Medical Article Discussion Course

http://manabi.st/MANABI.st Medical Article Discussionコース
コース概要
このコースは12 年以上製薬業界の第一線で活躍する Sharon BeltrandelRio先生が MANABI.stのホームページ上で連載しております医療コラムを題材に作成したものです。コラムはその時々の医療・製薬業界の動向について書かれたもので、レッスンは各コラムを読みディスカッション形
式に行われます。
医療業界に勤めていらっしゃる方で同僚や顧客・患者さんとより円滑にコミュニケーションを図りた
い方や医療関係の国際会議に出席される方で外国人出席者とのコミュニケーションをより図りたい方々向けのコースとなっております。
授業は1レッスン＝1トピックで進みます（もちろん1トピックに1レッスン以上利用されても構いません）。トピック毎に6−8つの質問が事前課題として記載されております。

コース受講方法1.

トピックは30個あります。以下が各トピックの概要です。
TOPIC 1: New Obesity Treatments on the Horizon （肥満治療）
TOPIC 2： The Pharmaceutical Industry and Direct-to-Consumer Advertising:
What Can Japan and Europe Learn from the U.S.?
TOPIC 3: The FDA in 2004: Highs and Lows (2004 年度の FDA 総括)
TOPIC 4: When Giants Stumble (Merck's withdrawal of Vioxx?)
TOPIC 5: Are There Differences Between Men and Women Suffering from Heart
Diseases? （心臓病の性別要因）
TOPIC 6: When Spring is Around the Corner…So is Hay Fever Season（春はすぐそこ 花粉症の季節です）
TOPIC 7: Alzheimer’s disease and Dementia: Two More Reasons to Watch your Waistline(ウェーストラインに注意！)
TOPIC 8: Gastric Cancer in Japan （日本の胃癌事情）
TOPIC 9: A Brief Look at Age-related Macular Degeneration （加齢性黄斑変性症）
TOPIC 10: The Human Skeleton (人間の骨格)
TOPIC 11: Osteoporosis: Not Just a Women’s Disease (骨粗しょう症)
TOPIC 12: Arthritis: A Description of Three Common Disease Types (関節炎)
TOPIC 13: How Long is Too Long? （日本の患者の平均入院日数は異常に長い？）
TOPIC 14: Knee Replacement Surgery Part 1 膝関節移植手術①
TOPIC 15: Knee Replacement Surgery Part 2 膝関節移植手術②
TOPIC 16: An introduction to Type 2 Diabetes 2型糖尿病
TOPIC 17: An introduction to Type 1 Diabetes 1型糖尿病
TOPIC 18: The Mind’s Effect on the Body プラシーボ効果及び白衣高血圧症
TOPIC 19： Counting Sheep: The Importance of a Good Nightʼs Sleep 不眠治療の現状
TOPIC 20: Chronic Obstructive Pulmonary Disorder (COPD) 慢性閉塞性肺疾患
TOPIC 21: Schizophrenia -Part one- 統合失調症①
TOPIC 22: Schizophrenia -Part two- 統合失調症②
TOPIC 23 Autism 自閉症
TOPIC 24 Depression うつ病
TOPIC 25 Metabolic Syndrome メタボリック症候群
TOPIC 26 Traumatic Brain Injury (Part 1) 外傷性脳損傷
TOPIC 27: Traumatic Brain Injury (Part 2) 外傷性脳損傷２
TOPIC 28: Healthcare Professionals’ Alphabet Soup ヘルスケア・医療業界人の肩書き
TOPIC 29: Colorectal Cancer 結腸直腸癌
TOPIC 30: Health insurance and emergency care 医療保険及び緊急医療2.

まず『ログイン後』→『コースを探す』→ 医療英語 > テキストの使用 > MANABI.st Medical
Article Discussionコースよりご予約下さい。

3.

トピックの内最も話しやすいトピックを選び『先生への伝言』板を利用し先生に伝えてください。

4.

選択されたトピックをよく読み事前課題に対する答えを準備してください。

5.

レッスンは質問に沿って行われますが、脱線しても一向に構いません。質問を全てカバーできなくても気になさらないで下さい。本コースの目的はあくまで医療分野におきましてより高いコミュニケーション能力をつけて頂くもので、一つの質問で深い議論になる可能性ももちろんございます。1トピックに1レッスン以上利用されても構いません。ご自分のペースでレッス
ンを受講いただければ幸いです。

6.

既にやられたトピックを別の先生とDiscussionされるのもお勧めします。その場合、『先生への伝言』を通じ、"I have already done this topic with a different teacher so I would like to havea free discussion using this topic"とお書き下さい。

Topic 1: New Obesity Treatments on the Horizon
Obesity is becoming a problem of epidemic proportions. According the World Health Association,1
there are more than 300 million obese adults (body mass index or BMI > 30) worldwide . In the U.S.,
approximately 9 million adults suffer from extreme obesity (BMI > 40), approximately 60 million
2
suffer from obesity (BMI > 30), and approximately 127 million are overweight (BMI > 25) . Analysts
predict that the prevalence of obesity and extreme obesity will increase to 168 million in the U.S. by
32012 . Overweight and obese people have an increased incidence of a number of serious diseases,
4
including diabetes, cardiovascular disease, hypertension and stroke, and certain forms of cancer . The
health consequences of obesity range from increased risk of premature death to serious chronic
conditions that reduce the overall quality of life. Furthermore, the National Institutes of Health5calculate that overweight and obese individuals cost the U.S. about $122.9 billion per year . Obesity
and related ailments result in at least $62.7 million in doctors’ visits and $39.3 million in lost6
workdays .
Currently there are not many options for treating obesity. Pharmacological therapies(Xenical®/orlistat and Meridia® or Reductil®/subutramine) have shown little efficacy in thetreatment of obesity. They typically produce a 5-10% reduction in body weight and have unpleasant7
side effects. Sales of obesity drugs totaled about $526 million in 2004 . Bariatric surgery is
recommended only for extremely obese (BMI > 40) or obese people (BMI > 35) that also suffer fromother serious medical conditions. The patients undergo a surgical procedure to reduce the size of theirstomach and intestine. After the surgery, the patients become full with less food, and some of thecalories ingested do not get absorbed, resulting in a very significant reduction in caloric intake. Thesepatients typically lose 70% of their excess weight (50-60 kg) in 12 to 18 months following the surgery
and they keep it off. The American Society for Bariatric Surgery estimates the number of gastric8
bypass surgeries performed in the U.S. increased from 16,800 in 1993 to 103,200 in 2003 . However,9
complications caused by the surgery may be as high as 10 percent or more .
However, promising new obesity treatments are on the horizon. Sanofi-Aventis’ Acomplia™
(rimonabant) is expected to become the first obesity treatment to achieve blockbuster status. The drug
affects the Endocannabinoid System, a natural physiological system believed to play a role inmaintaining energy balance through the regulation of food intake and energy expenditure. The EC
system is also believed to play a role in tobacco dependence. In overweight/obese people, excessive
eating and fat accumulation is associated with over-activation of the EC System, which also becomes
unbalanced with chronic tobacco use. In clinical trials, Acomplia treatment resulted in weight loss,
reduced waist circumference and improvement of lipid and glucose metabolism. In those that smoke,the drug is thought to help people to stop smoking without significant post-cessation weight gain.
Side effects included depression, headaches, dizziness and nausea. In June 2005, Sanofi-Aventis
announced that the US FDA accepted for filing the company’s New Drug Application (NDA) for
Acomplia, and that a Marketing Authorization Application to the European Medicines Agency
10(EMEA) had also been submitted . In February 2006, the company received an approvable letterfrom the FDA for weight management and a non approvable letter for smoking cessation. The EMEA
review process is ongoing.
Another new obesity drug on the horizon is UK-based Alizyme’s ATL-962 (celistat), which many
analysts believe is the second most promising drug in the pipeline. It is a drug that reduces theabsorption of dietary fat with a similar mechanism of action to Roche’s Xenical. However, ATL-962
appears to have fewer side effects and lower production costs11. Alizyme recently completed a study inWritten by Sharon BeltrandelRio©MANABI Limited

370 obese patients. After three months patients treated with ATL-962 showed similar weight loss to thatseen with Xenical, however patients on ATL-962 experienced 90% fewer severe gastro intestinal side
12
effects compared to patients receiving Xenical . In January 2004, Takeda paid $3 million to exercise its
rights to license and develop ATL-962 in Japan, and clinical trials are underway (the total agreement isworth up to $42 million including milestone payments, plus royalty payments). Analysts expect the drug to13
be launched in 2008 .
Of course the best way to avoid obesity is to eat a healthy diet and exercise at least three times a week.
However, for those who need help losing weight, hopefully these new treatments will assist them inachieving their weight-loss goals and thereby improve their health.

Discussion questions
1.
Please summarize the article. What is the main point of the article?
2.
What are the health and economic consequences of obesity?
3.
Is the number of obese people increasing in Japan? Why or why not?
4.
What obesity treatments are currently available?
5.
What new obesity treatments are being developed?
6.
What do you think is the best way to lost weight?

[1] World Health Organization. Controlling the global obesity epidemic. 9/23/2003.
http://www.who.int/nut/obs.htm. (2000 estimate for worldwide obesity)[2] The Endocrine Society and The Hormone Foundation. The Endocrine Society Weighs in: A Handbook on
Obesity in America. 2004. (Reference cited in report: American Obesity Association. AOA Fact Sheets: “Obesityin the U.S.” http://www.obesity.org/subs/fastfacts/obesity_US.shtml. Accessed: February 2004.)[3] DataMonitor. Pharmaceutical companies set to make a significant profit from anti-obesity drugs.
26 Jul 04. http://www.pharmiweb.com/Features/feature.asp?ROW_ID=447.
Accessed June 2005.
[4] World Health Organization. http://www.who.int/nut/obs.htm. Accessed June 2005.
[5] Thomsan Medstat™. Fact File: Weighing our Options. January 2004. www.healthleaders.com/factfile.
Accessed June 2005.
[6] Thomsan Medstat™. Fact File: Weighing our Options. January 2004. www.healthleaders.com/factfile.
Accessed June 2005.
[7] DataMonitor. Pharmaceutical companies set to make a significant profit from anti-obesity drugs. 26 Jul 04.
http://www.pharmiweb.com/Features/feature.asp?ROW_ID=447.
Accessed June 2005.
[8] Kazel, Robert. Insurers trim bariatric surgery coverage. American Medical News (amednews.com). 4/5/04.
http://www.ama-assn.org/amednews/2004/04/05/bil20405.htm#s1.
[9] The Endocrine Society and The Hormone Foundation. The Endocrine Society Weighs in: A Handbook on
Obesity in America. 2004.
[10] Sanofi-Aventis press release. Rimonabant accepted for filing by the FDA. 23 June 2005. http://en.sanofiaventis.com/images/44_26005.pdf. Accessed June 2005.
[11] Alizyme web site. http://www.alizyme.com/default.htm. Accessed June 2005.
[12] Alizyme press release. Alizyme plc today announces its preliminary results for the year ended 31 December
2004. 21 April 2005. http://www.alizyme.com/news/20050421_003.htm. Accessed June 2005.
[13] Pharmaceutical companies set to make a significant profit from anti-obesity drugs. DataMonitor. 26 July
2004. http://www.pharmiweb.com/Features/feature.asp?ROW_ID=447. Accessed June 2005.

Written by Sharon BeltrandelRio©MANABI Limited

Topic 2: The Pharmaceutical Industry and DTC1 Advertising:
What can Japan and Europe Learn from the US?
Whether watching the evening news or an afternoon soap opera, advertisements for prescription drugs
to treat high blood pressure, high cholesterol, type 2 diabetes, erectile dysfunction, overactive bladder,depression and other common ailments and diseases fill commercial breaks on American television
networks. Since the US Food and Drug Administration (FDA) legalized direct-to-consumer (DTC)
broadcast advertising in 1997, Americans have been bombarded by advertisements for prescription
drugs that treat all kinds of physical and psychological ailments.
What is DTC advertising for pharmaceuticals and what effects has it had on Americans’ health and thepharmaceutical industry? In DTC advertising, prescription drug advertisements are aimed directly at theconsumer. Traditionally, pharmaceutical companies promoted their drugs to doctors and medical
professionals only. Although the FDA legalized DTC advertising in 1985, advertisements increased
substantially after 1997, when the FDA allowed companies to name both the drug and the disease it
treated in the same advertisement with just a brief summary of the possible side-effects instead of
having to list every possible side-effect. According to IMS Health, pharmaceutical companies’
spending on DTC advertising in the US increased from $75 million in 1996 to $2.5 billion in 2000.
Experts and analysts have mixed opinions regarding the effects of DTC advertising on Americans’
health. According to FDA survey results released in 2003, DTC ads help educate patients about theirhealth problems and provide greater awareness of treatments. The 500-physician survey indicated thatwhen a patient asked about a drug, 88 percent of the time they had the condition that the drug treated.
Furthermore, 80 percent of physicians believed patients understood what condition the drug treats.
However, approximately 75 percent of physicians believed that DTC ads lead patients to believe thatthe drug works better than it does, and many physicians felt some pressure to prescribe something when
patients mentioned DTC ads.
All experts agree that drugs carry risks, and that each drug’s benefits must be weighed against its risks.
However, some observers believe that due to DTC advertising, new drugs are used by more people
faster than ever before, creating a potential problem if the drugs have unanswered safety questions. The
FDA has been criticized for being negligent in its role of policing drug safety, but its recent warning to
Pfizer that its DTC advertising made “misleading” safety and efficacy claims about cox-2 inhibitors
Celebrex® and Bextra® indicates that the agency is becoming stricter.
Critics blame DTC advertising for contributing to the high cost of American healthcare, in whichprescription drugs are the fastest-growing part of total healthcare costs. For example, cox-2 inhibitors
such as Merck’s Vioxx® and Pfizer’s Celebrex® were advertised for all patients, regardless of the factthat cheaper retail medications such as Ibuprofen work just as well for most patients. The US
pharmaceutical industry maintains that DTC advertising increases patient awareness of innovative
treatments and improves compliance.

Written by Sharon BeltrandelRio©MANABI Limited

What does the future hold for DTC advertising? Will it be introduced in Europe and Japan? In the US, the
FDA commissioned three surveys to help it decide whether DTC advertising rules need to be changed.
Health authorities in Japan and Europe are closely watching the effects of DTC advertising in the US. It isinteresting to note that although pharmaceutical companies publicly support DTC advertising in the US, top
executives from GlaxoSmithKline and AstraZeneca recently told a British parliamentary committee that they
did not believe that it was appropriate to allow pharmaceutical companies to advertise medicines in public
places in the UK. It appears that discussions between pharmaceutical companies and health authorities
regarding DTC advertising will continue. Hopefully each country will find a solution that is culturally
appropriate and that will provide the benefits of DTC advertising, such as increasing people’s awareness ofand accountability for their health.

Discussion questions
1.
Please summarize the article. What is the author’s main point?
2.
What is DTC advertising?
3.
When did DTC advertising for pharmaceuticals become popular in the United States?
4.
What are the benefits of DTC advertising?
5.
What are the risks or negative aspects of DTC advertising?
6.
Do you think that DTC advertising for pharmaceuticals should be allowed in Japan? Why or why
not?

1.

Direct-to-consumer advertising

Written by Sharon BeltrandelRio©MANABI Limited

Topic 3: The FDA in 2004: Highs and Lows
(2004 年度の FDA 総括)

Based on recent headlines, it may appear that the U.S. Food and Drug Administration (FDA)
had a rough year in 2004. On September 30th, Merck withdrew its blockbuster cox-2 inhibitor
Vioxx? from the market. On October 16th, the FDA ordered pharmaceutical companies toinclude a "black box" warning on the labels of antidepressants, linking the drugs to anincreased risk of suicide or suicidal thoughts among young people. A "black box" warning is
the FDA's strongest safety alert and is one step below banning the drug. In both cases critics
have been vocal in saying that the agency is not doing enough to safeguard public health.
In an attempt to improve the situation, President Bush has recently increased the FDA'sfunding (but only moderately) and a new oversight board has been created to supervise safetyissues. The agency has not had a permanent leader for more than a year, but President Bush's
nominee, Dr. Lester Crawford, who has been the acting commissioner for the past year, isundergoing confirmation hearings in the U.S. Senate this week.
A bright spot in the FDA's 2004 activities is the large number of new drug approvals. Last
year the FDA approved more new medicines than in any of the previous eight years. In 2004,
a total of 113 new drugs were approved, compared to 87 approvals in 2003. The last time that
the FDA approved more than one hundred drugs in one year was in 1997, when 121 drugs
were approved.
Very importantly, 31 of the new drugs are new molecular entities (NME), nearly double thenumber of NME's approved in 2003. A new molecular entity is an active pharmaceuticalingredient in a dosage form that has never been approved for marketing in the U.S. NME's
often represent novel treatments for diseases. Some of the most promising new drugs
approved in 2004 include:
Avastatin (Genentech) - The first angiogenesis inhibitor to be approved for marketing.
Avastatin is for the treatment of first-line or previously untreated metastatic cancer of thecolon or rectum.
Cymbalta (Eli Lilly) - The first drug approved to treat the pain caused by diabetic peripheral
neuropathy. Cymbalta was also approved for the treatment of major depressive disorder in
2004.
Spiriva HandiHaler (Boehringer Ingelheim Pharmaceuticals) - The first once-daily inhaled
drug to improve lung function for patients with chronic obstructive pulmonary disease.
Tysabri (Biogen Idec and Elan) - The first humanized monoclonal antibody approved fortreating multiple sclerosis. The drug works by inhibiting adhesion molecules on the surface of
immune cells.
All medicines have risks and benefits. One of the most important parts of the FDA's mission is
promoting public health by promptly and efficiently reviewing clinical research and taking
appropriate action on the marketing of regulated products in a timely manner. Hopefully the
FDA will soon obtain a permanent commissioner to provide the agency with the additional
strength and stability it needs to overcome and learn from the low points of 2004, and tocontinue carrying out its mission of promoting public health.
Written by Sharon BeltrandelRio©MANABI Limited

Discussion questions
1.

