Search

The demographic transition towards an ageing population and the epidemiological transition from communicable to noncommunicable diseases have increased the demand for rehabilitation services globally. The aims of this paper were to describe the integration of rehabilitation into the Japanese health system and to illustrate how health information systems containing real-world data can be used to improve rehabilitation services, especially for the ageing population of Japan. In addition, there is an overview of how evidence-informed rehabilitation policy is guided by the analysis of large Japanese health databases, such as: (i) the National Database of Health Insurance Claims and Specific Health Checkups; (ii) the long-term care insurance comprehensive database; and (iii) the Long-Term Care Information System for Evidence database. Especially since the 1990s, the integration of rehabilitation into the Japanese health system has been driven by the country's ageing population and rehabilitation is today provided widely to an increasing number of older adults. General medical insurance in Japan covers acute and post-acute (or recovery) intensive rehabilitation. Long-term care insurance covers rehabilitation at long-term care institutions and community facilities for older adults with the goal of helping to maintain independence in an ageing population. The analysis of large health databases can be used to improve the management of rehabilitation care services and increase scientific knowledge as well as guide rehabilitation policy and practice. In particular, such analyses could help solve the current challenges of overtreatment and undertreatment by identifying strict criteria for determining who should receive long-term rehabilitation services. Tant la transition demographique vers un vieillissement de la population que la transition epidemiologique des maladies transmissibles vers les maladies non transmissibles ont entraine une augmentation de la demande en services de readaptation dans le monde. Le present document poursuit plusieurs objectifs: decrire l'integration de la readaptation dans le systeme de sante au Japon, et illustrer comment les systemes de sante contenant des donnees reelles peuvent etre utilises en vue d'ameliorer de tels services, en particulier pour une population nipponne vieillissante. En outre, il offre un apercu de la maniere dont la politique de readaptation etayee par des faits s'inspire de l'analyse de vastes bases de donnees sanitaires japonaises, parmi lesquelles: (i) la base de donnees nationale des demandes de remboursement au titre de l'assurance-maladie et des bilans de sante specifiques; (ii) la base de donnees complete de l'assurance pour les soins longue duree; et enfin, (iii) la base de donnees du systeme d'information relatif aux attestations de soins longue duree. Le vieillissement de la population a pousse le Japon a inclure la readaptation dans son systeme de sante, surtout depuis les annees 1990; aujourd'hui, un nombre croissant de personnes agees ont aisement acces a des services de readaptation. Au Japon, l'assurance-maladie globale prend en charge la readaptation intensive aigue et post-aigue (ou de retablissement). De son cote, l'assurance pour les soins longue duree couvre la readaptation dans les etablissements dedies et les infrastructures collectives accueillant des personnes agees, avec pour but de contribuer a preserver l'autonomie au sein d'une population vieillissante. Lanalyse de vastes bases de donnees sanitaires peut favoriser une meilleure gestion des services de readaptation et accroitre les connaissances scientifiques, mais aussi orienter les politiques et pratiques en la matiere. Ce type d'analyse peut surtout aider a s'attaquer aux enjeux actuels que representent les traitements excessifs ou insuffisants, en identifiant des criteres stricts permettant de determiner qui doit faire l'objet d'une readaptation sur le long terme. La transicion demografica hacia el envejecimiento de la poblacion y la transicion epidemiologica de las enfermedades transmisibles a las no transmisibles han aumentado la demanda de servicios de rehabilitacion en todo el mundo. Los objetivos de este articulo son describir la integracion de la rehabilitacion en el sistema sanitario japones e ilustrar como los sistemas de informacion sanitaria que contienen datos del mundo real se pueden utilizar para mejorar los servicios de rehabilitacion, en especial para la poblacion que envejece en Japon. Ademas, se ofrece una vision general de como la politica de rehabilitacion fundamentada en la evidencia se guia por el analisis de las grandes bases de datos sanitarias japonesas, como: (i) la Base de Datos Nacional de Reclamaciones al Seguro de Enfermedad y Chequeos Medicos Especificos; (ii) la base de datos integral del seguro de cuidados de larga duracion; y (iii) la base de datos del Sistema de Informacion de Cuidados de Larga Duracion para la Evidencia. En particular, desde la decada de 1990, la integracion de la rehabilitacion en el sistema sanitario japones se ha visto impulsada por el envejecimiento de la poblacion del pais y, en la actualidad, la rehabilitacion se ofrece de forma generalizada a una cantidad cada vez mayor de adultos mayores. El seguro medico general de Japon cubre la rehabilitacion intensiva aguda y posaguda (o de recuperacion). El seguro de cuidados de larga duracion cubre la rehabilitacion en instituciones de larga estancia y centros comunitarios para adultos mayores con el objetivo de ayudar a mantener la independencia en una poblacion que envejece. El analisis de las grandes bases de datos sanitarias puede servir para mejorar la gestion de los servicios de atencion a la rehabilitacion y aumentar los conocimientos cientificos, asi como para orientar la politica y la practica de la rehabilitacion. En concreto, estos analisis podrian ayudar a resolver los problemas actuales de sobretratamiento y subtratamiento, al identificar criterios estrictos para determinar quien debe recibir servicios de rehabilitacion de larga duracion., Introduction Member States of the United Nations are committed to the sustainable development goals, (1) which include universal health coverage as a key driver of health and well-being. In addition, [...]

