ケンコウ ジュミョウ ト ロコモ

The average lifespan of Japanese is about 83 years and the average health longevity is 75 years. These are the highest in the word. Japan has rapidly been becoming an aged society. In 2010 the elderly people（age 65 or older）were account for 23% of the country’s total population. This number will increase steadily, and is expected to reach 40% by 2050. Many elderly require nursing care services and its main causes are suffering from locomotive organ disorders. Recognizing these circumstances, the Japanese Orthopaedic Association（JOA）proposed the concept of locomotive syndrome“, locomo”in short, in 2007. This syndrome refers to those elderly who have become to need nursing care services because of problems of the locomotive organs, or have risk conditions which may require them to have such services in the future. The JOA also prepared a self-check list, so called“loco check”, for this syndrome to become aware of degeneration of the locomotive organs and to recognize risks of locomo for individuals. The JOA recommends“standing on one leg with eyes open”and“half squats”as beneficial locomotive exercises. It is very important to educate and spread this concept more global. We hope that this concept“locomo”contributes to the health and welfare of the nation

Bias amplification in the g-computation algorithm for time-varying treatments: a case study of industry payments and prescription of opioid products

BACKGROUND: It is often challenging to determine which variables need to be included in the g-computation algorithm under the time-varying setting. Conditioning on instrumental variables (IVs) is known to introduce greater bias when there is unmeasured confounding in the point-treatment settings, and this is also true for near-IVs which are weakly associated with the outcome not through the treatment. However, it is unknown whether adjusting for (near-)IVs amplifies bias in the g-computation algorithm estimators for time-varying treatments compared to the estimators ignoring such variables. We thus aimed to compare the magnitude of bias by adjusting for (near-)IVs across their different relationships with treatments in the time-varying settings. METHODS: After showing a case study of the association between the receipt of industry payments and physicians' opioid prescribing rate in the US, we demonstrated Monte Carlo simulation to investigate the extent to which the bias due to unmeasured confounders is amplified by adjusting for (near-)IV across several g-computation algorithms. RESULTS: In our simulation study, adjusting for a perfect IV of time-varying treatments in the g-computation algorithm increased bias due to unmeasured confounding, particularly when the IV had a strong relationship with the treatment. We also found the increase in bias even adjusting for near-IV when such variable had a very weak association with unmeasured confounders between the treatment and the outcome compared to its association with the time-varying treatments. Instead, this bias amplifying feature was not observed (i.e., bias due to unmeasured confounders decreased) by adjusting for near-IV when it had a stronger association with the unmeasured confounders (≥0.1 correlation coefficient in our multivariate normal setting). CONCLUSION: It would be recommended to avoid adjusting for perfect IV in the g-computation algorithm to obtain a less biased estimate of the time-varying treatment effect. On the other hand, it may be recommended to include near-IV in the algorithm unless their association with unmeasured confounders is very weak. These findings would help researchers to consider the magnitude of bias when adjusting for (near-)IVs and select variables in the g-computation algorithm for the time-varying setting when they are aware of the presence of unmeasured confounding

Clinical outcome of tapered wedge stem

The purpose of this study is to evaluate the results and intraoperative or postoperative complications of primary total hip arthroplasty (THA) using a contemporary tapered wedge titanium femoral component. A total of 213 THAs in 187 patients were followed up more than 5 years (mean, 102 months ; range, 60-150). The mean age at surgery was 64.2 years (range, 20–89 years). These patients were clinically evaluated using the JOA scoring system and radiographically host bone reactions around the implants, as well as femoral loosening. The mean JOA score improved from 49 (range, 21–75) to 92 (range, 59–100). All 12 patients with poor results (JOA < 75) coexisted with cerebral, spinal, joint, and musculoskeletal disorders. At the final follow-up, implant survival was 100%. Complications occurred in 23 hips. They consisted of 12 hips with intra-operative fractures, 2 hips with sciatic nerve palsy, one hip with infections, 3 hips with recurrent dislocations, and 8 hips with aseptic cup loosening. In conclusion, we have shown excellent survival rate of the contemporary tapered wedge stem in primary THA ; however, patients with coexisting diseases could not acquire sufficient improvement in hip function and ambulatory ability