Please summarize the article. What is the main point of the article?

2.

Why was 2004 a rough year for the FDA?

3.

What positive events occurred in 2004?

4.

What is a new medical entity (NME)?

5.

What promising new drugs were approved by the FDA in 2004?

6.

What promising new drugs have recently been approved in Japan? What are thebenefits of these new drugs?*

Written by Sharon BeltrandelRio©MANABI Limited

Topic 4: When Giants Stumble
On September 30, 2004, pharmaceutical giant Merck announced the voluntary withdrawal of its multibillion dollar arthritis drug, Vioxx®, because new clinical trial data found that Vioxx doubled the riskof cardiovascular events, including heart attack and stroke, after 18 months of use. Vioxx, which
belongs to a class of drugs called cox-2 inhibitors used to treat pain and inflammatory illnesses, waslaunched in the US in 1999, and it has been used by more than 80 million people around the world.
Sales of Vioxx totaled $2.5 billion in 2003, making it Merck’s second best-selling drug. Given themagnitude of this event and its effects on Merck, it is not surprising that several aspects of thepharmaceutical and biotechnology industry are feeling the ramifications.
In the area of research, the withdrawal of Vioxx has led to an increased focus on biomarkers. As
defined by the US National Institute of Health (NIH), a biomarker is a characteristic that can beobjectively measured and evaluated as an indicator of normal biological processes, pathogenic
processes or pharmacological responses to a therapeutic intervention. In other words, biomarkers arebiological markers that would allow doctors to determine whether a patient will respond to a particulardrug. Scientists believe that in the future, physicians might be able to run a battery of tests on eachpatient before prescribing any medication to make sure that the drug will actually provide some benefit
to the patient. Pharmaceutical companies are dedicating additional funds to this area of research, andthere are new opportunities for biotechnology companies such as Caprion Pharmaceuticals, Aclara
Biosciences and Power3 Medical Products. These companies have recently formed collaborations withpharmaceutical companies such as AstraZeneca, GlaxoSmithKline and Wyeth to discover biomarkers.
The development and approval process for new pharmaceutical agents has also been affected by theVioxx withdrawal. Companies have increased their attention on the development process and strategy,
including the types of clinical trials to be conducted and the information to be gained. Regulatory
agencies such as the US Food and Drug Administration (FDA) are expected to apply more scrutiny
than ever before and could increase the number of clinical trials required both prior to approval andafter approval. Merck's second-generation cox-2 inhibitor, called Arcoxia, is currently under review at
the FDA. However, now the FDA is likely to request more safety data, not only from Merck but also
from other companies developing cox-2 inhibitors.
In the area of sales and marketing, companies will continue to question whether their reliance on a few
blockbusters is the best strategy. Given the lawsuits that have been filed against Merck in the US, allcompanies must review their risk management plans, since virtually all medicines carry a risk of side
effects that may not be decisively recognized until millions of people have taken the drugs. Pfizer, themaker of Vioxx's main competitors, Celebrex and Bextra, has reviewed its studies and has not seen
cardiovascular problems. Pfizer does not plan to stop selling its drugs, and Novartis and Merck, both ofwhich are developing new cox-2 inhibitors, plan to continue developing drugs in this lucrative area.
Given the wide-ranging effects of the withdrawal of Vioxx, some experts question whether Merck cansurvive as an independent company, especially since Zocor®, its best selling drug for treating highcholesterol, loses patent protection in early 2006. Merck has distinguished itself as a top company inmany areas, ranging from its ground-breaking scientific research to awards for its human resource
management. Its ability to weather this current quandary will truly test the company. However, during
this trying time, hopefully they will keep in mind thatIt’s not what happens to you that counts, but how you handle it.
It’s not how far you fall, but how well you bounce.
Hopefully Merck will persevere and continue its rich tradition as a top pharmaceutical company, andcontinue to contribute to the advancement of human health.

Discussion questions
1.
What is the main point of this article?
2.
What is Vioxx? What illnesses does it treat?
3.
Why did Merck stop selling Vioxx?
4.
What are biomarkers?
5.
Are regulatory agencies such as the US FDA becoming stricter? Why or why not?
6.
Why do companies need risk management plans?
7.
What does the phrase “It’s not how far you fall, but how well you bounce” mean?

Written by Sharon BeltrandelRio©MANABI Limited

Topic 5
Are There Differences Between Men and Women
Suffering from Heart Diseases? （心臓病の性別要因）
Heart diseases are diseases that affect the heart such as heart attacks, heart failure and arrhythmia.
They are the second leading cause of death in Japan. The incidence of heart diseases in both men andwomen is escalating around the world due to an increase in fat and cholesterol intake, lack of exercise,smoking and longer life spans.
Physically men’s and women’s hearts are the same. But studies show that when suffering from heartdiseases variations emerge. For example, when suffering from a heart attack, although both men andwomen may present ‘classic’ chest pain (pain that begins in the chest and spreads to the shoulders, neckand arms), women seem to have a greater tendency than men to suffer from atypical chest pain,
abdominal pain, dyspnea (difficulty breathing), nausea and fatigue. In addition, women tend to haveheart attacks later in life compared to men and a woman’s first heart attack is more likely to be fatal
than a man’s first heart attack.
Interestingly, a study presented at the American Heart Association’s Asia Pacific Scientific Forumsuggests different things may trigger sudden cardiac arrest in men and women. The study showed thatin women psychosocial (emotional) stress may be a more common trigger for sudden cardiac arrest
than physical exertion. Physical exertion is a more common trigger in men. In a study of 122 men andwomen who had suffered from cardiac arrest, forty percent of the women said they had experienced
psychosocial stress caused by things such as divorce, death of a loved one or family conflicts, and only
five percent reported physical exertion prior to their cardiac arrest. In contract, forty percent of the menreported physical stress and sixteen percent reported psychosocial stress prior to their cardiac arrest.
The study’s authors believe that while physical exertion may cause an increased level of adrenaline (astress hormone that can cause rapid heart beats) in men, emotional stress may cause an increased levelof adrenaline in women.
More research is needed to further clarify the potential differences between men and women sufferingfrom heart diseases. Of course, another important goal is to stop heart diseases before they start. By
eating a balanced diet, avoiding tobacco, exercising regularly and reducing stress both men and womencan prevent heart diseases.
Discussion questions
1.
Please summarize the article. What is the main point of the article?
2.
Why is the incidence of heart diseases increasing around the world?
3.
Are men’s and women’s hearts the same?
4.
What are typical symptoms of a heart attack? What are atypical symptoms? Do men or womentend to present with atypical symptoms?
5.
Is it possible that different things trigger sudden cardiac arrest in men and women?
6.
What is psychosocial stress? How may it be related to sudden cardiac arrest?
7.
How can heart diseases be prevented?
References:
Ministry of Health and Welfare. Abridged life tables for Japan 2004.
http://www.mhlw.go.jp/english/database/db-hw/lifetb04/4.html
American Heart Association. Is it gender difference or gender bias?
http://www.americanheart.org/presenter.jhtml?identifier=2633
Norman Ratliff, M.D., Robert Hauser; M.D.; Adrian Almquist, M.D.; Julka Almquist, Fredarick Gobel,
M.D.; and Mike Ornes, M.D. Triggers for sudden cardiac death differ by gender. Report presented at theAmerican Heart Association’s Asia Pacific Scientific Forum. 24 April 2002.
http://www.americanheart.org/presenter.jhtml?identifier=3002347
Written by Sharon BeltrandelRio©MANABI Limited

Topic 6
When Spring is Around the Corner…So is Hay Fever Season（春はすぐそこ 花粉症の季節です）

It’s March and the weather is finally starting to get warmer. A patient visits the doctor complaining ofsneezing, itchy eyes, a runny nose, and a sore throat. What’s the diagnosis? It’s most likely seasonalallergic rhinitis, also known as hay fever.
Seasonal allergic rhinitis is an allergy-related inflammation of the nasal passages, throat and eye
membrane (conjunctiva) caused by exposure to pollen, dust or dander. Although hay fever in Japan ismainly caused by pollen from Japanese cedar and cypress trees, there are more than 40 kinds of plants
throughout the country that produce pollen that causes hay fever. Usually Japan’s hay fever season
begins in mid-February, peaks in March, decreases at the end of April, and ends by mid-May. Hayfever affects Japanese people of all ages throughout the country. According to Kafun Joho Kyokai, a
non-profit organization that monitors hay fever in Japan, one in five people in the Tokyo metropolitan
area is affected by the pollen that causes hay fever.
Hay fever, like all allergies, is caused by an oversensitive immune system. It occurs when the immune
system reacts to allergens (substances such as pollen, dust and dander) that are usually harmless. When
pollen is inhaled by a person allergic to pollen, his or her immune system responds by producing
antibodies, leading to the release of histamine. This causes itchy eyes, sneezing and mucus production.
In severe cases it can also cause hives or rashes.
A variety of treatments for hay fever are available, including: antihistamines (short-acting and longacting), corticosteroid nasal sprays, topical decongestants, comolyn sodium and hyposensibilization(‘allergy shots’). The treatments have various side effects, therefore it is important to choose theappropriate medication based on each individual patient and the type and severity of the symptoms.
The best treatment is prevention – on days when the outdoor pollen count is very high stay inside orwear a mask and goggles to avoid the allergens that cause hay fever.
Discussion questions
1.
Please summarize the article. What is the main point of the article?
2.
What is seasonal allergic rhinitis?
3.
What causes seasonal allergic rhinitis?
4.
When is hay fever season in Japan?
5.
What are the symptoms of seasonal allergic rhinitis?
6.
What treatments for hay fever are available?
7.
Can hay fever be prevented? If so, how?

References:
Sakaya Yakushiji. Invisible enemy: For sufferers in misery, hay fever is nothing to sneeze at.
Asahi.com. 03 March 2005. http://www.asahi.com/english/lifestyle/TKY200503050134.html
Hay fever. Wikipedia. http://en.wikipedia.org/wiki/Hay_fever

Written by Sharon BeltrandelRio©MANABI Limited

Topic 7
Alzheimer's disease and Dementia:
Two More Reasons to Watch your Waistline(ウエストラインに注意!)
Waistlines are increasing all over the world as people exercise less and consume more calories. The
dangers of obesity and being over-weight in terms of heart disease, vascular disease and joint pain are
well documented. But did you know that there may also be a link between obesity, dementia and
Alzheimer's disease?
A study performed by researchers at the Karolinska Institute in Sweden found a direct link between
obesity, dementia and Alzheimer's disease1. Researchers measured the body mass index (BMI), bloodpressure and cholesterol levels of 1,449 middle-aged men and women. A follow-up exam was conducted
twenty years later and the study participants' cognitive abilities were measured. Almost seventeen
percent of those who were obese at middle age (BMI > 30) developed either Alzheimer's disease ordementia, compared to five percent for those of normal weight. After taking other risk factors such as
high blood pressure and high cholesterol into account, the risk of Alzheimer's disease or dementia wasstill twice as high from being overweight alone.
The mechanism is not entirely understood, but the vascular problems associated with high blood pressure
and cholesterol may affect the brain's ability to function. After all, the brain is one of the most active
organs in the human body. The heart pumps about twenty percent of the body's blood to the brain, whichuses about twenty percent of the blood's oxygen and fuel2. If the heart is not strong or if blood vessels
are damaged the brain may not receive all the oxygen and fuel it needs.
More research is needed to better understand the link between Alzheimer's disease, dementia and obesity.
In the meantime, people of all ages should maintain a healthy lifestyle by eating a balanced diet,exercising and refraining from tobacco. In addition to the well-documented benefits to the heart andvascular system, as well as the prevention of chronic diseases such as diabetes, maintaining a healthy
weight may help preserve cognitive function.
Discussion questions
1.
Please summarize the article. What is the main point of the article?
2.
What are some of the dangers of being obese or over-weight?
3.
What were the results of the long-term study performed at the Karolinska Institute?
4.
Why might vascular problems affect the brain?
5.
What are the benefits of maintaining a healthy lifestyle?
6.
What advice would you give to someone who is trying to lose weight?
References:1.
Miia Kivipelto, MD, PhD; Tiia Ngandu, BM; Laura Fratiglioni, MD, PhD; Matti Viitanen, MD,
PhD; Ingemar Kåreholt, PhD; Bengt Winblad, MD, PhD; Eeva-Liisa Helkala, PhD; Jaakko
Tuomilehto, MD, MPolSci, PhD; Hilkka Soininen, MD, PhD; Aulikki Nissinen, MD, PhD.
Obesity and vascular risk factors at midlife and the risk of dementia and Alzheimer’s disease. Arch
Neurol. 2005;62:1556-1560. http://archneur.ama-assn.org/cgi/content/abstract/62/10/1556;
http://attworldnet.healthology.com/focus_article.asp?b=attworldnet&f=mentalhealth&c=mentalhe
alth_stayinglean&spg=ART
2.

Alzheimer’s Association. http://www.alz.org/maintainyourbrain/brainheart.asp

Written by Sharon BeltrandelRio©MANABI Limited

Topic 8
Gastric Cancer in Japan
日本の胃癌事情
The good news is that gastric cancer incidence rates are decreasing in Japan, which means that a smaller
percentage of the population is being diagnosed with stomach cancer. The bad news is that the absolute
number of people with gastric cancer is increasing due to the rapid aging of the Japanese population.1
However, there is more good news. In Japan, gastric cancer is usually diagnosed at an early stage,
resulting in improving survival rates. In fact, although gastric cancer is five times more prevalent inJapan than in the West, mortality rates are lower in Japan.2
Stomach cancer, or gastric cancer, is the growth of cancer cells in the lining and wall of the stomach.
Most stomach cancers start in the mucosa, the innermost layer of the stomach. About 90 to 95% ofmalignant tumors of the stomach are adenocarcinomas.3 Other types of stomach cancer include
lymphomas, sarcomas and other rare types. Surgery is the most common treatment for stomach cancer.
Sometimes, especially in advanced cases, surgery may be combined with chemotherapy or radiation.4
There is much debate regarding the cause of stomach cancer. It is thought that a combination ofhereditary and environmental factors play a part.5 According to the National Cancer Institute in the
United States, since 1930 the incidence of gastric cancer in the U.S. has decreased four-fold, toapproximately seven cases per 100,000 people.6 The reasons for this decrease are unknown but are
believed to be related to improved food storage or dietary changes such as reduced salt intake. It is also
believed that Japanese gastric cancer incidence rates are decreasing due to lifestyle and dietary changes,
such as reduced salt use, increased consumption of fresh fruits and vegetables, and improved foodstorage.7 Hopefully, these changes, as well as an avoidance of smoking, will lead to both a decrease ingastric cancer incidence rates and a decrease in the absolute number of Japanese diagnosed with stomach
cancer.
Discussion questions
1.
Please summarize the article. What is the main point of the article?
2.
If the incidence of gastric cancer is decreasing in Japan, why is the absolute number ofpeople with gastric cancer increasing?
3.
What is the most common type of stomach cancer?
4.
How is stomach cancer treated?
5.
What causes stomach cancer?
6.
Why is the incidence of stomach cancer decreasing in Japan?
1.
2.

3.

4.

5.
6.

7.

