in winter significantly reduced the risk of depression onset.  Conclusions: New-onset depression was shown to be infrequent in older adults who bathe in a tub frequently. Tub bathing was suggested to potentially contribute to the prevention of depression in the elderly.

  Background: The traditional Japanese style of soaking in a hot bath is a lifestyle custom for many citizens, no study had ever investigated the association between bathing as a lifestyle practice and the onset of long-term depression. Through a large-scale six-year longitudinal study, we aimed to determine whether tub bathing as a lifestyle custom plays a role in preventing the onset of long-term depression.  Methods: Of 11,882 individuals who responded to surveys conducted in 2010 and 2016 as part of the Japan Gerontological Evaluation Study (the JAGES) project, we analyzed 6,452 and 6,465 individuals for whom information was available regarding summer bathing frequency and winter bathing frequency, respectively; all of these individuals were independent, had a Geriatric Depression Scale (hereafter, “GDS”) score of ≤4, and did not suffer from depression. The cohort study involved dividing participants into a group of those who bathed 0-6 times a week and a group of those who bathed ≥7 times a week and determining the percentages of individuals who developed depression based on their GDS scores six years later. Multiple logistic regression analysis was performed to determine odds ratios for the association between depression onset and tub bathing.   Results: For individuals who tub bathed ≥7 times a week, the odds ratios for depression onset versus individuals who bathed 0-6 times a week in summer and winter were 0.84 (95% confidence interval, 0.64-1.10) and 0.76 (95% confidence interval, 0.59-0.98), respectively. Tub bathing ≥7 times a week in winter significantly reduced the risk of depression onset.  Conclusions: New-onset depression was shown to be infrequent in older adults who bathe in a tub frequently. Tub bathing was suggested to potentially contribute to the prevention of depression in the elderly.

Objectives: To reveal a relationship between bathing and sleep quality making for healthy aging. Materials and Methods: A population based self-administered mail survey was conducted for randomly selected or all independent people without long-term care needs aged 65 and over in 31 municipalities of Japan in 2010. This data is a part of the Japan Gerontological Evaluation Study (JAGES) project. Frequency of bathing using bathtub in summer and winter was asked. Logistic regression analyses were applied to estimate univariate and multivariate odds ratios of bad sleep quality by regular bathing (7 times or more per week for average of summer and winter) adjusting sex, age, equivalized household income, self-rated health, depression, working status, and region. Results: Response rate of the mail survey was 66.3%. The number of people who made a valid answer for bathing was 18,090. Among them, 53.0% did bathing 7 times a week, 44.6% did less than 7 times, and 2.4% did more than 7 times. Odds ratios by regular bathing were shown on the tables. Most of them indicated significantly low risk for sleeping problems. Conclusion: Regular bathing would be helpful to better sleep quality. After the survey, we are now following up the participants for incidence of long-term care needs and death.