Objectives: Motor deficits related to imitation have been observed in autism spectrum disorder (ASD) patients. This pilot investigation focused on motor performances, including daily tool-use actions, performing an action in the absence of the tool, and imitating (copying tool-use action presented visually), in eight children with ASD and eight children with typical development (TD), with all of pre-school age (4-6 years). Methods: Motor performances were compared between the children with ASD and TD. Differences between an actual tool-use action and performing a tool-use action without the tool according to verbal instruction were also assessed between the groups. Results: Children with ASD showed impairments in imitating, but their actual tool-use actions and tool-use actions without tools following verbal instruction were not different from those of TD children. The spatial error rate in the tasks was higher in children with ASD. Conclusions: The present study indicates that disturbance in imitating actions appears by the age of 4-6 years in children with ASD, possibly as a characteristic symptom affecting motor performance at pre-school age. Generalized apraxia might follow by the age of 8 years or older.

Seronegative rheumatoid arthritis (RA) is less likely to have extra-articular manifestations than seropositive RA. An 80-year-old man with polyarthritis was diagnosed with seronegative RA in which rheumatoid factors and anti-cyclic citrullinated peptides were not detected. He had multiple pulmonary nodules that diminished in size following treatment for RA, leading to the diagnosis of pulmonary rheumatoid nodules. During his treatment course, he developed scleritis, which could have resulted in blindness. As oral steroids did not improve his condition, topical steroid injections were administered, and his symptoms gradually improved. Here, we present a case of seronegative RA with an unusual combination of extra-articular manifestations: rheumatoid pulmonary nodules and scleritis. [ABSTRACT FROM AUTHOR]

Objectives: Motor deficits related to imitation have been observed in autism spectrum disorder (ASD) patients. This pilot investigation focused on motor performances, including daily tool-use actions, performing an action in the absence of the tool, and imitating (copying tool-use action presented visually), in eight children with ASD and eight children with typical development (TD), with all of pre-school age (4–6 years). Methods: Motor performances were compared between the children with ASD and TD. Differences between an actual tool-use action and performing a tool-use action without the tool according to verbal instruction were also assessed between the groups. Results: Children with ASD showed impairments in imitating, but their actual tool-use actions and tool-use actions without tools following verbal instruction were not different from those of TD children. The spatial error rate in the tasks was higher in children with ASD. Conclusions: The present study indicates that disturbance in imitating actions appears by the age of 4–6 years in children with ASD, possibly as a characteristic symptom affecting motor performance at pre-school age. Generalized apraxia might follow by the age of 8 years or older. [ABSTRACT FROM AUTHOR]

Aims: Although it has been reported that general anesthesia affect the perioperative sleep cycle, no studies have yet evaluated how general anesthesia affects dentally disabled patients. In this study, we investigated the alteration of perioperative sleep cycles in dentally disabled patients receiving dental treatment under general anesthesia.Subjects and Methods: The study included 16 patients receiving dental procedures under general anesthesia. Using a sleep monitoring mat, the patients' sleep cycles were measured at home from 5 days before the scheduled surgery date until 5 days after discharge following general anesthesia. The change in all the variables of sleep cycles were analyzed in comparison to the value in preoperative period. Daily differences in these variables were assessed for statistical analysis.Results: The percentage of deep sleep (Stages 3 and 4) decreased significantly on postoperative day 1, and the percentage of light sleep increased. Furthermore, sleep cycles were significantly extended on postoperative day 1.Conclusion: The percentage of deep sleep decreased significantly on postoperative day 1 while the percentage of light sleep increased. Sleep cycles were also significantly extended on postoperative day 1. These results reveal that the sleep cycle is somehow affected on the first day following general anesthesia. [ABSTRACT FROM AUTHOR]