Epidemiology of gastric cancer in Japan discussed. Cancer Weekly. 23 August 2005.
http://www.newsrx.com/newsletters/Cancer-Weekly/2005-08-23/082320053333CW.html
Stakeholder Opinions: Gastric Cancer - Targeted Therapies Home In On a Neglected Tumor Type.
Datamonitor. 30 March 2006.
http://www.datamonitor.com/~1ba17c87c8ab424298104c5c87388699~/industries/research/?pid=DMHC21
60&type=Report
Detailed Guide: Stomach Cancer. American Cancer Society. Accessed 29 May 2006.
http://www.cancer.org/docroot/CRI/content/CRI_2_4_4X_Treatment_Choices_by_Type_and_Stage_of_St
omach_Cancer_40.asp?rnav=criDetailed Guide: Stomach Cancer. American Cancer Society. Accessed 29 May 2006.
http://www.cancer.org/docroot/CRI/content/CRI_2_4_4X_Treatment_Choices_by_Type_and_Stage_of_St
omach_Cancer_40.asp?rnav=criNetdoctor.co.uk. Accessed 29 May 2006. http://www.netdoctor.co.uk/diseases/facts/stomachcancer.htm
Gastric Cancer (PDQ®): Screening. Health Professional Version. National Cancer Institute. Last modified
23 March 2006.
http://www.cancer.gov/cancertopics/pdq/screening/gastric/healthprofessional/allpages/print
A. Ohtsu, S. Yoshida, and N. Saijo. Disparities in Gastric Cancer Chemotherapy Between the East andWest. J. Clin. Oncol., 10 May 2006; 24(14): 2188 - 2196.

Written by Sharon BeltrandelRio©MANABI Limited

Topic 9
A Brief Look at Age-related Macular Degeneration
加齢（性）黄斑変性症
Age-related macular degeneration (AMD) is the leading cause of blindness in developed
countries, and the third leading cause of visual impairment globally1. It affects people over theage of 50 and can lead to a significant decrease in quality of life and independence. Tasks
such as driving, walking and reading can be greatly affected.
AMD affects the central field of vision and occurs when the central (or macular) retina develops
degenerative lesions. There are two forms of AMD: “dry” and “wet”.
-Dry AMD is characterized by drusen, or yellow deposits, in the macula. As the drusen
grow in size and quantity they may lead to a dimming or distortion of vision. In moreadvanced stages a deterioration of the light-sensitive layer of cells in the macula leads
to atrophy (cell death), causing patients to experience blind spots in the center of theirvision or lose their central vision completely.
-Wet AMD is characterized by choroidal neovascularization, or growth of abnormal
blood vessels from the choroid underneath the macula. These abnormal blood vessels
grow toward the macula and leak blood and fluid into the retina, resulting in distortion(straight lines look wavy), blind spots and loss of central vision. Eventually theseabnormal blood vessels scar, which leads to permanent central vision loss.
Dry AMD is more prevalent than wet AMD and vision loss is more gradual. Most patients with
dry AMD will not lose central vision, however the dry form can lead to the wet form. People
suffering from the wet form, about 10% of all people with AMD, are usually those who
experience the most serious loss of vision2.
The main risk factor for AMD is ageing. Researchers believe that other risk factors may
include tobacco use, genetic tendencies, degree of eye pigmentation (light colored eyes are at
greater risk), arterial hypertension, ultraviolet rays and eating a non-balanced diet3.
Symptoms of AMD include distorted central vision, the appearance of dark and blurry areas or
white out in the central vision, and diminished color perception. If patients experience any ofthese symptoms it is imperative that they see an ophthalmologist as soon as possible.
Prevention and treatment options are currently limited. Lasers, dynamic phototherapy andanti-angiogenesis drugs may retard AMD’s progress, but early detection is very important. A
recent study, AREDS (Age-Related Eye Disease Study), conducted by The National Eye
Institute of the National Institutes of Health in the United States demonstrated that vitamins C,
E, beta carotene, zinc and copper can decrease the risk of vision loss in people withintermediate to advanced dry macular degeneration4. Special aids that produce enlarged
images of nearby objects may help those with impaired vision.
Scientists are currently searching for better ways to detect, treat and prevent vision loss inpeople with AMD. For example, they are studying submacular surgery and retinal
translocation, which are surgical procedures to remove the abnormal blood vessels and rotate
the macular center away from the abnormal blood vessels, respectively. In other studies,scientists are investigating the possibility of transplanting healthy cells into a diseased retina
and researching certain anti-inflammatory treatments.

Written by Sharon BeltrandelRio©MANABI Limited

Discussion questions
1.

Please summarize the article. What is the main point of the article?

2.

Please describe AMD.

3.

How does AMD affect patients’ quality of life?

4.

What are the symptoms of AMD?

5.

What are the risk factors?

6.

What options are available for treating AMD?

7.

What types of treatments are scientists currently researching?

1.

World Health Organization. Magnitude and causes of visual impairment. Fact sheet No. 282. November
2004. http://www.who.int/mediacentre/factsheets/fs282/en/ andhttp://www.who.int/blindness/causes/priority/en/index8.html. Accessed 23 June 2006.
WebMD. Eye health: Macular degeneration.
http://aolsvc.health.webmd.aol.com/content/article/63/72004.htm. Accessed 23 June 2006.
World Health Organization. Age related macular degeneration.
http://www.who.int/blindness/causes/priority/en/index8.html. Accessed 23 June 2006.
National Eye Institute of the National Institutes of Health in the United States. The AREDS Formulation
and Age-Related Macular Degeneration. http://www.nei.nih.gov/amd/summary.asp. Accessed 23 June 2006.

2.
3.
4.

Written by Sharon BeltrandelRio©MANABI Limited

Topic 10
The Human Skeleton
人間の骨格
When we think about the body’s skeleton, we usually picture the bones, one of the human body’s
hardest, most durable substances. When we think about the bones’ function in the human body,
we usually assume that they are responsible for giving the body its shape, and protecting andsupporting organs, tissues and other body parts.
However, the skeleton is much more dynamic than that. In addition to the functions listed above,bones repair and renew themselves constantly, and they are involved in the body’s mineralbalance. Bone is mostly (65%) made up of hard minerals such as calcium, phosphate, magnesium
and other minerals; the other 35% is made of a soft protein called collagen1. Bones consist of two
distinct structures: trabecular bone (which appears spongy-looking) is found on the inside, and issurrounded by cortical bone (a tough, dense outer layer) on the outside. The combination of hardand soft materials, plus the combination of structures, makes bones strong and flexible2.
In addition to consisting of two types of materials and two types of structures, bones rely on two
types of cells, osteoclasts and osteoblasts, both of which are scattered throughout the bones, fortheir constant renewal process. In this process, old or damaged bone is taken away and resorbedby the body and new, healthy bone takes its place. The osteoclasts break down the old bone, andthen the osteoblasts put down the new bone3. Throughout childhood and into young adulthood(twenties), new bone formation surpasses bone resorption. However, after the age of thirty thisprocess begins to reverse and bone resorption exceeds new bone formation. This means thatpeople reach their peak bone mass by age thirty, after which bone density slowly begins todecrease4. For women, the rate of decrease in bone density accelerates after menopause due tothe lack of estrogen. Men’s bone density also diminishes, although at a slower rate, as
testosterone levels decrease with age5.
The skeleton also contributes to the body’s mineral balance. The human body contains
approximately 900 to 1800 grams of calcium, nearly 99 percent of which can be found in the teeth
and skeleton6. Although the remaining one percent is a very small amount, it plays a critical role infunctions such as blood clotting, nerve transmission and muscle contraction (including theheartbeat)7. The blood level of calcium is kept in a very narrow range, and when needed, bones
release calcium.
Since people reach their peak bone mass by age thirty, it is important to build up as much bone aspossible during childhood and the early adult years in order to prevent diseases such as
osteoporosis (a disease in which the bones become thin and brittle, and as a consequence breakeasily). Peak bone mass depends about 80% on genetics and 20% on lifestyle factors (diet,exercise, habits); however, as mentioned above sexual hormones (estrogen and testosterone) arealso a critical factor8. It is important that both children and adults receive adequate amounts ofcalcium and vitamin D. In addition, regular weigh-bearing exercise (such as walking, hiking,jogging, and dancing) is important for building and maintaining a strong skeleton. Finally, it isimportant to avoid tobacco use and limit alcohol intake9. Hopefully understanding the skeleton’s
important role in maintaining our health will motivate us to lead a healthy lifestyle!

Written by Sharon BeltrandelRio©MANABI Limited

Discussion questions
1.

Please summarize the article. What is the main point of the article?

2.

What is the role of the skeleton in the human body?

3.

What does bone consist of and what is its structure?

4.

What are osteoclasts and osteoblasts? What are their functions?

5.

How do bones contribute to the body’s mineral balance?

6.

What factors determine peak bone mass?

7.

What can be done to help ensure that bones develop properly and remain healthy?

1.

Becker, Carolyn. Prevention of osteoporosis: Maximizing peak bone mass.
http://attworldnet.healthology.com/focus_article.asp?b=attworldnet&f=osteoporosis&c=peakbonemass_article&spg=SCH. Accessed 25 July 2006.
Strange, Carolyn. Boning up on osteoporosis. WebMD Public Information from the FDA.
http://www.webmd.com/content/article/7/1680_51715.htm. Accessed 25 July 2006.
Becker, Carolyn. Prevention of osteoporosis: Maximizing peak bone mass.
http://attworldnet.healthology.com/focus_article.asp?b=attworldnet&f=osteoporosis&c=peakbonemass_article&spg=SCH. Accessed 25 July 2006.
Becker, Carolyn. Prevention of osteoporosis: Maximizing peak bone mass.
http://attworldnet.healthology.com/focus_article.asp?b=attworldnet&f=osteoporosis&c=peakbonemass_article&spg=SCH. Accessed 25 July 2006.
Becker, Carolyn. Prevention of osteoporosis: Maximizing peak bone mass.
http://attworldnet.healthology.com/focus_article.asp?b=attworldnet&f=osteoporosis&c=peakbonemass_article&spg=SCH. Accessed 25 July 2006.
Strange, Carolyn. Boning up on osteoporosis. WebMD Public Information from the FDA.
http://www.webmd.com/content/article/7/1680_51715.htm. Accessed 25 July 2006.
Strange, Carolyn. Boning up on osteoporosis. WebMD Public Information from the FDA.
http://www.webmd.com/content/article/7/1680_51715.htm. Accessed 25 July 2006.
Becker, Carolyn. Prevention of osteoporosis: Maximizing peak bone mass.
http://attworldnet.healthology.com/focus_article.asp?b=attworldnet&f=osteoporosis&c=peakbonemass_article&spg=SCH. Accessed 25 July 2006.
Becker, Carolyn. Prevention of osteoporosis: Maximizing peak bone mass.
http://attworldnet.healthology.com/focus_article.asp?b=attworldnet&f=osteoporosis&c=peakbonemass_article&spg=SCH. Accessed 25 July 2006.

2.
3.

4.

5.

6.
7.
8.

9.

Written by Sharon BeltrandelRio©MANABI Limited

Topic 11
Osteoporosis: Not Just a Women’s Disease
骨粗しょう症
Osteoporosis, which means “porous bones”, is a disease in which the bones become thin and brittle,
and as a consequence, break easily. It affects more than 200 million women world-wide, andapproximately thirty percent of women over the age of 50 have one or more vertebral fracturesduring their lifetime1. But osteoporosis also affects men. One out of every five men over the age offifty will suffer from an osteoporosis-related fracture during their lifetime2. More than 1.5 million
osteoporosis-related fractures occur in men and women annually3. Most fractures occur in the spine,
hip and wrist, and cause suffering, disability and a diminished quality of life. In fact, according to
the International Osteoporosis Foundation, twenty percent of all patients die within one year after a
hip fracture4.
There is no single factor that causes osteoporosis, but a combination of genetic, dietary, hormonal,
age-related and lifestyle factors contribute to its development5. Throughout childhood and theteenage years, the body develops new bone faster than existing bone is absorbed by the body. Bonemass peaks at about age thirty, then this process begins to reverse, and bone begins to be absorbedby the body faster than new bone is made. The volume of bone remains about the same, but its
density decreases6.
Low bone mass is the most important risk factor, and therefore sufficient calcium and vitamin D
intake during childhood and young adulthood is critical to reaching peak adult bone mass7. Otherrisk factors include being female, having a small-boned frame, family history of osteoporosis, early
estrogen deficiency, ethnic heritage (white and Asian women are at a higher risk than AfricanAmerican and Hispanic women), and advanced age8. Although genetics determine the maximum
amount of bone mass an individual can acquire, lifestyle habits such as eating a diet rich in calcium
and vitamin D, exercising regularly, refraining from tobacco use and limiting alcohol consumption
can help build and maintain bone mass9.
Bone loss increases in women around menopause, when the ovaries decrease their production of
estrogen. In men, bone loss increases when the production of testosterone decreases, at about 45 to
50 years of age10. However, since men tend to build more bone mass than women, they tend to get
to osteoporosis later in life11. Most people do not experience symptoms in the early stages ofosteoporosis. However, as the disease progresses, symptoms such as back pain, loss of height, acurved upper back and broken bones may occur.
Osteoporosis treatment includes the lifestyle habits mentioned above (eating a diet rich in calcium
and vitamin D, exercising regularly, refraining from tobacco use and limiting alcohol consumption),but can also include medication to reduce bone loss and increase bone density. Biophosphates (forexample, alendronate, ibandronate and risedronate), reduce the rate of bone loss and can be taken by
men and women. Raloxine, a selective estrogen receptor modulator, reduces the rate of bonethinning and produces some increase in bone thickness, but it can only be taken by women (unlike
estrogen, raloxine does not cause an increased risk of endometrial cancer). Calcitonin, a hormonethat regulates calcium levels in the body, slows the rate of bone loss and can be taken by men andwomen. Finally, parathyroid hormone can be used for men and women with severe osteoporosis12.

Written by Sharon BeltrandelRio©MANABI Limited

Discussion questions
1.

Please summarize the article. What is the main point of the article?

2.

What is osteoporosis?

3.

Who is affected by osteoporosis?

4.

What causes osteoporosis?

5.

What are the symptoms of osteoporosis?

6.

What can be done to prevent osteoporosis?

7.

How can osteoporosis be treated?

1.

International Osteoporosis Foundation. 2006.
http://www.osteofound.org/health_professionals/teaching_resources/download/teaching_slide_kit.pdf.
Accessed 25 July 2006.
International Osteoporosis Foundation. 2006.
http://www.osteofound.org/health_professionals/teaching_resources/download/teaching_slide_kit.pdf.
Accessed 25 July 2006.
International Osteoporosis Foundation. 2006.
http://www.osteofound.org/health_professionals/teaching_resources/download/teaching_slide_kit.pdf.
Accessed 25 July 2006.
International Osteoporosis Foundation. 2006.
http://www.osteofound.org/health_professionals/teaching_resources/download/teaching_slide_kit.pdf.
Accessed 25 July 2006.
Strange, Carolyn. Boning up on osteoporosis. WebMD Public Information from the FDA.
http://www.webmd.com/content/article/7/1680_51715.htm. Accessed 25 July 2006.
Strange, Carolyn. Boning up on osteoporosis. WebMD Public Information from the FDA.
http://www.webmd.com/content/article/7/1680_51715.htm. Accessed 25 July 2006.
Strange, Carolyn. Boning up on osteoporosis. WebMD Public Information from the FDA.
http://www.webmd.com/content/article/7/1680_51715.htm. Accessed 25 July 2006.
Strange, Carolyn. Boning up on osteoporosis. WebMD Public Information from the FDA.
http://www.webmd.com/content/article/7/1680_51715.htm. Accessed 25 July 2006.
Strange, Carolyn. Boning up on osteoporosis. WebMD Public Information from the FDA.
http://www.webmd.com/content/article/7/1680_51715.htm. Accessed 25 July 2006.
WebMD. Osteoporosis: What increases your risk. http://www.webmd.com/hw/osteoporosis/hw131497.asp.
Accessed 25 July 2006.
WebMD. Osteoporosis: What happens. http://www.webmd.com/hw/osteoporosis/hw131462.asp. Accessed
25 July 2006.
WebMD. Osteoporosis: Medications. http://www.webmd.com/hw/osteoporosis/hw131640.asp. Accessed
25 July 2006.

2.

3.

4.

5.
6.
7.
8.
9.
10.
11.
12.

