Objective: This study aims to statistically clarify the association between disability characteristics and school refusal in school-aged children with Autism Spectrum Disorder (ASD).Methods: The subjects were 158 school-aged children with ASD who were prescribed rehabilitation at Narita Hospital of International University of Health and Welfare. The following information was collected from medical records: presence or absence of school refusal, age, gender, the Autism Screening Questionnaire (ASQ) scores, result of the Wechsler Intelligence Test 4th version, the Sensory Profile (SP) scores, the Liebowitz Social Anxiety Scale for Children and Adolescents scores, decline in family functions, bullying, and enrolled class. Poisson regression analysis was conducted using both crude and adjusted models. School refusal was the dependent variable, while ASQ and SP subcategories were the independent variables. Age and other factors were used as covariates in the adjusted model.Results: The “sensory avoidance” of the SP subcategory was significantly associated with school refusal in both the crude and adjusted models (odds ratio, 95% confidence interval: 1.03, 1.01-1.05, 1.03, 1.00-1.05, respectively).Conclusion: Analysis of the association between disability characteristics and school refusal in school-aged children with ASD suggests that sensory processing deficits are associated with school refusal.

Objective: This study aims to statistically clarify the association between disability characteristics and school refusal in school-aged children with Autism Spectrum Disorder (ASD).Methods: The subjects were 158 school-aged children with ASD who were prescribed rehabilitation at Narita Hospital of International University of Health and Welfare. The following information was collected from medical records: presence or absence of school refusal, age, gender, the Autism Screening Questionnaire (ASQ) scores, result of the Wechsler Intelligence Test 4th version, the Sensory Profile (SP) scores, the Liebowitz Social Anxiety Scale for Children and Adolescents scores, decline in family functions, bullying, and enrolled class. Poisson regression analysis was conducted using both crude and adjusted models. School refusal was the dependent variable, while ASQ and SP subcategories were the independent variables. Age and other factors were used as covariates in the adjusted model.Results: The “sensory avoidance” of the SP subcategory was significantly associated with school refusal in both the crude and adjusted models (odds ratio, 95% confidence interval: 1.03, 1.01-1.05, 1.03, 1.00-1.05, respectively).Conclusion: Analysis of the association between disability characteristics and school refusal in school-aged children with ASD suggests that sensory processing deficits are associated with school refusal.

Objective: The aim of this study was to establish the proper definitions of venous thromboembolism (VTE) and bleeding events for a healthcare database in Japan.
Study Design: Validation study.
Methods: The study comprised patients with VTE or who had undergone orthopedic surgery of the lower extremities and whose outpatient or inpatient medical information from April 1, 2008 to September 30, 2013 was available.  The source population of the database was derived from 100 acute-care hospitals.  The endpoints were VTE events (deep venous thrombosis [DVT], pulmonary thromboembolism [PE]) and bleeding events (bleeding requiring blood transfusion, intracranial hemorrhage, intraocular hemorrhage, upper gastrointestinal [GI] bleeding, and lower GI bleeding).  The frequent events with laboratory data were randomly extracted and evaluated, while all the infrequent events with laboratory data were extracted and evaluated.  Positive predictive value (PPV) was defined as the proportion of events judged to be clinical by medical experts of all the extracted events.  First, we conducted a test with a small number of cases and then revised the definitions of events.  Second, we extracted and evaluated data in 50 patients for VTE and bleeding events patients, based on which we defined the target PPV level between 60 and 70%.
Results: Of the 5,044,743 patients in the database, 36,947 patients underwent orthopedic surgeries of the lower extremities and 3,578 patients experienced a VTE event.  The PPV at the first evaluation was 80.0% (8/10) for DVT, 57.1% (4/7) for PE, and 27.3% (6/22) for bleeding events.  At the second evaluation using the revised definitions, the PPV were 75.0% (42/56) for VTE and 73.3% (33/45) for bleeding events.  Overall, the PPVs for VTE and bleeding events were over 70%.  The PPV of the VTE events were 76.9% (30/39) for DVT and 70.6% (12/17) for PE.  The PPVs of each type of bleeding event were over 70% except for intracranial hemorrhage (44.4%, 4/9).
Conclusion: The PPV was high for VTE events (75.0%) and bleeding events (73.3%).  The definitions used in this study are rational for the identification of VTE, DVT, PE, and bleeding events in the healthcare database in Japan.  The definition for each type of bleeding event should be investigated in further studies.

[Object]Any reports on acupuncture for patients with POEMS syndrome, which almost manifests disturbance of peripheral nerve in all cases and is known as a very rare disease together with disturbance of multiple organs, are not yet found. The present paper is concerned with a case report that improvement of symptoms and progress of ADL were brought out by acupuncture.
[Case]A sixty year-old man who was diagnosed as POEMS syndrome and received rehabilitation therapy after treatment with autologous peripheral blood stem cell transplantation complained of difficulty in walking with numbness in the lower legs at rest time and with numbness and muscular tension in the same sections after walking. Therefore, acupuncture was practiced once or twice per week for the patient in order to raise the threshold of pain and to relax muscular tension in the lower extremities.
[Results]After acupuncture, the patient could lengthen the walking distance, had reduced numbness in the soles and relaxation of muscular tension in the lower legs at rest time, and improved numbness after walking.
[Discussion and Conclusion]Acupuncture for a patient with POEMS syndrome resulted in improved symptoms and progress of ADL without severe side effects. From the above results, acupuncture is considered to be a useful therapeutic method used together with present medical treatment.