OBJECTIVE : This study was conducted in a Japanese population to better understand the association between insomnia and sleeping prone.
METHODS : 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.
RESULTS : 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).
CONCLUSION : These data suggest that sleeping in the prone position is associated with good quality sleep.

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BACKGROUND : Electronic medical records (EMRs) were first introduced in the 1960s, and in Japan they are starting to become popular. Recognizing the need to adapt to a new clinical setting with EMRs, we aimed to explore which interviewing skills were associated with patient satisfaction in this era of EMR use.
METHODS : A prospective observational study was conducted to evaluate interviewing skills among medical residents and to collate data on patients' satisfaction levels at an outpatient general medicine walk-in clinic at a teaching hospital in Japan. Five trained raters reviewed the video recordings of these interviews and assessed them based on a predetermined set of criteria for medical interview skills developed specifically for an outpatient EMR setting. The relationships between these assessment scores and patient satisfaction levels were analyzed.
RESULTS : Significant skills that were associated with higher scores of patient satisfaction included : employed appropriate eye contact (P=0.021) ; and, invited patients directly without using a microphone (P=0.008). In addition, the degree of keyboard typing during interviews was not associated with patient satisfaction.
CONCLUSIONS : In an outpatient setting with EMR, using good non-verbal communication skills to build trustful relationships with patients is more likely to influence patient satisfaction levels. Even when physicians are typing on a keyboard, if they keep appropriate eye contact during medical interviews, patient satisfaction can be improved.

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BACKGROUND : Norm-referenced equations to predict the 6-minute walk distance (6MWD) in healthy Japanese subjects have not been established. The current study aimed to determine the reference values for 6MWD in healthy Japanese adults.
METHODS : Ninety-seven healthy Japanese men and women aged 40-79 years were recruited from Kyoto city using posters and flyers. Measurements of 6MWD were performed twice on an indoor 30 m track with 20 minutes rest between the two tests. Before performing the tests, age, gender, height, body weight, waist circumference, a questionnaire for health status, spirometry, and a 12-lead electrocardiogram were recorded. The 6MWD was measured following guidelines published in 2002 by the American Thoracic Society.
RESULTS : The mean age of the study subjects was 57.0±9.4, and 63 of the 97 subjects were female. The mean 6MWD for all subjects was 672±83 m, with a range of 483-903 m. The 6MWD is significantly correlated with age, height, waist circumference, forced vital capacity (FVC), and forced expiratory volume in one second (FEV₁). A multiple linear model showed age, waist circumference, and FVC were significantly associated with 6MWD and the model explained 35% of the variability in 6MWD. When FVC was replaced by height, the regression model also explained 32% of the variation. The measured 6MWD of Japanese subjects was similar to the predicted 6MWD using the equations derived from Caucasian subjects.
CONCLUSIONS : The 6MWD was affected to a substantial degree by age, waist circumference, height, and FVC in healthy Japanese adults.

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Diagnosis is difficult in patients who complain of slight fever without objective abnormalities. It is not rare that patients without signs of typical Mycobacterium tuberculosis (TB) infection have a delayed TB diagnosis. It has been reported that the QuantiFERON TB-2G test is useful for diagnosing latent TB infection. We report a patient who suffered from sweating, body weight loss, and a fever of less than 37.5C without abnormalities in routine tests. Except for his complaints, only QuantiFERON TB-2G testing suggested his illness, after which he was successfully treated with isoniazid administration. QuantiFERON TB-2G testing might be useful to diagnose patients with slight fever when TB is suspected but a conventional workup is not diagnostic.

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Numb chin syndrome (NCS) is a sensory neuropathy characterized by numbness involving the distribution of the mental nerve. Although rare, NCS is very important because it could be the first and only symptom of an underlying malignancy. Therefore, primary care physicians should pay attention to middle-aged persons or cancer-treated persons who complain of unilateral numbness of the lip or chin, and consider malignant etiology until proven otherwise. In this article we describe a 54-year-old man complaining of numbness of the right side of his chin due to peripheral spread of Burkitt lymphoma, and provide review of several articles.

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