Written by Sharon BeltrandelRio©MANABI Limited

Topic 12
Arthritis: A Description of Three Common Disease Types
関節炎
Like many English words describing medical conditions, the word ‘arthritis’ comes from the Greek
language: arthro means joint and itis means inflammation. There are more than 100 different typesof arthritis, including osteoarthritis, rheumatoid arthritis and gout. Arthritis is a major cause ofmorbidity and significantly influences the health and quality of life of millions of people around theworld. Approximately 40% of people over 70 years old suffer from osteoarthritis of the knee and
80% of people with osteoarthritis have some limitation of movement, including 25% that cannot
perform major daily life activities1. In more than 50% of rheumatoid arthritis cases, the diseaseleads to the inability to work within ten years of onset2.
The most common type of arthritis is osteoarthritis, which occurs when the cartilage covering theend of the bones gradually wears away. Osteoarthritis is sometimes called degenerative joint
disease because it often occurs as the cartilage degenerates, or breaks down. The joints mostcommonly affected include the hips, knees and spine, all of which are weight bearing joints. The
fingers, neck and large toe can also be affected3. Heredity (an inherited defect in one of the genesthat makes cartilage, leading to more rapid deterioration of joints), obesity, injury and joint overuse
may increase a person’s risk of developing osteoarthritis4. The disease is usually treated by
medication (e.g., pain-relievers such as acetaminophen and anti-inflammatory drugs, creams,
steroids), exercise, hot and cold compresses to the painful joint, the use of supportive devices suchas canes, and weight loss. When other treatment options have not been effective, surgery may be
performed to relieve pain5.
Rheumatoid arthritis, an autoimmune disease, occurs when immune cells migrate from the blood
into the joints and produce substances that cause inflammation. This results in joint irritation,
causing the cartilage to wear down, and the joint lining (synovium) to swell and produce fluid6. The
joints become very painful, swollen and warm to the touch. Rheumatoid arthritis occurs in joints on
both sides of the body; its symmetrical nature is one distinguishing factor from other types ofarthritis. It occurs most commonly in the hands, wrists and knees. In rheumatoid arthritis,
something seems to trigger the immune system to attack the joints. The exact cause is unknown, but
a combination of genetic, environmental and hormonal factors are thought to play a role7.
Treatments include medications (e.g., anti-inflammatory drugs and disease-modifying antirheumatic drugs that interfere with or suppress the immune system’s attack on the joints), rest andexercise, and surgery to correct joint damage8.
Gout, another common type of arthritis, occurs when the body cannot eliminate uric acid, a natural
substance produced during the breakdown of RNA and DNA in cells. Foods such as red meats,
organ meats (e.g., liver, kidney) and anchovies contain large amounts of uric acid. It usually
dissolves in the blood, passes through the kidneys and leaves the body. Gout occurs when excess
uric acid forms needle-like crystals in the joints, causing sudden, severe pain and tenderness, as well
as swelling. It most often affects the big toe, knee and wrist joints9. Since heredity partly
determines the kidney’s ability to rid the body of uric acid, not everyone with high levels of uricacid will develop gout. Symptoms can often be treated and controlled, but there is no cure for gout.
Treatments include NSAIDs (non-steroidal anti-inflammatory drugs), corticosteroids andcolchicine10.

Written by Sharon BeltrandelRio©MANABI Limited

Most types of arthritis can be managed, and the pain and disability minimized, with early diagnosis.
To reduce the risk of developing arthritis and to prevent or slow joint damage, it is important tomaintain a healthy weight, exercise regularly, use joint-protecting devices and techniques (e.g.,proper lifting posture) and eat a healthy diet11.

Discussion questions
1.
Please summarize the article. What is the main point of the article?
2.
Who is affected by arthritis?
3.
What causes osteoarthritis?
4. What is rheumatoid arthritis?
5. What is gout?
6.
Please describe the treatments for the types of arthritis in this article.
7. How can the risk of developing arthritis be reduced?

1.

2.

3.
4.
5.
6.
7.
8.
9.
10.
11.

World Health Organization Scientific Group. The burden of musculoskeletal conditions at the start of
the new millennium. World Health Organization. 2003.
http://whqlibdoc.who.int/trs/WHO_TRS_919.pdf. Accessed 22 September 2006.
World Health Organization Scientific Group. The burden of musculoskeletal conditions at the start of
the new millennium. World Health Organization. 2003.
http://whqlibdoc.who.int/trs/WHO_TRS_919.pdf. Accessed 22 September 2006.
Arthritis: Arthritis basics. WebMD. http://www.webmd.com/content/article/78/95594.htm. Accessed
22 September 2006.
Arthritis: Osteoarthritis basics. WebMD. http://www.webmd.com/content/article/78/95594.htm.
Accessed 22 September 2006.
Arthritis: Osteoarthritis basics. WebMD. http://www.webmd.com/content/article/78/95594.htm.
Accessed 22 September 2006.
Arthritis: Rheumatoid arthritis basics. WebMD. http://www.webmd.com/content/article/78/95599.htm.
Accessed 22 September 2006.
Arthritis: Rheumatoid arthritis basics. WebMD. http://www.webmd.com/content/article/78/95599.htm.
Accessed 22 September 2006.
Arthritis: Rheumatoid arthritis basics. WebMD. http://www.webmd.com/content/article/78/95599.htm.
Accessed 22 September 2006.
Arthritis: Gout basics. WebMD. http://www.webmd.com/content/article/78/95591.htm. Accessed 22
September 2006.
Arthritis: Gout basics. WebMD. http://www.webmd.com/content/article/78/95591.htm. Accessed 22
September 2006.
[xi] Arthritis: Arthritis basics. WebMD. http://www.webmd.com/content/article/78/95594.htm.
Accessed 22 September 2006.

Written by Sharon BeltrandelRio©MANABI Limited

Topic 13
How Long is Too Long?
日本の患者の平均入院日数は異常に長い？
In Japan, acute care* patients stayed in the hospital for an average of 20.7 days in 2003. In the
U.S., the average length of stay was 5.7 days. The average length of stay in OECD countries**
was 6.8 days.1 Why did Japanese patients spend nearly three times as many days in the hospitalcompared to patients in other industrialized nations?
Of course the optimum length of a patient’s stay depends on his or her injury or disease, andthere are many factors to consider. However, similar differences in length of hospital stay were
found in a study evaluating patients with the same condition, acute myocardial infarction. Data
regarding patients admitted to teaching hospitals in the United States, Japan, Brazil, Germany
and Switzerland were analyzed.2 The average length of stay ranged from 7.7 +/- 4.3 days in theAmerican hospital to 47.2 +/- 27.9 days in the Japanese hospital.3 The researchers did not detecta difference in outcomes at one year. Although the U.S. hospital had the lowest prevalence ofantero-septal myocardial infarction and the lowest use of thrombolytic therapy, the difference inaverage length of stay is noteworthy.
When Japanese researchers at the Hyogo Brain and Heart Center evaluated another specificcondition, acute ischemic stroke, they found that the mean length of hospital stay for Japanesepatients was 33 days, more than three times longer than in the United States.4 They explainedthat the variation may be due to a difference in hospital type or healthcare systems. For
example, in Japan stroke centers usually provide care for the acute and subacute phases ofstroke. They also mention that the payment system may influence the length of stay. In a
separate analysis involving ischemic stroke, Senior Economist Reiko Suzuki of the Japan
Center for Economic Research attributes the difference to the abundant supply of beds in Japanand the fee-for-service system which allows hospitals and patients to use health services asmuch as they like.5
The cost of health care is increasing around the world. Governments will have to raise taxes or
people will have to pay more out of their own pockets if current trends continue. In order toreform health care systems and decrease costs, it is important to understand the impact of
current policies and provide patients with incentives to take care of themselves (e.g., maintain ahealthy weight and refrain from using tobacco). Incentives should also be used to encourage
health care professionals to provide high quality medical care at the lowest possible cost.

*Acute care includes all types of medical care, excluding long-term care. It includes rehabilitative care, palliative
care and acute psychiatric care.
**OECD stands for Organization for Economic Cooperation and Development. It consists of 30 countries
committed to democratic government and the market economy, including Australia, Austria, Belgium, Canada,
Czech Republic, Denmark, Finland, France, Germany, Greece, Hungary, Iceland, Italy, Ireland, Japan, Korea,
Luxembourg, Mexico, Netherlands, New Zealand, Norway, Poland, Portugal, Slovak Republic, Spain, Sweden,
Switzerland, Turkey, United Kingdom, and United States.

Written by Sharon BeltrandelRio©MANABI Limited

Discussion questions
1.
Please summarize the article. What is the main point of the article?
2.

What is the average length of time that acute care patients stay in the hospital in Japan, theU.S.? What is the average length of stay for patients in OECD member nations?

3.

Were similar differences in the average length of hospital stay found when researchers
studied specific diseases? Please describe the findings of the studies evaluating acute
myocardial infarction and ischemic stroke.

4.

Why do Japanese patients spend nearly three times as many days in the hospital comparedto other industrialized nations?

5.

Do you think that Japanese patients spend too many days in the hospital? Why or why
not?

6.

Do you think that American patients spend too few days in the hospital? Why or why not?

7.

What can be done to decrease health care costs?

1.
2.

OECD Health Data 2005.
Teaching hospitals were: Brigham and Women's Hospital, USA; Iizuka Hospital, Japan; Hospital de Clinicas
de Porto Alegre, Brazil; Universitätsklinikum Charité, Germany; and Hôpital Cantonal Universitaire deGenève, Switzerland.
K Matsui, et. al. Management of patients with acute myocardial infarction at five academic medical centers:
clinical characteristics, resource utilization, and outcome. Journal of Investigative Medicine. 1999 March;
47:134-40. http://lib.bioinfo.pl/auth:Okamatsu,S. Accessed 23 October 2006.
Yukihiro Yoneda, et. al. Hospital-based study of the care and cost of acute ischemic stroke in Japan. Stroke.
2003; 34:718.
http://ahavj.ahajournals.org/cgi/content/full/strokeaha;01.STR.0000056171.55342.FF#TBL5
Accessed 23 October 2006.
Reiko Suzuki. A comparison of health care technology: Why is treatment so different across countries? Japan
Center for Economic Research. July 2003. http://www.jcer.or.jp/eng/pdf/kenrep030715e.pdf. Accessed 23
October 2006.

3.

4.

5.

Written by Sharon BeltrandelRio©MANABI Limited

Topic 14
Knee Replacement Surgery-- Part 1: A Technical Overview
膝関節移植手術①

Knee replacement surgery has become very common in the United States, and is becoming
increasingly common around the world. According to the United States National Center for
Health Statistics, the rate of knee replacement in the U.S. increased 70% during the period 19952004, for people 65 years and older.1 An estimated 300,000 knee replacements are performed in
the U.S. each year and the costs of knee replacement surgery totaled $11.9 billion in the UnitedStates in 2003.2, 3Equally important, the surgery has had a tremendous impact on improving thequality of life for thousands of people.4
The knee joint is one of the most important joints in the body, as well as the largest and mostcomplex joint. It is a hingelike joint, formed where the femur (thighbone), tibia (shinbone) andpatella (kneecap) meet. Two rounded protrusions at the end of the femur and two at the end of
the tibia slide against each other, enabling the knee to bend. Cartilage, a smooth layer of tissue,
covers the protrusions so that the femur and tibia move smoothly against each other. The
remaining surfaces are covered by synovial membrane, a thin, smooth tissue that releases a
special fluid to lubricate the knee and reduce friction. The patella is a thick flat triangular bonethat protects the front of the joint and increases the leverage of the quadriceps (thigh muscle).
Stability is provided by large ligaments attached to the femur and tibia, and the quadriceps gives
the knee strength.
Infection, injury and disease can result in knee pain and stiffness. Ninety-seven percent of all
knee replacements are performed due to osteoarthritis.5 Osteoarthritis causes swelling of thejoints and friction between the cartilage and bones. The friction causes the cartilage and bones
to break down, and then the bones begin to move against each other, resulting in pain and loss of
movement. Knee replacement surgery is performed when medication and walking aids nolonger provide relief. In knee replacement surgery, the roughened ends of the femur and tibia, as
well as the underside of the patella, are replaced with a knee prosthesis. The prosthesis is madeof metal (usually titanium, stainless steel or cobalt) and polyethylene, a type of plastic. The
prosthesis is held in place by special cement and the bone growing into the prosthesis. The
complication rate after knee replacement surgery is low, about 2 percent.6
Knee replacement surgery, first performed in 1968, is one of the most important orthopedic
surgical advances of the twentieth century.7 Knee replacement techniques, prostheses and carehave improved significantly during the past few decades. In the future, the prevalence of knee
replacement surgery is expected to increase due to the aging population and increasing trends inoverweight and obesity.

Written by Sharon BeltrandelRio©MANABI Limited

Discussion questions
1.
Please summarize the article. What is the main point of the article?
2.

How many knee replacements are performed in the U.S. and what are the total costs?

3.

Please describe the knee joint.

4.

How does the knee joint work? Why is the knee an important joint?

5.

Why is knee replacement sometimes required?

6.

Please describe knee replacement surgery.

7.

Why is the prevalence of knee replacement increasing?

References:
Total Knee Replacement. Morton Plant Mease Health Care. Clearwater, FL. Received 2006.
After Total Knee Replacement. The StayWell Company. San Bruno, CA. September 2005.
1.
2.

3.

4.
5.

6.

7.

Maturity Health Matters, FDA News for Older Adults, their Families and Caregivers. Issue 3, summer
2006. http://www.fda.gov/cdrh/maturityhealthmatters/issue3.html#1 (Accessed December 1, 2006)
American Academy of Orthopaedic
Surgeons.http://orthoinfo.aaos.org/fact/thr_report.cfm?Thread_ID=513&topcategory=Knee (Accessed
December 1, 2006)
National Center for Health Statistics, Health, United States, 2006, With Chartbook on Trends in the
Health of Americans, Hyattsville, MD: 2006 http://www.cdc.gov/nchs/data/hus/hus06.pdf (Accessed
December 1, 2006)
Maturity Health Matters, FDA News for Older Adults, their Families and Caregivers. Issue 3, summer
2006. http://www.fda.gov/cdrh/maturityhealthmatters/issue3.html#1 (Accessed December 1, 2006)
National Center for Health Statistics, Health, United States, 2006, With Chartbook on Trends in the
Health of Americans, Hyattsville, MD: 2006 http://www.cdc.gov/nchs/data/hus/hus06.pdf (Accessed
December 1, 2006)
American Academy of Orthopaedic Surgeons.
http://orthoinfo.aaos.org/fact/thr_report.cfm?Thread_ID=513&topcategory=Knee (Accessed
December 1, 2006)
American Academy of Orthopaedic Surgeons.
http://orthoinfo.aaos.org/fact/thr_report.cfm?Thread_ID=513&topcategory=Knee (Accessed
December 1, 2006)

Written by Sharon BeltrandelRio©MANABI Limited

Topic 15
Knee Replacement Surgery-- Part 2: A Patient’s Perspective
膝関節移植手術②In the U.S., when a physician recommends knee replacement surgery, he also provides thepatient with a pre-surgery strengthening program. This program consists of a series of exercisesthat the patient can do at home to strengthen the muscles surrounding the knee and to improveoverall fitness. The patient’s general health is checked by physicians on an out-patient basis, andhe (or she) arrives at the hospital the day of the surgery. Knee replacement surgery takes
approximately one to two hours. Immediately after the surgery, foot and ankle movement isencouraged to increase blood flow and prevent swelling and blood clots in the leg. In addition,
many patients use a continuous passive motion (CPM) machine, which is designed to gently
bend and straighten the knee. Physical therapy begins the day after surgery.
Most patients spend three or four nights in the hospital, by which time they are able to walk witha walking aid (a walker or crutches). When patients are discharged they usually go home,although some patients go to a rehabilitation center. A nurse visits patients at home two or threetimes during the first week and once or twice during the second week. The nurse checks thepatient’s general condition, heart and blood, and closely inspects the knee to ensure that it ishealing properly. A physical therapist visits three times a week for about four weeks. Physicaltherapy enables the patient to gradually increase the new knee’s strength and flexibility. The
patient should perform physical therapy exercises, an extremely important part of the healing
process, at least three times a day, after which ice must be applied to the knee to reduce swelling.
A variety of medications are used throughout the surgery and recovery periods. Usually generalanesthesia is used during the surgery. After surgery, physicians choose the most appropriate pain
control medicine based on the patient’s needs (I.V.’s, pills or injections). Anti-inflammatory
drugs such as celecoxib and anti-coagulants such as warfarin may also be prescribed. The
patient performs respiratory exercises to prevent lung congestion and is encouraged to eat anutritious diet. Protein, zinc, fluids, calcium, iron, vitamin A and vitamin C are especially
important to the healing process. By eating a healthy diet and diligently doing physical therapy
the patient can usually resume his normal daily activities within a short period, and his quality oflife greatly improves due to his increased mobility and decreased pain.

Discussion questions
1.
Please summarize the article. What is the main point of the article?
2.
How do patients prepare for surgery?
3.
What happens after the surgery?
4.
Why is physical therapy important?
5.
What medications are used during knee replacement surgery and the recovery period?
6. What should a patient do to ensure a full recovery?
7. Are there any differences between knee replacement surgery as described in this article andas performed in Japan? What are they?

