Positive Association Between Sleeping Prone and Good Quality Sleep / General Medicine

<b>OBJECTIVE</b> : This study was conducted in a Japanese population to better understand the association between insomnia and sleeping prone.<br><b>METHODS</b> : A cross sectional questionnaire study was conducted with outpatients of St. Luke's International Hospital in August, 2007. Information on sleep position habits, symptoms, quality of life, and sleep quality was collected. The Athens Insomnia Scale (AIS) was used to measure sleep quality. Participants with an AIS score of 4 or higher were categorized as sub-threshold insomnia and as the insomnia group.<br><b>RESULTS</b> : Of the 784 subjects who returned completed questionnaires (response rate=65%) 30.4% were men. About 13% of the respondents slept in the prone position at least three times a week. Based on multivariate adjusted logistic regression analysis, there was a significant association between sleeping prone and having no problem with insomnia (odds ratio, 0.61 ; 95% CI, 0.38-0.99).<br><b>CONCLUSION</b> : These data suggest that sleeping in the prone position is associated with good quality sleep.

Introducing a new medical school system into Japan

Entering into medical schools is the most difficult yet most prestigious among all of the undergraduate university departments. Most of the medical students in Japan come from the Mathematics/Physicochemical Science track, while a few are from the Humanities/Social Science track. However, to meet the needs of the Japanese society, medical students need to learn core competencies, such as professionalism, humanism, and ethics. Issues with regard to these competencies among medical students have recently become a widespread serious concern to medical educators and the general public in Japan. In this article, we suggest that the introduction of a new medical school system, by reforming the admission criteria, can be an effective measure for meeting the current needs of the Japanese society.

Sociodemographic Characteristics for Use of Complementary and Alternative Medicine in Japan / General Medicine

BACKGROUND: Use of complementary and alternative medicine (CAM) has become popular in Japan.<BR>OBJECTIVE: To investigate associations of symptom-related CAM use with sociodemographic factors in Japan.<BR>DESIGN AND SETTING: A prospective cohort study of a nationally representative sample of households in Japan.<BR>PARTICIPANTS: Community-dwelling adults who developed at least one symptom during a 31-day period.<BR>MAIN OUTCOME MEASURES: Self-reported, symptom-related use of CAM, either physical CAM or oral CAM.<BR>RESULTS: Of 2, 453 adults, 2, 103 participants (86%) developed at least one symptom. Of these symptomatic adults, 156 (7.4% ; 95% CI: 6.3-8.5%) used physical CAM therapy. The likelihood of using physical CAM was not significantly influenced by annual household income, employment, or education. Participants living in large cities had an increased likelihood of using physical CAM with an odds ratio (OR) of 2.6 (95% CI: 1.2-5.8), compared to those living in rural areas. Oral CAM therapy was used by 480 participants (22.8%; 95% CI: 21.0-24.6%) among the symptomatic adults. An age of 60 years old and older (OR 2.0; 95% CI: 1.2-3.3) and female gender (OR 1.8; 95% CI: 1.3-2.6) were significantly associated with an increased use of oral CAM. The unemployed participants had a lower likelihood of using oral CAM, with an OR of 0.6 (95% CI: 0.4-0.9), compared to the employed.<BR>CONCLUSIONS: Oral CAM use is common among Japanese patients and is associated with older age, female gender, and employed status, while physical CAM use is less common and is associated with living in a large city.

Preparations to Stay Hale and Hearty in Your Old Age / 日本農村医学会雑誌

The author founded the “Society of the New Elderly” in 2000 and launched a campaign to redefine old age. It was some 50 years back that the elderly were defined as those people over the age of 65 in industrially advanced countries.However, with the average life expectancy of Japanese at birth topping 82, the author suggested five years ago that the elderly should refer to those people 70 and over. The Society adopted the following four slogans:(1) to love, (2) to initiate, (3) to endure, and (4) to promote world peace by letting school children learn how peace could be realized through the stories of the horrors of war told by the aged who experienced them during World War II.It was emphasized that good models of the elderly should be shown to the young generation through hearty communication at their homes or at public places.The author recently visited Dr. Schweitzer's hospital at Lambarene in Gabon and learned how the Alsatian medical missionary had dedicated himself to the people there to let them know how precious the life of humans and all other living things, because they were created by God.Finally, the author mentioned the latest research we had been conducting with the participation of volunteers among the memebers of the Society. Through the cohort study, it is to investigate how their genus are influenced by their lifestyle.The author has been trying to persuade health professionals in different disciplines into working together more closely in order to improve the quality of health care.