Written by Sharon BeltrandelRio©MANABI Limited

References:
Maturity Health Matters, FDA News for Older Adults, their Families and Caregivers. Issue 3, summer 2006.
http://www.fda.gov/cdrh/maturityhealthmatters/issue3.html#1 (Accessed December 1, 2006)
American Academy of Orthopaedic Surgeons.
http://orthoinfo.aaos.org/fact/thr_report.cfm?Thread_ID=513&topcategory=Knee (Accessed December 1, 2006)
Bren, Linda. Joint Replacement: An Inside Look. FDA Consumer Magazine. March-April 2004 Issue.
http://www.fda.gov/fdac/features/2004/204_joints.html (Accessed December 21, 2006)

Written by Sharon BeltrandelRio©MANABI Limited

Topic 16
An introduction to Type 2 Diabetes
2型糖尿病“Diabetes is a major threat to global public health that is rapidly getting worse,and the biggest impact is on adults of working age in developing countries. At
least 171 million people worldwide have diabetes. This figure is likely to morethan double by 2030 to reach 366 million."-- World Health Organization1

Diabetes mellitus is a serious disease that can be life threatening. In 2000, nearly 6.8 million
Japanese suffered from diabetes, and this number is expected to increase to nearly 8.9 million by
2030.2 Diabetes is a chronic disease in which the pancreas cannot produce enough insulin or the
body cannot use the insulin it produces effectively. Over time, diabetes, especially uncontrolled
diabetes, can lead to serious damage of the nerves, blood vessels and other areas. According to
the World Health Organization, almost three million people worldwide die annually due todiabetes.3
Diabetes comes from the Greek word meaning ‘passing through’ or ‘siphon’ and refers to one ofthe disease’s major symptoms: excessive urine production. Mellitus comes from the Latin word
meaning ‘sweet taste’ and refers to the sweetness of the urine. There are three main types ofdiabetes: Type 1, Type 2 and gestational diabetes. This article focuses on Type 2 diabetes(subsequent articles will focus on the other types).
Ninety percent of the people with diabetes suffer from Type 2 diabetes (formerly called noninsulin-dependent or adult-onset diabetes), in which the body cannot effectively use insulin.4
Insulin, a hormone produced in the pancreas, regulates carbohydrate metabolism, has effects on
fat metabolism and impacts the liver’s activity in storing or releasing glucose and in processing
blood lipids.5 In patients with Type 2 diabetes, since the body cannot effectively use insulin,
blood glucose levels increase and over time damage the heart, blood vessels, eyes, kidneys andnerves.
The symptoms of Type 2 diabetes include polydipsia (thirst), polyuria (excessive urination),constant hunger, weight loss, vision changes and fatigue.6 Type 2 diabetes is largely the result ofexcess body weight and lack of exercise, although genetic factors may also increase a person’s
susceptibility.
Initial treatment of Type 2 diabetes includes diet and exercise, and even moderate weight loss
can result in a significant improvement. Oral antidiabetic drugs such as sulfonylureas,
biguanides (metformin) and thiazolidinedines are often used to treat Type 2 diabetes. One of thenewest treatments, exanatide, is an incretin mimetic. Incretins such as GLP-1 (glucagon-like
peptide-1) enhance glucose-dependent insulin secretion and have other antihyperglycemic
actions following their release into the circulation from the gut.7 Exanatide (Byetta) is aninjectable medicine used to improve glucose control. There is no cure for Type 2 diabetes, but it
can be prevented by maintaining a healthy weight, exercising regularly and eating healthy foods.

Written by Sharon BeltrandelRio©MANABI Limited

Discussion questions
1.
Please summarize the article. What is the main point of the article?
2. What is diabetes?
3.
How many people suffer from diabetes?
4. What causes diabetes?
5.
Why do you think the incidence of diabetes is increasing so rapidly?
6.
What medications are used to treat diabetes?
7.
How can diabetes be prevented?

1.
2.
3.
4.
5.
6.
7.

World Health Organization. Diabetes Programme. http://www.who.int/diabetes/en/ (Accessed January
25, 2007).
World Health Organization. Diabetes Programme.
http://www.who.int/diabetes/facts/world_figures/en/index6.html (Accessed January 25, 2007).
World Health Organization. Diabetes Programme. http://www.who.int/diabetes/facts/en/ (Accessed
January 25, 2007).
World Health Organization. Diabetes Programme.
http://www.who.int/mediacentre/factsheets/fs312/en/ (Accessed January 25, 2007).
Wikipedia. Insulin. http://en.wikipedia.org/wiki/Insulin (Accessed January 25, 2007).
World Health Organization. Diabetes Programme.
http://www.who.int/mediacentre/factsheets/fs312/en/ (Accessed January 25, 2007).
Amylin and Eli Lilly. Byetta package insert. http://pi.lilly.com/us/byetta-pi.pdf (Accessed January 25,2007).

Written by Sharon BeltrandelRio©MANABI Limited

Topic 17
An introduction to Type 1 Diabetes
1型糖尿病
Type 1 diabetes is an autoimmune disease that affects approximately one of every 250
Americans.1 Japan has one of the lowest incidence rates of Type 1 diabetes in the world,
averaging 2.37 cases per 100,000 persons in children aged 0-14.2
Usually insulin is secreted by the pancreas in small amounts. However, after a meal, glucose
from the food stimulates the pancreas to release insulin in an amount based on the size of themeal. Once insulin has transported the glucose to the body’s cells and the amount of glucose in
the blood has decreased, the beta cells in the pancreas reduce the amount of insulin secreted to
avoid hypoglycemia (low blood glucose levels). In Type 1 diabetes, the body’s immune system
destroys the beta cells (which are responsible for producing insulin) in the pancreas. This results
in a complete lack of insulin. Without insulin, the body cannot move nutrients, especiallyglucose, into the body’s cells where the nutrients are used as a source of energy to function, andthe entire process breaks down.
Researchers are not sure what causes Type 1 diabetes. There is a genetic component that makes
certain people susceptible, but scientists also believe that an environmental trigger plays a role incausing the disease. It appears that something in the environment, perhaps a toxin or a virus,
tricks the immune system into mistakenly destroying the beta cells. Autoantibodies, markers ofthe destruction, can be seen in 85 to 90 percent of people with Type 1 diabetes when their blood
glucose levels are high.3
The symptoms of Type 1 diabetes include polydipsia (thirst), polyuria (excessive urination),increased hunger, dry mouth, nausea, unexplained weight loss and fatigue. Currently it is notpossible to prevent diabetes, and there is no cure. People with Type 1 diabetes inject insulin tomaintain their blood glucose levels within the normal range. Exubera (insulin human [rDNA
origin]), the first inhaled insulin, was approved by the U.S. Food and Drug Administration in2006. It is a short-acting insulin designed to be taken just before meals, and is usually used in
combination with longer-acting injected insulins. Other forms of insulin, such as mouth sprays
and topical applications (e.g., patches), are also in development.
When blood glucose levels are not well controlled, retinopathy, nephropathy (kidney damage)and neuropathy (damage to nerves) can result. However, with effective meal planning, exercise
and intensive insulin therapy, many people with Type 1 diabetes live long and healthy lives.

Written by Sharon BeltrandelRio©MANABI Limited

Discussion questions
1.
Please summarize the article. What is the main point of the article?
2.
What is the prevalence of Type 1 diabetes?
3.
What is Type 1 diabetes?
4.
What causes Type 1 diabetes?
5. How is Type 1 diabetes treated?
6. What are the potential long-term effects of Type 1 diabetes?
7. How can the potential long-term effects of Type 1 diabetes be avoided?

1.
2.

3.

WebMD.com. http://diabetes.webmd.com/guide/diabetes-type-1-diabetes. (Accessed February 26, 2007).
Kawasaki E, Matsuura N, Eguchi K. Type 1 diabetes in Japan. Diabetologia. 2006 May; 49(5):828-36.
Epub 2006 Mar 28.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=16568259&dopt=Abstract. (Accessed February 26, 2007).
WebMD.com. http://diabetes.webmd.com/guide/diabetes-type-1-diabetes?page=2 (Accessed February 26,2007).

Written by Sharon BeltrandelRio©MANABI Limited

Topic 18
The Mind’s Effect on the Body: The Placebo Effect and White Coat Syndrome
プラシーボ効果及び白衣高血圧症
According to the American Heritage Science Dictionary, a placebo is a substance containing no
medication that is used as a control in a clinical research trial to determine the effectiveness of apotential new drug.1 Those receiving the placebo sometimes get better, a phenomenon known as
the placebo effect. Although doctors and researchers have known about the placebo effect for along time, it is not well understood.
Professor Fabrizio Benedetti of the University of Turin in Italy has shown that a saline placebo
can reduce tremors and muscle stiffness in people with Parkinson’s disease.2 When measuring
the activity of neurons in patients’ brains during the administration of saline, they found that
individual neurons in the subthalamic nucleus (the part of the brain that is sometimes a target
when using surgery in an attempt to relieve Parkinson’s symptoms) had the desired affect offiring less often when the saline was given. The neuron activity decreased at the same time as
the symptoms improved.
However, it appears that the placebo effect can be either positive or negative and depends on theactivities surrounding the medical treatment. In a study performed by Ted Kaptchuk (AssistantProfessor of Medicine, Harvard Medical School) et al, researchers compared two placebo
treatments: a sham device and inert pills.3 The researchers recruited 270 volunteers sufferingfrom chronic arm pain due to repetitive use that had lasted at least three months despite
treatment and who scored three or more on a ten-point scale. The patients were randomized toreceive either acupuncture with a sham device (trick needles whose tips retract so they don’t
penetrate the skin) twice a week for six weeks or blue cornstarch pills once a day for eight weeks.
Twenty-five percent of the acupuncture group experienced side effects from the nonexistentneedle pricks, including 19 people who experienced pain and four people whose skin became redor swollen. In the cohort taking the sugar pill, 31 percent experienced side effects including
dizziness, restlessness, rashes, headaches, nausea and nightmares. Dry mouth and fatigue werethe most common complaints, and 3 patients withdrew from the study after reducing the dosage
failed to control their symptoms. The side effects reported by the participants exactly matchedthose described by the physicians when the patients joined the study.
At the end of the study, the patients receiving the fake acupuncture (sham device) reported that
their pain decreased an average of 2.64 points on the ten-point scale and those taking the sugar
pills said their pain decreased an average of 1.5 points.4 In other words, the sham device had agreater effect than the placebo pill on self reported pain. The researchers believe that thedifference may be due to the activities surrounding the medical treatment; performing
acupuncture is more elaborate than prescribing pills.
Another phenomenon that illustrates how the mind can affect the body is known as “white coat
syndrome” or “white coat hypertension”. These terms refer to the situation in which bloodpressure measured in a physician’s office is consistently higher than when measured at home orat work. Studies suggest that ten to twenty percent of patients may experience white coat
syndrome.5 It is believed that white coat syndrome or white coat hypertension is due to theanxiety that some people experience during visits to a physician’s office.
Written by Sharon BeltrandelRio©MANABI Limited

The placebo effect and white coat syndrome are just a couple of phenomena that demonstrate
how the mind can affect the body. Researchers have a lot to learn regarding these effects,
including their causes, mechanisms of action and how to take advantage of the potential positive
nature of the placebo effect.

Discussion questions
1.
2.
3.
4.
5.
6.
7.

1.
2.

3.

4.
5.

Please summarize the article. What is the main point of the article?
What is a placebo and what is the placebo effect?
How did treatment with saline solution affect Parkinson’s disease patients?
What happened when researchers compared two placebos?
What do you think causes the placebo effect?
What is white coat syndrome?
What do you think causes white coat syndrome?

American Heritage Dictionary. Houghton Mifflin and Company. 2002.
Benedetti F et al. Placebo-responsive Parkinson’s patients show decreased activity in single
neurons of subthalamic nucleus. Nature Neuroscience pp. 587-588; volume 7, no 6, 2004.
http://space.newscientist.com/article.ns?id=mg18524911.600. (Accessed 23 March 23, 2007)
Kaptchuk TJ et al. Sham device v. inert pill: randomized controlled trial of two placebo treatments.
BMJ 1 February 2006. http://www.bmj.com/cgi/content/abstract/bmj.38726.603310.55v1 (Accessed
23 March 23, 2007)
Ruvinsky J. Placebo vs. placebo. Discover magazine. 26 April 2006.
http://discovermagazine.com/2006/apr/placebo-placebo. (Accessed 23 March 23, 2007)
Davis J. WebMD personal reporter. WebMD.com.
http://www.webmd.com/content/article/59/66764.htm. (Accessed 23 March 23, 2007)

Written by Sharon BeltrandelRio©MANABI Limited

Topic 19
Counting Sheep: The Importance of a Good Night’s Sleep
不眠症治療の現状
Mike, a 37-year-old male, considered himself healthy. He exercised moderately two or threetimes a week, but since he worked for a large financial corporation he spent long hours at his
desk and frequently dined with customers. As a result of his sedentary lifestyle and rich diet, his
BMI was 28.6*. He presented at his doctor’s office complaining of lethargy and sleepinessduring the day. In addition, he often had headaches in the morning and his wife mentioned that
he had begun to snore loudly.
The physician ordered a polysomnogram, or PSG, to record Mike’s brain activity, eye movement,
muscle activity, breathing and heart rates, lung function and the percentage of oxygen in his
blood throughout the night. After studying the test results, the physician diagnosed Mike with
obstructive sleep apnea, the most common type of sleep apnea. The number of people in thewest suffering from obstructive sleep apnea has increased in line with increased levels of obesity,
as well as improved awareness and diagnosis1.
Sleep apnea occurs when a person regularly stops breathing for ten seconds or longer during
sleep. It ranges from mild to severe, depending on the number of times in an hour that apnea(breathing stops) and/or hypopnea (breathing becomes very slow) occur. Obstructive sleep
apnea is caused by a blockage or narrowing of the airways in the nose, mouth or throat. Factorsthat cause sleep apnea include: obesity, large tonsils and adenoids, throat muscles and tonguethat relax more than normal, and a bony structure of the head and neck that result in a somewhat
smaller airway size in the mouth and throat area2.
Sleep apnea disrupts sleep and reduces its quality. It may result in many brief drops in the
blood’s oxygen levels and interrupts “sleep architecture” or sequence of stages. Healthy sleep
normally begins with about eighty minutes of non-rapid eye movement, or NREM, when brain
activity and bodily functions slow down. Each NREM stage is followed by about ten minutes of
rapid eye movement, or REM, during which brain and body activity increase. REM is the stage
during which dreams occur. This ninety-minute cycle is repeated four to six times each night3. A
good night’s sleep (seven to eight hours) enables people to function both mentally and physically.
During sleep, the body secretes growth hormone, which promotes the repair and regeneration oftissues throughout the body4.
There are a variety of treatments for obstructive sleep apnea, and treatment often helps
associated medical problems such as high blood pressure, as well as reduces the risk for heart
attack and stroke5. Mild cases of obstructive sleep apnea can be treated with lifestyle changes,
such as: losing weight; avoiding alcohol, smoking and medicines that cause drowsiness; and by
sleeping on one’s side. Moderate cases are usually treated with continuous positive airway
pressure (CPAP), in which a mask blows air into the throat at a pressure level that keeps thethroat open during sleep. Surgery to remove the tonsils and adenoids, or surgery to treat obesity
is performed in serious cases. In Mike’s case, CPAP proved to be an effective treatment.

*

Underweight = <18.5, Normal weight = 18.5-24.9, Overweight = 25-29.9, Obesity = BMI of 30 or greater

Written by Sharon BeltrandelRio©MANABI Limited

Discussion questions
1.
2.
3.
4.
5.
6.
7.
8.

1.
2.
3.
4.
5.

Please summarize the article. What is the main point of the article?
Describe Mike’s symptoms and the physician’s diagnosis.
What is obstructive sleep apnea?
What causes obstructive sleep apnea?
Why is the incidence of sleep apnea increasing?
What is “sleep architecture”?
Why is it important to sleep seven to eight hours every night?
How can sleep apnea be treated?

http://www.ft.com/cms/s/ed7f38f8-f200-11db-b5b6-000b5df10621.html. Accessed 25 April 2007.
Sleep apnea. U.S. Department of Health and Human Services, National Institutes of Health, National Heart
Lung and Blood Institute. http://www.nhlbi.nih.gov/health/dci/Diseases/SleepApnea/SleepApnea_Causes.html.
Accessed 25 April 25, 2007.
Healthy sleep. Shuteye.com. Sanofi-Aventis.
http://www.shuteye.com/healthysleep.asp?utm_source=google&utm_medium=cpc&utm_term=sleep+apnea&
utm_content=content&utm_campaign=baseline1&PromoCode=AMC604. Accessed 25 April 2007.
Healthy sleep. Shuteye.com. Sanofi-Aventis.
http://www.shuteye.com/healthysleep.asp?utm_source=google&utm_medium=cpc&utm_term=sleep+apnea&
utm_content=content&utm_campaign=baseline1&PromoCode=AMC604. Accessed 25 April 2007.
Sleep apnea. U.S. Department of Health and Human Services, National Institutes of Health, National Heart
Lung and Blood Institute.
http://www.nhlbi.nih.gov/health/dci/Diseases/SleepApnea/SleepApnea_Treatments.html. 25 April 25, 2007.

Written by Sharon BeltrandelRio©MANABI Limited

Topic 20
Chronic Obstructive Pulmonary Disorder (COPD)
慢性閉塞性肺疾患
COPD has traditionally been described as the combination of two manifestations: parenchymal
destruction (emphysema) and small airway disease (obstructive bronchitis). Emphysema ischaracterized by damaged lung tissue and alveoli (tiny air sacs) at the end of the airways,
causing air to be trapped in the lungs and leading to shortness of breath1. Bronchitis ischaracterized by inflammation in the bronchial tubes, making it difficult to breathe, and at times
a chronic cough that brings up sputum (mucus)2. Recently the Global Initiative for Obstructive
Lung Disease (GOLD) Workshop Report defined COPD as a disease characterized by airflow
limitation that is not fully reversible3. In view of common clinical observations in Japan, thenew definition acknowledges that some patients can develop significant airflow limitations
without the classic symptoms of chronic cough and sputum production.
COPD is a chronic disease that develops over many years. It is most often caused by smoking,and 80-90% of people with COPD have been long-term smokers4. It is believed that long-term
inhalation of lung irritants such as industrial dust and chemical fumes may also lead to COPD.
Due to changes in smoking habits, the prevalence of the disease is expected to increase over the
next twenty years in the United States and Europe, and then reach a plateau. In Japan and Asia,
the disease prevalence is expected to continue increasing for the next 40 years. For example, asurvey found that in China, the average daily consumption of tobacco per person increased fromone cigarette in 1952 to ten cigarettes in 1990, a rate similar to that found in the U.S. in the
1950’s5. In Japan, the estimated total cost of COPD is more than 805 billion yen per year,
imposing a high economic burden on the Japanese healthcare system6.
Early diagnosis and treatment greatly determine the outcome for COPD patients. The diseasecan only be reliably diagnosed through a medical history and lung function tests (e.g.,
spirometry). There is no cure for COPD, but steps can be taken to manage the disease. The only
way to slow the progression of the disease is to stop smoking. Medications such as
anticholinergics (ipratropium, tiotropium), inhaled corticosteroids and beta-agonists, as well as
ventilators and oxygen therapy may make it easier to breathe7. COPD is a progressive disease
and may be complicated by a COPD exacerbation (sudden and prolonged increase in symptoms
including shortness of breath, cough and sputum production). COPD exacerbations may be lifethreatening and may require immediate treatment. In addition, cor pulmonale (heart failure that
affects the right side of the heart) frequently occurs in COPD patients8.

Written by Sharon BeltrandelRio©MANABI Limited

Discussion questions
1.
2.
3.
4.
5.
6.
7.

1.
2.
3.
4.
5.

6.

7.
8.

Please summarize the article. What is the main point of the article?
What is COPD?
How has the definition of COPD changed? Why?
What causes COPD?
Explain the difference in prevalence in Asia, the United States and Europe. Whatcauses this difference?
How is COPD treated?
What is the best way to prevent COPD?

What is chronic obstructive pulmonary disease? WebMD. http://www.webmd.com/a-to-z-guides/ChronicObstructive-Pulmonary-Disease-COPD-Overview (Accessed 19 May 2007).
What is chronic obstructive pulmonary disease? WebMD. http://www.webmd.com/a-to-z-guides/ChronicObstructive-Pulmonary-Disease-COPD-Overview (Accessed 19 May 2007).
Tatsumi K et al. Clinical phenotypes of COPD: Results of a Japanese epidemiological survey. Respirology(2004) 9, 331-336.
What is chronic obstructive pulmonary disease? WebMD. http://www.webmd.com/a-to-z-guides/ChronicObstructive-Pulmonary-Disease-COPD-Overview (Accessed 19 May 2007).
Teramoto S et al. Global burden of COPD in Japan and Asia. The Lancet. Volume 362, Issue 9397, 22
November 2003, pages 1763-1765. Available online 25 November 2003.
http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6T1B-4B29NTX18&_user=15064&_coverDate=11%2F22%2F2003&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_
acct=C000000715&_version=1&_urlVersion=0&_userid=15064&md5=fe1aa75b879daa42ec05191bb06ce
b43 (Accessed 19 May 2007).
Nishimura S and Zaher C. Cost impact of COPD in Japan: Opportunities and challenges? Respirology
2004 November 9, volume 9 issue 4 pages 466-73.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15612957&dopt=
Abstract (Accessed 19 May 2007).
COPD treatment overview. WebMD. http://www.webmd.com/a-to-z-guides/Chronic-ObstructivePulmonary-Disease-COPD-Treatment-Overview (Accessed 19 May 2007).
COPD treatment overview. WebMD. http://www.webmd.com/a-to-z-guides/Chronic-ObstructivePulmonary-Disease-COPD-Treatment-Overview (Accessed 19 May 2007).

Written by Sharon BeltrandelRio©MANABI Limited

Topic 21
Schizophrenia -Part one統合失調症①
Schizophrenia is a psychotic brain disorder characterized by distortions in the way a person
perceives reality, thinks, acts, expresses emotions and relates to others. According to the World
Health Organization, an estimated 24 million people worldwide suffer from schizophrenia; it
affects about seven people per thousand of the adult population, mostly in the age group 15-35
years1. Approximately 260,000 people with schizophrenia were treated every day in 1999 in
Japan, and 202,012 were admitted to a mental hospital in 20022.
The symptoms of schizophrenia can be classified into three categories3 Positive symptoms
include unusual thoughts or perceptions, such as hallucinations, delusions, thought disorder andmovement disorder. Negative symptoms are characterized by a loss or decrease in the ability to
speak, express emotion, initiate plans or find pleasure in everyday life. Cognitive symptoms
include problems with attention, memory and the functions that enable us to plan and organize.
There are four basic subtypes of schizophrenia4. In paranoid schizophrenia, patients arepreoccupied with delusions of being persecuted or punished. However, their thinking, speechand emotions may remain reasonably normal. In disorganized schizophrenia, patients are often
confused and incoherent, with jumbled speech, and their behavior may be emotionless orinappropriate. They often demonstrate disorganized behavior that may disrupt their ability toperform daily activities. In catatonic schizophrenia, patients are immobile and unresponsive.
They may also have peculiar movements or display bizarre postures. Undifferentiatedschizophrenia is diagnosed when the patient’s symptoms do not clearly represent one of the othersubtypes.
Schizophrenia varies in severity from person to person. Psychotic episodes occur when a person
loses touch with reality, causing a sudden change in personality and behavior. Some people have
only one psychotic episode, while others may experience many episodes, although it is possible
for them to lead relatively normal lives between episodes. The symptoms of schizophrenia seem
to worsen and improve in cycles (relapses and remissions)5.
Part two of this article will describe schizophrenia’s potential causes and treatments.

Written by Sharon BeltrandelRio©MANABI Limited

Discussion questions
1.
2.
3.
4.
5.

1.
2.
3.
4.
5.

Please summarize the article. What is the main point of the article?
What is schizophrenia?
How many people suffer from schizophrenia?
What are the symptoms of schizophrenia?
What are the subtypes of schizophrenia?

Schizophrenia. World Health Organization.
http://www.who.int/mental_health/management/schizophrenia/en/ (Accessed 26 June 2007).
Sato M. Renaming schizophrenia: a Japanese perspective. World Psychiatry. 2006 February; 5(1): 53-55.
http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1472254 (Accessed 26 June 2007).
Schizophrenia. U.S. National Institutes of Mental Health.
http://www.nimh.nih.gov/publicat/schizoph.cfm#symptoms (Accessed 26 June 2007)
Mental health: Schizophrenia. WebMD. http://www.webmd.com/schizophrenia/guide/mental-healthschizophrenia (Accessed 26 June 2007)
Mental health: Schizophrenia. WebMD. http://www.webmd.com/schizophrenia/guide/mental-healthschizophrenia (Accessed 26 June 2007)

Written by Sharon BeltrandelRio©MANABI Limited

Topic 22
Schizophrenia -Part two統合失調症②
As described in “Schizophrenia (Part one)”, schizophrenia is a psychotic brain disordercharacterized by distortions in the way a person perceives reality, thinks, acts, expresses
emotions and relates to others. This article describes schizophrenia’s potential causes andtreatments.
It is believed that schizophrenia is caused by a combination of environmental and genetic
factors10. Approximately one percent of the general population has schizophrenia, but it is seen
in ten percent of those with a first-degree relative (parent, brother or sister) with the disorder2.
People who have a second-degree relative (aunt, uncle, grandparent or cousin) withschizophrenia also develop the disorder more often than the general population3. Recently
scientists from the Massachusetts Institute of Technology in the United States and RIKEN Brain
Science Institute in Japan reported that the PPP3CC and other genes in the early growth response(EGR) gene family (specifically, EGR3) may be linked to the disease4. These genes areimportant in the signaling pathway for calineurin, a brain enzyme that plays a role in manyneuronal functions whose disruption may lead to the disorganized thinking, attention deficits,
and memory and language problems symptomatic of schizophrenia.
Scientists believe that an imbalance in certain complex, interrelated chemical reactions in thebrain involving neurotransmitters such as dopamine, glutamate and possibly others plays a rolein schizophrenia5. It is believed that several genes are associated with an increased risk ofschizophrenia; however it is likely that environmental factors also contribute to the disorder.
Researchers believe that factors such as exposure to viruses or malnutrition in the womb,
problems during birth, and psychosocial factors such as stressful environmental conditions may
play a role in the development of schizophrenia6.
Schizophrenia treatment focuses on eliminating the symptoms, since the disease’s causes are still
unknown. Antipsychotic drugs are available, but everyone reacts differently and sometimes
several different medications must be tried before the most effective one is found. Atypicalantipsychotics, developed in the 1990’s, have overcome many of the side effects such as rigidity,
muscle spasms, tremors and restlessness traditionally associated with antipyschotics7. However,they may cause weight gain and metabolic changes. Psychosocial treatment may also be
effective in patients who are taking antipsychotic drugs and are in stable condition.[viii] Illness
management skills, cognitive behavior therapy, family education skills and self-help groups mayhelp patients deal with certain aspects of schizophrenia such as difficulty with communication,
motivation, work and maintaining relationships with others. It is very important to understandthat schizophrenia is a chronic disease that requires constant management.
Due to recent advances in schizophrenia research, the ambiguity of the old term and theentrenched negative image of schizophrenia, the Japanese Society of Psychiatry and Neurology
changed the Japanese term for the disease from “Seishin Bunretsu Byo” (mind-split-disease) to“Togo Shitcho Sho” (integration disorder) in 2002.[ix] The new term refers to the vulnerabilitystress model, and it implies that the disorder may be treated and that recovery is possible ifadvanced medications and psychosocial intervention is used.
Written by Sharon BeltrandelRio©MANABI Limited

Discussion questions
1.
2.
3.
4.
5.
6.

Please summarize the article. What is the main point of the article?
What causes schizophrenia?
What genes may be related to schizophrenia?
What types of drugs are used to treat schizophrenia?
What is psychosocial treatment?
Why was the Japanese term for schizophrenia changed?

1.

Mental health: Schizophrenia. WebMD. http://www.webmd.com/schizophrenia/guide/mental-healthschizophrenia (Accessed 26 June 2007)
2.
Schizophrenia. U.S. National Institutes of Mental Health.
http://www.nimh.nih.gov/publicat/schizoph.cfm#symptoms (Accessed 26 June 2007)
3.
Schizophrenia. U.S. National Institutes of Mental Health.
http://www.nimh.nih.gov/publicat/schizoph.cfm#symptoms (Accessed 26 June 2007)
4.
Study shows genetic link for schizophrenia. Massachusetts Institute of Technology. 20 February 2007.
http://web.mit.edu/newsoffice/2007/techtalk51-18.pdf (Accessed 26 June 2007)
5.
Schizophrenia. U.S. National Institutes of Mental Health.
http://www.nimh.nih.gov/publicat/schizoph.cfm#symptoms (Accessed 26 July 2007)
6.
Schizophrenia. U.S. National Institutes of Mental Health.
http://www.nimh.nih.gov/publicat/schizoph.cfm#symptoms (Accessed 26 June 2007)
7.
Schizophrenia. U.S. National Institutes of Mental Health.
http://www.nimh.nih.gov/publicat/schizoph.cfm#symptoms (Accessed 26 July 2007)
8.
Schizophrenia. U.S. National Institutes of Mental Health.
http://www.nimh.nih.gov/publicat/schizoph.cfm#symptoms (Accessed 26 July 2007)
9.
Sato M. Renaming schizophrenia: a Japanese perspective. World Psychiatry. 2006 February; 5(1): 53-55.
http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1472254(Accessed 26 July 2007)

Written by Sharon BeltrandelRio©MANABI Limited

Topic 23
Autism
自閉症
Autism is a developmental disorder characterized by impaired social interaction, problems withverbal and nonverbal communication, and unusual, repetitive or severely limited activities andinterests1. Although it was once reported as a rare disorder, according to the U.S. Centers for
Disease Control and Prevention, autism now affects one in every 150 children in the UnitedStates2. One reason for the increase may be that in the past, only the most severe forms of thedisease were reported3. The various types of autism (ranging from mild to severe) are now better
defined and awareness has increased substantially.
The potential causes of autism are intensely debated. Some researchers believe that it is caused
by a genetic mutation. Others believe that childhood vaccines or environmental toxins may be
involved. It has been suggested that the measles, mumps and rubella vaccine (MMR) may cause
autism. However, studies (including several performed in Japan, which used the MMR vaccine
between 1989 and 1993) show that the withdrawal of the MMR vaccination has had no effect on
the incidence of autism and is most unlikely to be a main cause of autism4,5.
Autism ranges from a mild to severe affliction. For example, people with Asperger syndrome(one type of autism), demonstrate normal language development but odd behaviors amenable tochange6. Severe autism involves developmental disorders that severely impair people for life.
The hallmark of autism is impaired social interaction7. Babies with autism may be unresponsive
and focus intently on one object for long periods of time. Children may fail to respond to theirname, have difficulty interpreting what others are thinking or feeling due to their inability tounderstand social cues (e.g., facial expressions and tone of voice), and lack empathy. Many
children with autism demonstrate repetitive movements such as rocking or self-abusive behavior
such as biting or head-banging. In addition, they may have a reduced sensitivity to pain, yet beabnormally sensitive to sensory stimulation such as sound or touch. Since autism varies widelyin its severity and symptoms, doctors rely on a core group of behaviors related to thecharacteristics described above to diagnosis the disease. Furthermore, it is a very complex
affliction and a comprehensive evaluation may involve a psychologist, neurologist, psychiatrist,
speech therapist and other professionals. It is important to rule out hearing disorders that may
cause behavior that could be mistaken for autism (e.g., delayed speech development).
Autism does not have a cure8. Behavioral interventions and therapies are designed to remedy
specific situations and can be very effective. Interventions and therapies target the core
symptoms of autism, including impaired social interaction, verbal and nonverbal communication
problems, and obsessive or repetitive routines. Most professionals agree that the earlier that theintervention begins, the better. Anti-depressants and anti-psychotic medications are sometimes
prescribed (especially to treat severe behavioral problems).

Written by Sharon BeltrandelRio©MANABI Limited

Discussion questions
1.
2.
3.
4.
5.
6.
7.

1.
2.
3.
4.

5.

6.
7.
8.

Please summarize the article. What is the main point of the article?
What is the incidence of autism?
What do some researchers believe is causing the increased incidence of autism?
What causes autism?
What are the symptoms of autism?
How is autism diagnosed?
How is autism treated?