Curriculum of Medical Schools in North America Offering Various Education Programs: A Report of the Inspection Tour Organized by Dr. Hinohara in July, 2005 / 医学教育

1) The study tour was organized by Dr. Hinohara to learn about the medical education in North America and its philosophy to support the method.<BR>2) The McMaster University, which started PBL curriculum in 1969, began COMPASS curriculum which focuses on conceptual thinking and e-learning in which tutorial groups still remain as the key to the learning process.<BR>3) The Duke University, which values the researcher promotion, began a new curriculum including at further integration of basic and clinical medicine and structural clinical training (Intersession).<BR>4) The Washington University, which constructed WWAMI Program that cooperated with the medical institutions in four states surrounding Washington, started College System to support the students and to strengthen their clinical competencies.<BR>5) Common aspects of the innovation of medical education in North America are (1) further integration of the basic and clinical medicine, (2) early exposure to the principle of clinical medicine and (3) promotion of professionalism by Clinical Preceptorship.

Technological Aspect of Basic Clinical Training in Primary Care Medicine / 医学教育

The main purpose of basic clinical training for housestaff is to acquire the ability to be a primary physician who can properly manage acute medical problems, develop intimate bonds with patients, and provide them with continuous care. We emphasize the importance of training in the office, clinic, or patients' homes. Although residents have so far spent most of their clinical rotations in an inpatient setting, a training program that devotes substantial time to ambulatory care is indispensable to improve basic clinical training in primary care medicine.

Initial Two-Year Clinical Training Program in Postgraduate Medical Education / 医学教育

In 1991, the committee on postgraduate clinical training proposed revised behavioral objectives for basic clinical training in the initial two years. We present here a model for a clinical training program that should enable most residents to attain these objectives within two years.<BR>The program begins with orientation for 1-2 weeks, including a workshop on team care, and nursing practice.<BR>Basic clinical skills for primary care and emergency managements should be learned by experience during rotations through various clinical specialities. All staff members, even senior residents, should participate in teaching beginning residents in hospitals.

Objectives of post-graduate clinical training / 医学教育

Japanese medical graduates are recommended to receive clinical training for more than two years after graduation, because undergraduate clinical training is insuffiicient.<BR>In 1976 the committee of postgraduate clinical training proposed the objectives of basic clinical training after graduation of medical schoool and in 1981 the committee proposed the objectives for the first postgraduate year of training and the methods of clinical skill assessment.<BR>We here present the revised objectives of basic clinical training after graduation of medical school.<BR>It is emphasized that clinical trainees should have basic clinical skills of primary and emergency care during the two year training.<BR>These clinical skills include interviewing techniques, skills in physical examination and interpretation of physical findings, laboratory skills, skills relating to diagnosis and managements, communication skills to other doctors and to other medical co-workers and terminal care.

Studies on the target heart rate(THR) in exercise prescription - Usefulness of the Karvonen's formula / 体力科学

Exercise intensity is one of the major determinats in the exercise prescription, where THR plays an important role. This study was designed to reemphasize the usefulness of the Karvonen's formula with special regard to the anaerobic threshold (AT) in the exercise prescription to middle-aged healthy men. Fifty normal adult subjects between 30 and 59 years who were refered to the Life Planning Center for the evaluation of physical fitness were selected for the study. Symptom limited maximal treadmill stress testing after Bruce's protocol was performed for all subjects and AT was determined as the level, where the minute ventilatory volume curve during exercise revealed the first breaking point. The heart rate at AT (HR<SUB>AT</SUB>) was compared to those obtained by the Karvonen's formula (k=0.6) and the other conventional method, in which the 70% and 85% of the maximal heart rate (HRmax) were determined as an optimal range for the exercise intensity. The following results were obtained: the average value of HRAT just coincided with the THR obtained with Karvonen's formula and its±1 S.D. values just fitted into the range of 70% and 85% of HRmax, respectively. THR by the Karvonen's formula varies with k values and is mostly affected by the resting heart rate (HRr) . If the k is fixed to 0.6, THR thus obtained can keep its range between 70% and 85% of HRmax under the normal range of HRr (mean±2 S. D. ; 37-116 bpm) . Moreover, THRs obtained from the Karvonen's formula (k=0.6) using the age predicted HRmax were best fitted into the ones derived from the HRmax obtained by the maximal exercise testings. Thus, THR detemined by the Karvonen's flrmula (k=0.6) can be the most suitable with regard to the anaerobic threshold and the most reliable within the wide range of normal resting heart rate.