Autism Fact Sheet. National Institute of Neurological Disorders and Stroke. National Institutes of Health.
http://www.ninds.nih.gov/disorders/autism/detail_autism.htm (accessed 28 August 2007)
Autism by the numbers. Newsday. 26 August 2007. http://www.newsday.com/news/opinion/nyvpuno265345124aug26,0,4226450.story (accessed 28 August 2007)
Autism by the numbers. Newsday. 26 August 2007. http://www.newsday.com/news/opinion/nyvpuno265345124aug26,0,4226450.story (accessed 28 August 2007)
Honda H, Shimuzu Y, Rutter M. No effect of MMR withdrawal on the incidence of autism: a total population
study. J Child Psychol Psychiatry. 2005 Jun;46(6):572-9.
http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&db=pubmed&dopt=AbstractPlus&list_uids=158777
63 (accessed 28 August 2007)
Uchiyama T, Kurosawa M, Inaba Y. MMR-vaccine and regression in autism spectrum disorders: negative
results presented from Japan. J of Autism and Developmental Disorders, 2007 Feb;37(2):210-217(8).
http://www.ingentaconnect.com/content/klu/jadd/2007/00000037/00000002/00000157?crawler=true(accessed 28 August 2007)
Autism by the numbers. Newsday. 26 August 2007. http://www.newsday.com/news/opinion/nyvpuno265345124aug26,0,4226450.story (accessed 28 August 2007)
Autism Fact Sheet. National Institute of Neurological Disorders and Stroke. National Institutes of Health.
http://www.ninds.nih.gov/disorders/autism/detail_autism.htm (accessed 28 August 2007)
Autism Fact Sheet. National Institute of Neurological Disorders and Stroke. National Institutes of Health.
http://www.ninds.nih.gov/disorders/autism/detail_autism.htm (accessed 28 August 2007)

Written by Sharon BeltrandelRio©MANABI Limited

Topic 24
Depression
うつ病
Depressive disorders are illnesses that involve the body, mood and thoughts1. Everyone feels sadsometimes; this is a natural response to loss and to life’s challenges and disappointments.
However, if the feeling of sadness becomes intense, lasts for a long period of time and prevents a
person from leading a normal life, it is a depressive disorder and one of several depressive
illnesses.
According to a report from the U.S. National Institutes of Mental Health, nearly 18.8 million
American adults suffer from major depression2. Furthermore, suicide, which is closely linked todepression, is the third leading cause of death in people aged 10 to 24 years old. Older
Americans are also affected by depression and suicide. Although people aged 65 and older
comprise only 12 percent of the U.S. population, they accounted for 16 percent of suicide deathsin 20043. Surprisingly, studies show that many older adults (up to 75 percent) who committed
suicide visited a physician within a month prior to death4. Depression is not always recognized
and left undiagnosed and untreated, it can worsen, lasting for months or years and causing untold
suffering.
There are several types of depressive disorders, and within each type there are variations in theseverity and persistence of the symptoms. Major depression may involve a variety of symptoms
such as a persistent sad or anxious mood, pessimism, feelings of guilt or helplessness, loss ofinterest in activities that were once enjoyed, fatigue, insomnia, loss of appetite or overeating,thoughts of death/suicide and restlessness, as well as persistent physical symptoms such as
headaches that do not respond to treatment5. The symptoms of major depression are disablingand interfere with a person’s ability to work, study, sleep, eat and enjoy activities that were once
pleasurable.
Dysthymia, a less severe type of depression, is manifested by long-term, chronic symptoms that
do not disable as in major depression. However, the symptoms of dysthymia prevent a personfrom functioning well or from feeling good. Furthermore, people with dysthymia often
experience major depressive episodes throughout their lives6.
Bipolar disorder is not nearly as prevalent as other types of depression, and it is characterized asa manic-depressive illness. People with bipolar disorder suffer from cycling mood changes:
mania (severe highs during which the individual may be overactive and have a great deal ofenergy) and depression (lows during which the individual has the symptoms of a depressive
disorder).
Major depressive disorder is often associated with changes in brain function or brain structures7.
Some types of depression, including bipolar disorder, run in families, suggesting that hereditary
factors may play a role. However, other factors such as stress may also be a factor. Physicalchanges in the body such as stroke, heart attack, cancer, Parkinson’s disease and hormonal
disorders may be accompanied by mental changes such as depression. Often, a combination ofgenetic, psychological and environmental factors is involved in the inception of a depressive
disorder8.
Written by Sharon BeltrandelRio©MANABI LimitedDepressive disorders are often treated with a combination of antidepressant medications andpsychotherapies. Medications include selective serotonin reuptake inhibitors (SSRIs), tricyclics
and monoamine oxidate inhibitors (MAOIs). Usually, they must be taken regularly for three tofour weeks before the full therapeutic effect occurs. Once the individual feels better, themedication must be taken for at least four to nine months to prevent a recurrence9 Treatment isavailable for people suffering from depressive disorders. The first step is to seek help and obtainan appropriate diagnosis.

Discussion questions
1.
2.
3.
4.
5.
6.

1.

2.
3.

4.

5.
6.

7.

8.

9.

Please summarize the article. What is the main point of the article?
What is a depressive disorder?
How many people suffer from depressive disorders in the U.S.?
What are some of the most different types of depressive disorders?
What causes depressive disorders?
How are depressive disorders treated?

What is a depressive disorder? U.S. National Institute of Mental Health.
http://www.nimh.nih.gov/health/publications/depression/what-is-a-depressive-disorder.shtml (Accessed 27
September 2007)
Depression guide. WebMD. http://www.webmd.com/depression/guide/depression-basics (Accessed 27
September 2007)
Older adults: Depression and suicide risk. U.S. National Institute of Mental Health.
http://www.nimh.nih.gov/health/publications/older-adults-depression-and-suicide-facts.shtml (Accessed 27
September 2007)
Conwell Y. Suicide in later life: a review and recommendations for prevention. Suicide and Life Threatening
Behavior, 2001; 31(Suppl): 32-47. [Reference in Older adults: Depression and suicide risk. U.S. National
Institute of Mental Health. http://www.nimh.nih.gov/health/publications/older-adults-depression-andsuicide-facts.shtml (Accessed 27 September 2007)]
Symptoms of depression and mania. U.S. National Institute of Mental Health.
http://www.nimh.nih.gov/health/publications/depression/symptoms.shtml (Accessed 27 September 2007)
What is a depressive disorder? U.S. National Institute of Mental Health.
http://www.nimh.nih.gov/health/publications/depression/what-is-a-depressive-disorder.shtml (Accessed 27
September 2007)
Causes of depression. U.S. National Institute of Mental Health.
http://www.nimh.nih.gov/health/publications/depression/causes-of-depression.shtml (Accessed 27 September
2007)
Causes of depression. U.S. National Institute of Mental Health.
http://www.nimh.nih.gov/health/publications/depression/causes-of-depression.shtml (Accessed 27 September
2007)
Causes of depression. U.S. National Institute of Mental Health.
http://www.nimh.nih.gov/health/publications/depression/treatment.shtml (Accessed 27 September 2007)

Written by Sharon BeltrandelRio©MANABI Limited

Topic 25
Metabolic Syndrome
メタボリック症候群
Metabolic syndrome, also known as Syndrome X, is not a disease. The term refers to a group ofrisk factors that increase a person’s chance for heart disease, diabetes, stroke and other healthproblems. For example, people with metabolic syndrome are twice as likely to develop heartdisease and five times as likely to develop diabetes compared to people without metabolic
syndrome1.
The American Heart Association and the U.S. National Heart, Lung, and Blood Institute define
metabolic syndrome as the presence of three or more of the following components2:
•
•
•
•
•

Elevated waist circumference (men: ≥ 102 cm, women: ≥ 88 cm)
Elevated triglycerides (≥ 150 mg/dL)
Reduced HDL cholesterol (men: ≤ 40 mg/dL, women: ≤ 50 mg/dL)
Elevated blood pressure (≥ 130/85 mm Hg)
Elevated fasting glucose (≥ 100 mg/dL)

Despite the high prevalence of metabolic risks in Asians, obesity is relatively low. Therefore, it
has been suggested that a waist-to-height (W/Ht) ratio ≥ 0.5 is a more effective index than waist
circumference in identifying metabolic syndrome3. Similarly, although the World HealthOrganization (WHO) defines obesity as body mass index (BMI) > 30.0 kg/m2, researchers haveproposed that obesity in Japanese be defined as BMI > 25.0 kg/m2 based on studies evaluatinghigh risk groups for cardiovascular disease in Japan4.
According to the Japanese Health, Labor and Welfare Ministry, an estimated 13 million people
in Japan suffer from metabolic syndrome and another 14 million are estimated to be at risk ofgetting it5. In the U.S., the National Institutes of Health’s National Heart, Lung and Blood
Institute reports that 47 million Americans, or nearly one out of six people, have metabolic
syndrome6.
Metabolic syndrome is closely linked to people who are overweight or obese and to a lack ofphysical activity. Insulin resistance, a condition in which the body does not use insulin properly,
is another cause. It is believed that genetics and older age are other important underlying causes7.
Metabolic syndrome can be prevented or delayed with lifestyle changes such as exercising
regularly, eating a healthy diet, losing weight and avoiding tobacco. Sometimes the individualcomponents of metabolic syndrome are treated with blood pressure, cholesterol and/or diabetes
medications8.

Written by Sharon BeltrandelRio©MANABI Limited

Discussion questions
1.
2.
3.
4.
5.
6.
7.

1.
2.
3.

4.

5.

6.
7.
8.

Please summarize the article. What is the main point of the article?
What is metabolic syndrome?
Should the same definitions of elevated waist circumference and obesity apply to
Americans and Asians? How should obesity be measured in Japan?
How many people have metabolic syndrome in Japan? In the U.S.?
What causes metabolic syndrome?
How can metabolic syndrome be prevented?
Is it possible to treat metabolic syndrome?

What is metabolic syndrome. U.S. National Institutes of Health’s National Heart, Lung and Blood Institutehttp://www.nhlbi.nih.gov/health/dci/Diseases/ms/ms_whatis.html (accessed 29 October 2007)
Metabolic syndrome, American Heart Association.
http://www.americanheart.org/presenter.jhtml?identifier=4756 (accessed 29 October 2007)
Hsieh SD and Muto T. Metabolic syndrome in Japanese men and women with special reference to theanthropometric criteria for the assessment of obesity: Proposal to use the waist-to-height ratio. Preventive
medicine. Vol. 42, issue 2, February 2006, pages 135-139.
http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6WPG-4HWX8ND1&_user=10&_coverDate=02%2F28%2F2006&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=9582ed4e7dbe5e888f608f7d96d74985(accessed 29 October 2007)
Ota T, Takamura T, Hirai N, Kobayashi K. Letter: Observations to Preobesity in World Health Organization
classification involves the metabolic syndrome in Japanese. Diabetes Care. 25:1252-1253, 2002.
http://care.diabetesjournals.org/cgi/content/full/25/7/1252 (accessed 29 October 2007)
13 million suffer from metabolic syndrome, study indicates. Japan Times. 9 May 2006.
http://search.japantimes.co.jp/cgi-bin/nn20060509a8.html (accessed 29 October 2007) [Note: the study
examined men with waists measuring ≥ 85 cm and women with waists measuring ≥ 90 cm]
What is metabolic syndrome. U.S. National Institutes of Health’s National Heart, Lung and Blood Institutehttp://www.nhlbi.nih.gov/health/dci/Diseases/ms/ms_whatis.html (accessed 29 October 2007)
What is metabolic syndrome. U.S. National Institutes of Health’s National Heart, Lung and Blood Institutehttp://www.nhlbi.nih.gov/health/dci/Diseases/ms/ms_whatis.html (accessed 29 October 2007)
Metabolic syndrome health center. WebMD. http://www.webmd.com/heart/metabolic-syndrome/metabolicsyndrome-what-is-it (accessed 29 October 2007)

Written by Sharon BeltrandelRio©MANABI Limited

Topic 26
Traumatic Brain Injury (Part 1)
外相性脳損傷Traumatic brain injury (TBI) can affect anyone at any age. Males aged 15 to 24 are vulnerable
due to their tendency towards a high-risk lifestyle. Young children and people over 75 years old
are susceptible to head injuries caused by falling. Violent shaking of an infant can also cause
brain injury. Half of all TBI’s in the United States are caused by accidents involving
automobiles, motorcycles, bicycles and pedestrians1. Alarmingly, fifty percent of TBI incidents
involve the use of alcohol2. The incidence rate of traumatic brain injury is estimated to be
between 150-250 cases per 100,000 people per year in both industrialized and non-industrializedcountries3. In the U.S., approximately 1.4 million people suffer from TBI annually andapproximately 50,000 die from head injury4.
Traumatic brain injury occurs when sudden trauma causes damage to the brain5. It can result
from a closed head injury, such as when the head suddenly and violently hits an object, or apenetrating head injury, when an object pierces the skull and enters brain tissue. The damage
can be focal (limited to one area of the brain) or diffuse (involve more than one area of the brain).
Depending on the extent of damage, the symptoms can be mild, moderate or severe. There areseveral types of TBI’s6:••••

Concussion: short loss of consciousness due to a head injury
Depressed skull fracture: pieces of the broken skull press into brain tissue
Penetrating skull fracture: something such as a bullet pierces the skull
Contusion: a distinct area of swollen brain tissue mixed with blood released frombroken blood vessels; can also occur in response to shaking of the brain within theconfines of the skull (e.g., shaken baby syndrome)• Diffuse axonal injury or shearing: damage to individual neurons and loss ofconnections among neurons• Hematoma: heavy bleeding into or around the brain• Epidural hematoma: bleeding between the skull and the dura (one of the three
membranes that covers the brain)• Subdural hematoma: bleeding between the dura and the arachnoid membrane(one of the three membranes that covers the brain)• Intracerebral hematoma – bleeding within the brain itself
Since little can be done to reverse the initial brain damage caused by trauma, initial medical carefocuses on stabilizing the patient, preventing further injury and ensuring proper oxygen supply tothe brain and the rest of the body. Many TBI patients may also have spinal cord injuries so greatcare must be taken in moving and transporting them.
After the patient has been stabilized, medical personnel assess his or her condition by measuring
vital signs and reflexes, and by performing a neurological examination. The patient’s level ofconsciousness and neurological functioning is assessed using the Glasgow Coma Scale (GCS), a
standardized 15-point test that uses eye opening, best verbal response and best motor response todetermine the severity of the brain injury7. In addition, imaging tests such as x-rays, CT scansand MRI’s are used to determine the diagnosis and prognosis.
Written by Sharon BeltrandelRio©MANABI Limited

Approximately fifty percent of TBI patients require surgery to remove or repair hematomas orcontusions8. Serious head injuries may result in9:
• Stupor: patient is unresponsive and can be aroused briefly by a strong stimulus such as
sharp pain
• Coma: patient is totally unconscious, unresponsive, unaware and unarousable, anddoes not have sleep-wake cycles; length is generally a few days to a few weeks• Vegetative state: patient is unconscious and unaware, but continues to have sleepwake cycles and periods of alertness• Persistent vegetative state (PVS): patient is in a vegetative state for more than thirty
days; upper portions of the brain are damaged but the lower portions are spared• Locked-in syndrome: patient is aware and awake but cannot move or communicate
due to complete paralysis of the body; lower portions of the brain and the brainstem
are damaged but the upper brain is not damaged
Disabilities caused by TBI depend on the severity of the injury as well as the age and general
health of the patient. Some common disabilities include problems with cognition, sensory
processing, communication, behavior and mental health. Part two of this article will address
post-injury complications, long-term disabilities, treatment and prevention.
Discussion questions
1.
2.
3.
4.
5.
6.
7.

1.
2.
3.

4.
5.
6.
7.
8.
9.

Please summarize the article. What is the main point of the article?
What is a traumatic brain injury?
What are the main causes of TBI’s?
What are the various types of TBI’s?
What is the Glasgow Coma Score?
How is a patient treated immediately after a TBI?
What are the potential results of a TBI?

Traumatic Brain Injury: Hope through Research. National Institute of Neurological Disorders and Stroke. U.S. National
Institutes of Health. http://www.ninds.nih.gov/disorders/tbi/detail_tbi.htm (Accessed November 15, 2007)
Traumatic Brain Injury: Hope through Research. National Institute of Neurological Disorders and Stroke. U.S. National
Institutes of Health. http://www.ninds.nih.gov/disorders/tbi/detail_tbi.htm (Accessed November 15, 2007)
León-Carrión J, Domínguez-Morales M, Barroso y Martín, Murillo-Cabezas F. Epidemiology of Traumatic Brain Injury
and Subarachnoid Hemorrhage. Pituitary. Volume 8, Numbers 3-4 / December, 2005.
http://www.springerlink.com/content/6213461j004054m1/ (Accessed November 15, 2007)
Traumatic Brain Injury: Hope through Research. National Institute of Neurological Disorders and Stroke. U.S. National
Institutes of Health. http://www.ninds.nih.gov/disorders/tbi/detail_tbi.htm (Accessed November 15, 2007)
NINDS Traumatic Brain Injury Information Page. National Institute of Neurological Disorders and Stroke. U.S. National
Institutes of Health. http://www.ninds.nih.gov/disorders/tbi/tbi.htm (Accessed November 15, 2007)
Traumatic Brain Injury: Hope through Research. National Institute of Neurological Disorders and Stroke. U.S. National
Institutes of Health. http://www.ninds.nih.gov/disorders/tbi/detail_tbi.htm (Accessed November 15, 2007)
Traumatic Brain Injury: Hope through Research. National Institute of Neurological Disorders and Stroke. U.S. National
Institutes of Health. http://www.ninds.nih.gov/disorders/tbi/detail_tbi.htm (Accessed November 15, 2007)
NINDS Traumatic Brain Injury Information Page. National Institute of Neurological Disorders and Stroke. U.S. National
Institutes of Health. http://www.ninds.nih.gov/disorders/tbi/tbi.htm (Accessed November 15, 2007)
NINDS Traumatic Brain Injury Information Page. National Institute of Neurological Disorders and Stroke. U.S. National
Institutes of Health. http://www.ninds.nih.gov/disorders/tbi/tbi.htm (Accessed November 15, 2007) and Traumatic
Brain Injury: Hope through Research. National Institute of Neurological Disorders and Stroke. U.S. National Institutes of
Health.

Written by Sharon BeltrandelRio©MANABI Limited

Topic 27
Traumatic Brain Injury (Part 2)
外相性脳損傷 2
As discussed in part one, traumatic brain injury (TBI) occurs when sudden trauma causes
damage to the brain1. Depending on the extent of the damage, the symptoms can be mild,moderate or severe. Post-injury complications may include: seizures, hydrocephalus (anaccumulation of serous fluid within the cranium, also know as water on the brain) or posttraumatic ventricular enlargement, CSF (cerebrospinal fluid) leaks, infections, vascular injuries,
cranial nerve injuries, pain, bed sores, organ system failure in unconscious patients andpolytrauma (trauma to other parts of the body)2. Each complication must be addressed andtreated accordingly.
Long-term disabilities caused by TBI depend on the severity of the injury as well as the age andgeneral health of the patient. Some common disabilities include problems with cognition,
sensory processing, communication, behavior and mental health. For example, it is estimatedthat forty percent of TBI patients develop postconcussion syndrome (PCS)3. Symptoms include
headache, dizziness, vertigo, memory problems, restlessness, depression and anxiety, and may
persist for a few weeks. Memory loss characterized by the loss of specific memories and thepartial inability to form and store new ones is the most common cognitive impairment among
severe TBI patients4.
Once patients have been stabilized, rehabilitation is very important to the recovery process. The
overall goal of rehabilitation is to improve the patient’s ability to function at home and insociety5. The U.S. National Institutes of Health (NIH) recommends that TBI patients be provided
with individual rehabilitation programs based on their strengths and capacities, and that the
programs be modified over time6. A wide range of specialists may be required to provide
rehabilitation that could include physical therapy, occupational therapy, speech/language therapy,
physical medicine, psychology/psychiatry and social support. There are a wide variety ofrehabilitation settings, varying from home-based to inpatient rehabilitation centers to
independent and supportive living centers, and the most appropriate setting must be selectedbased on the needs of the TBI patient and his or her family.
Head injuries can be prevented by taking precautions such as7:
• Wearing a seatbelt and using child safety seats• Wearing a helmet when cycling, skating, skiing, horseback riding, playing contact sports suchas football, and batting and running the bases in baseball and softball• Locking firearms and bullets in a safe place• Avoiding falls by using handrails on stairs, using a step-stool with a grab bar, and using safety
gates at the top and bottom of stairs when young children are present• Putting shock-absorbing material such as mulch or sand on children’s playgrounds
These precautions greatly reduce the risk of TBI.

Written by Sharon BeltrandelRio©MANABI Limited

Discussion questions
1.
2.
3.
4.
5.
6.

1.

2.

3.

4.

5.

6.
7.

Please summarize the article. What is the main point of the article?
What are some of the potential post-injury complications of TBI?
What are some of the potential long-term disabilities caused by TBI?
What does rehabilitation involve?
In what setting is rehabilitation provided?
How can head injuries be prevented?

NINDS Traumatic Brain Injury Information Page. National Institute of Neurological Disorders and Stroke.
U.S. National Institutes of Health. http://www.ninds.nih.gov/disorders/tbi/tbi.htm (Accessed November 15,
2007)
Traumatic Brain Injury: Hope through Research. National Institute of Neurological Disorders and Stroke.
U.S. National Institutes of Health. http://www.ninds.nih.gov/disorders/tbi/detail_tbi.htm#106673218(Accessed December 17, 2007)
Traumatic Brain Injury: Hope through Research. National Institute of Neurological Disorders and Stroke.
U.S. National Institutes of Health. http://www.ninds.nih.gov/disorders/tbi/detail_tbi.htm#106673218(Accessed December 17, 2007)
Traumatic Brain Injury: Hope through Research. National Institute of Neurological Disorders and Stroke.
U.S. National Institutes of Health. http://www.ninds.nih.gov/disorders/tbi/detail_tbi.htm#106673218(Accessed December 17, 2007)
Traumatic Brain Injury: Hope through Research. National Institute of Neurological Disorders and Stroke.
U.S. National Institutes of Health. http://www.ninds.nih.gov/disorders/tbi/detail_tbi.htm#106673218(Accessed December 17, 2007)
National Institutes of Health Consensus Development Conference Statement, October 26-28, 1998.
Rehabilitation of Persons with Traumatic Brain Injury. Bethesda, MD, September 1999.
Heads Up: Preventing Brain Injuries. Centers for Disease Control (CDC), Department of Health and Human
Services. http://www.cdc.gov/ncipc/pub-res/tbi_toolkit/patients/preventing.htm (Accessed December 17,
2007)

Written by Sharon BeltrandelRio©MANABI Limited

Topic 28
Healthcare Professionals’ Alphabet Soup
ヘルスケア・医療業界人の肩書き

When attending a medical conference or visiting a hospital in the United States, both Americans
and foreigners sometimes feel as if they are swimming in a bowl of alphabet soup. All of thehealthcare professionals are wearing name tags, but the letters after their names are sometimes
confusing: M.D., Ph.D., D.O., P.A., N.P., A.R.P.N., B.S.N., A.D.N., R.N., L.P.N, and L.V.N., toname just a few. It’s no wonder that non-healthcare professionals feel like they are drowning inalphabet soup! What do all these letters mean?
M.D., or Medical Doctor, is probably the most familiar acronym. In the U.S., medical doctors
must first earn a four-year undergraduate degree, either a Bachelor of Science (BS) or a Bachelorof Arts (BA), during which most aspiring physicians focus on science (e.g., they major in
biology, chemistry or physiology). Then they attend medical school for another four years.
Most physicians then complete their residency or specialty (three to seven years, depending on
the specialty, e.g. internal medicine or surgery) and pass the state medical board examinations
for the state in which they plan to practice medicine. After completing their residencies, somephysicians choose to enter a fellowship to train for a sub-specialty such as endocrinology or
cardiovascular surgery. Medical doctors who are also board certified in their chosen specialty
often have the initials F.A.C.P. (Fellow, American College of Physicians) after their names too.
Ph.D. stands for Doctor of Philosophy, the traditional academic doctorate. Doctors ofphilosophy are qualified to teach at colleges or universities. They can only practice medicine ifthey have earned a joint M.D., Ph.D. degree, completed their residency and passed the state
medical board examinations.
D.O., or Doctor of Osteopathy, is somewhat similar to a medical doctor. They must also earn a
BS or BA, followed by successful completion of four years of osteopathic medical school, aresidency and the state osteopathic board examinations. Their medical schools usually include
training in physical manipulation techniques, somewhat similar to chiropractic techniques.
P.A., or Physician Assistant, is a relatively new position that came into being in the 1960’s when
there was a physician shortage in the U.S. Physician assistants must earn a BS or BA, followedby two to three years of additional coursework and training. After passing state examinations,they are licensed to practice medicine under the supervision of a physician. They can diagnose
and treat patients, as well as prescribe medications.
N.P. stands for Nurse Practitioner and A.R.N.P. means Advanced Registered Nurse Practitioner.
To earn these titles, nurses must complete a registered nursing degree as part of their BS, plus amaster’s degree, and pass the Family Nurse Practitioner National Certification Exam. Nurse
practitioners can diagnose and treat patients, as well as prescribe medications. Most work incollaboration with physicians and are accredited by the American Academy of Nurse
Practitioners.
B.S.N., or Bachelor of Science in Nursing, is awarded after four years of studying the scienceand principles of nursing, including coursework in not only bedside care, but also nursing
science, research, leadership and nursing informatics. To receive a license and practice as anurse, one must pass the National Council Licensure Examination for Registered Nurses(NCLEX-RN) or for Practical Nurses (NCLEX-PN).
Written by Sharon BeltrandelRio©MANABI Limited

A.D.N., which stands for Associate’s Degree in Nursing, is awarded after two-years of study. To
receive a license and practice as a nurse, one must pass the NCLEX-RN or NCLEX-PN.
R.N., or Registered Nurse, is another familiar title. A registered nurse is someone who hascompleted either a diploma in nursing, a bachelor’s degree in nursing (B.S.N.) or an associate’s
degree in nursing (A.D.N.), and who has passed the NCLEX-RN or NCLEX-PN.
L.P.N., Licensed Practical Nurse, and L.V.N., Licensed Vocational Nurse, are nurses that havecompleted only one year of coursework after high school. They are not Registered Nurses.
This is only the tip of the iceberg. There are multiple other acronyms for healthcare professionals.
Hopefully this is a helpful guide to the most common abbreviations and will help you navigate
through a hospital’s alphabet soup.

Discussion questions
1.
2.
3.
4.
5.
6.
7.

Please summarize the article. What is the main point of the article?
What does M.D. stand for, and what is required to practice medicine in the UnitedStates?
Which healthcare professionals can prescribe medications?
Which acronyms are related to nursing?
What is the difference between a nurse practitioner and a registered nurse?
Which of these healthcare professionals can one find in a Japanese hospital or clinic?
Which of these healthcare professionals do not exist in the Japanese healthcare
system? Would the Japanese healthcare system benefit from their services?

Written by Sharon BeltrandelRio©MANABI Limited

Topic 29
Colorectal Cancer
結腸直腸癌
In 2005, approximately 115,000 new patients were diagnosed with colorectal cancer in Japan,
making it one of the most common types of cancer in the country1. In the past fifty years theincidence of colorectal cancer in Japan has increased significantly2. Colorectal cancer includes
both colon cancer (cancer of the large intestine, the lower part of the digestive system) and rectal
cancer (the last six inches of the colon).
Colorectal cancer often begins as adenomatous polyps, which are small, benign (noncancerous)
clumps of cells. They are usually mushroom-shaped, but may also be flat or recessed into thecolon wall (nonpolypoid lesions). Over time, some of the polyps may become cancerous. In theearly stages, many patients do not experience any symptoms. As the cancer progresses, some ofthe symptoms may include rectal bleeding or blood in the stool, persistent cramping, gas andabdominal pain. Symptoms vary depending on the cancer’s size and location.
If symptoms are present, a colonoscopy is usually performed. Preparation for a colonoscopy
involves taking a laxative and drinking a large amount of fluid to clean out the colon. Then acolonoscope, a long, slender, flexible tube attached to a video camera and monitor, is used toview the colon. If polyps are found during the exam, the doctor usually removes them or takes atissue sample for laboratory analysis.
If cancer is diagnosed, it is then staged to determine the appropriate course of treatment:
•
•
•
•
•
•

Stage 0 – Earliest stage. Cancer is present in the colon or rectum mucosa (inner
layer) only. Also called carcinoma in situ.
Stage I – Cancer has grown through the mucosa but has not spread beyond the colon
wall or rectum.
Stage II – Cancer has grown through the colon or rectum wall but has not spread tolymph nodes nearby.
Stage III – Cancer has spread to nearby lymph nodes but isn’t affecting other parts ofthe body.
Stage IV – Cancer has metastasized to other parts of the body.
Recurrent – Cancer has returned after treatment. It may recur in the colon, rectum or
another part of the body.

The primary treatments for colorectal cancer can be used alone or in combination:••

Surgery – The cancerous portion of the colon or rectum is removed, and the healthy
portions are reconnected if possible. Otherwise, a colostomy is required. An
opening in the abdomen wall is created from a portion of the remaining bowel for theelimination of body waste into a special bag. Side effects of surgery may include
temporary pain, constipation and diarrhea.
Chemotherapy – Drugs are used to destroy cancer cells. Chemotherapy is often usedin combination with surgery, radiation therapy, and/or targeted colorectal cancer
drugs. Possible side effects may include nausea, vomiting, mouth sores, fatigue, hairloss and diarrhea.
Written by Sharon BeltrandelRio©MANABI Limited••

Radiation therapy – X-rays or another powerful energy source are used to kill cancer
cells. It is often used in combination with other treatments. Side effects may include
diarrhea, rectal bleeding, fatigue, loss of appetite, and nausea.
Targeted drug therapy – Drugs that specifically target the cancer cells include
bevacizumab (Avastin), which prevents tumors from developing new blood vessels,
as well as cetuximab (Erbitux) and panitumumab (Vectibix), which target a chemicalsignal that instructs cells to divide an reproduce. Not all of these drugs have been
approved in all countries, so they may still be considered experimental in some partsof the world.

To prevent colorectal cancer, screening should begin at age 50. Screening should begin sooner
for people at increased risk. The primary risk factors for colorectal cancer include age (90% of
people diagnosed are older than fifty), history of adenomatous polyps, inflammatory intestinal
conditions such as ulcerative colitis, inherited disorders that affect the colon, family history ofcolon cancer and polyps, diet (the risk of colon cancer increases when people move from adeveloping country to a Western country and adapt to the Western diet), sedentary lifestyle,diabetes, obesity, smoking, alcohol, growth hormone disorder, and radiation therapy for cancer
directed at the abdomen3.
•
•
•
•
•
•
•

Steps that can be taken to prevent colorectal cancer include:
Eat a diet rich in fruits, vegetables and whole grains, as well as a variety of foods toincrease the consumption of vitamins and minerals
Limit fat, especially saturated fat
Limit alcohol consumption
Refrain from smoking
Be physically active
Maintain a healthy body weight

Discussion questions
1.
2.
3.
4.
5.
6.
7.
8.

1.
2.
3.

Please summarize the article. What is the main point of the article?
What is colorectal cancer?
What is the incidence of colorectal cancer and what has been the trend over the past
fifty years?
What are the symptoms of colorectal cancer?
Why is colorectal cancer staged? What are the stages?
How is colorectal cancer treated?
What are the risk factors for colorectal cancer?
How can colorectal cancer be prevented?

Oshima A, Kuroishi T, Tajima K. "Cancer White Paper - Incidence/Death/Prognosis - 2004"
Shinoharashinsha Inc.
Koyame Y, Kotake K. Overview of colorectal cancer in Japan: report from the Registry of the JapaneseSociety for Cancer of the Colon and Rectum.; Dis Colon Rectum 1997, Oct, 40 (10 Suppl): S2-9.
Colon Cancer. Mayoclinic.com. http://www.mayoclinic.com/health/colon-cancer/DS00035/DSECTION=4.
Accessed 19 March 2008.

Written by Sharon BeltrandelRio©MANABI Limited

Topic 30
Health insurance and emergency care
医療保険及び緊急医療
According to the World Health Organization, health expenditure per capita in Japan was $2,244
in 2006, compared to $5,711 in the United States, and health expenditure as a percentage of GDP
was 7.9% in Japan compared to 15.2% in the U.S1. Healthcare in the U.S. is legendary for its
high cost. These high costs have lead to frequent increases in the price of health insurance,
making it unaffordable for many people. The Census Bureau reported that in 2006, 47 million
Americans had no health insurance2. What happens if someone in the U.S. who does not have
health insurance needs emergency medical care? Let’s look at a hypothetical example.
John is a 26 year-old man who works for a very small company. His company, like nearly halfof all companies with less than ten employees, does not offer health insurance3. He does not
qualify for Medicare (the government healthcare program for the elderly) because he is young,and he does not qualify for Medicaid (the government program for low-income and disabled
people) because he earns $30,000 per year (in 2006, the federal poverty level was $20,000 for afamily of four).
One day, John was riding his motorcycle to work. An oncoming car making a left-hand turn did
not see him, and crashed into him. John was wearing a helmet, but was thrown from his
motorcycle and knocked unconscious. Someone who saw the accident called 911, and an
ambulance arrived quickly and took him to the nearest hospital emergency room. Due to theEmergency Medical Treatment and Active Labor Act (EMTALA), a law passed by the U.S.
Congress in 1986, any patient that goes to a hospital emergency room requesting examination ortreatment must be provided with an appropriate medical screening examination to determine if
he is suffering from an emergency medical condition. If the patient is suffering from anemergency medical condition (a condition of sufficient severity that the absence of medical
attention would result in placing the health of the injured in serious jeopardy), the hospital is
obligated to treat him until he is stable or transfer him to another hospital in conformance withthe law’s directives. John was obviously in an emergency medical condition, and the law statesthat neither examination nor treatment may be delayed due to inability to pay. The law does notprohibit the hospital from asking whether the patient has health insurance or the ability to pay,
but treatment cannot be delayed if the patient is in an emergency medical condition. This law
was passed to prevent hospitals from rejecting patients, refusing to treat them, or transferring
them to “charity hospitals” or “county hospitals” based on their ability to pay.
After John’s condition stabilized, the hospital was no longer legally required to continue treatinghim. However, the hospital did not discharge him until appropriate, and a payment plan to coversome of the treatment costs was negotiated based on John’s ability to pay. The remaining costsof treatment had to be absorbed by the hospital.

Written by Sharon BeltrandelRio©MANABI Limited

Discussion questions
1.
2.
3.
4.
5.
6.
7.
8.

1.
2.

3.

Please summarize the article. What is the main point of the article?
Why has the cost of health insurance increased?
Explain the Japanese health insurance system.
Why doesn’t John qualify for Medicaid or Medicare?
What is the EMTALA?
Why was the EMTALA passed?
Is there a similar law in Japan?
What is the meaning of the last sentence, “The remaining costs of treatment had to beabsorbed by the hospital”?
World Health Organization, World Health Report, 2006.
http://www.pbs.org/newshour/indepth_coverage/health/uninsured/international.html (accessed 23 April 2008).
Number of Uninsured Hits New High, Census Shows. Transcript of The News Hour Health, interview by
Susan Dentzer. PBS. 28 August 2007. http://www.pbs.org/newshour/bb/health/july-dec07/uninsured_0828.html (accessed 23 April 2008).
The Uninsured in America. PBS. 6 April 2001.
http://www.pbs.org/newshour/indepth_coverage/health/uninsured/whoaretheuninsured.html (accessed 23
April 2008).

Written by Sharon BeltrandelRio©MANABI Limited