Family caregiving problems of suspected elderly neglect: A review of forensic autopsy cases in Japan

Background. Elder abuse is a severe violation of human rights, and the most recent domestic violence issue to gain the attention of public and medical communities especially highly aged country like Japan. Methods. To clarify family caregiving problems related to elder neglect in Japan, we reviewed 178 autopsies conducted between 2000 and 2003 at one centre. Results. Of the 178 cases (134 males and 44 females), 53 involved people were 65 years old and over (30%). A careful investigation of these 53 autopsy reports (39 males and 14 females) allowed us to exclude obvious causes of death, such as traffic and other accidents, drowning, poisoning, alcoholism, and clear disease pathology. We were left with nine cases of suspected neglect (three males and six females). The mean age of victims was 82.1 years (range, 68–91). According to the autopsy reports, two were severely starved, two were putrefied or mummified, three had pressure sores, two had dementia and three would have had difficulty in performing the activities of daily living. Each victim had lived with one family member; their sons in five cases, and a grandson, brother, wife or husband in each case. The caregivers’ ages ranged from 27 to 76 years, and five were unemployed; in three cases, the family incomes were very low. Of the caregivers, two were depressed, one was an alcoholic and one had dementia. Conclusions. This investigation indicated that elderly parents living with their sons are a high-risk group for neglect. A family support system is needed to target male caregivers who are likely isolated from social services. Autopsy cases provide valuable information for public health to prevent similar cases in future. Keywords: Elder abuse, Elder neglect, Male caregivers, Family caregiving, Autopsy records

Recognition of the "team medical-care" in medical field.

チーム医療に対して高い関心が寄せられていることから,チーム医療として認識される具体的な事柄や各職種に対する認識,その利点や職種間の認識の違いなどを明らかにする目的で,岡山県内の病院の看護師,診療放射線技師,臨床検査技師,計652名に対してアンケート調査を行った｡有効回答者数470名で,その内訳は看護師207名,診療放射線技師91名,臨床検査技師172名であった｡結果はチーム医療と認識される具体的な事柄については,異業種間カンファレンスがチーム医療を促進する事柄として認識されているが,整備･実施されていないことがうかがえた｡各職種に対する認識については,職種別･経験年数別にみても,医師,看護師,理学･作業療法士はチーム医療のメンバーとして認識されている割合が高かった｡また,経験年数別では,10～14年の人までは統計上ややばらつきがみられるが,経験年数15年以上の人はあらゆる職種をチーム医療のメンバーであると考え,その重要性を認識していることがわかった｡チーム医療の利点については,どの職種も共通して｢患者中心の医療｣と考えている割合が高かった｡Recently, the "team medical-care" has been received increasing attention in medical field. Therefore we have to develop a clear understanding of "team medical-care". The purpose of this study is to investigate things regarded as "team medical-care" by co-medical, recognition of other category of license, the advantages of "team medical-care" and recognition against the "team medical-care" by different category of license. Total 652 nurses, clinical radiological technologists and clinical laboratory technologists who are working at 8 hospitals in Okayama prefecture were examined by using questionnaire and 470 members (72.1%) responded to it. They were nurses 207 (44.0%), clinical radiological technologists 91 (19.4%), clinical laboratory technologists 172 (36.6%). Majority of respondents recognized that the medical conference consisted of different category of license promoted the "team medical-care", and ninety percent of participants prompted more frequent medical conference. In both by category of license and years of experience, they regarded doctor, nurse, physical therapist and occupational therapist as the menber of the "team medical-care" at high rate. The respondences which have over 15 years of experience regarded all category of license as the menber of the "team medical-care", while the respondences which have less than 10 to 14 years of experience showed disperision of the recongnition. The advantages of "team medical-care" were highly perceived as "patient-centered medical care" by all category of license

先天性血友病患者の移行期の実態

【Introduction】Congenital hemophilia is a category of hemorrhagic disease caused by a genetic defect in the production of coagulation factors. It is treated by administering regular coagulation factor injections on an ongoing basis. Hemophilia is a hereditary illness, often causing social and psychological problems as a result of the disease. To analyze the objective effects of hemophilia, we conducted a retrospective analysis in Tokushima University Hospital. 【Result】All ２３ cases were men between the ages of２０and７２. Hemophilia A was present in１７cases, and hemophilia B was present in six. Nineteen out of ２３ cases were severe, and the others were intermediate. Medical assessments were conducted at pediatrics in seven cases and hematology in １６ cases. Adoption of the self-injection technique was not realized in five cases. Seventeen cases were complicated by hemophilic arthropathy, seven with human immunodeficiency virus（HIV）, and １２ with hepatitis C virus. Eight participants were unemployed, and１７were unmarried. 【Discussion】 Many adult hemophilia patients still visit pediatrics in our hospital. Hemophilia in the period of growth between adolescence and young adulthood is often accompanied by life-altering events such as entering higher education, marriage, and work experience. Therefore, collaboration among professionals of multiple occupations, such as doctors, nurses, pharmacists, medical social workers, and clinical psychologists, is essential. Furthermore, there are many cases of HIV and hepatitis C virus infections complicating hemophilia study due to the stigma surrounding HIV-tainted blood. 【Conclusion】It is imperative that we establish a long-term, sustainable, and multi-disciplinary transitional care and medical support system for patients and their families

Residual laminin-binding activity and enhanced dystroglycan glycosylation by LARGE in novel model mice to dystroglycanopathy

Hypoglycosylation and reduced laminin-binding activity of α-dystroglycan are common characteristics of dystroglycanopathy, which is a group of congenital and limb-girdle muscular dystrophies. Fukuyama-type congenital muscular dystrophy (FCMD), caused by a mutation in the fukutin gene, is a severe form of dystroglycanopathy. A retrotransposal insertion in fukutin is seen in almost all cases of FCMD. To better understand the molecular pathogenesis of dystroglycanopathies and to explore therapeutic strategies, we generated knock-in mice carrying the retrotransposal insertion in the mouse fukutin ortholog. Knock-in mice exhibited hypoglycosylated α-dystroglycan; however, no signs of muscular dystrophy were observed. More sensitive methods detected minor levels of intact α-dystroglycan, and solid-phase assays determined laminin binding levels to be ∼50% of normal. In contrast, intact α-dystroglycan is undetectable in the dystrophic Largemyd mouse, and laminin-binding activity is markedly reduced. These data indicate that a small amount of intact α-dystroglycan is sufficient to maintain muscle cell integrity in knock-in mice, suggesting that the treatment of dystroglycanopathies might not require the full recovery of glycosylation. To examine whether glycosylation defects can be restored in vivo, we performed mouse gene transfer experiments. Transfer of fukutin into knock-in mice restored glycosylation of α-dystroglycan. In addition, transfer of LARGE produced laminin-binding forms of α-dystroglycan in both knock-in mice and the POMGnT1 mutant mouse, which is another model of dystroglycanopathy. Overall, these data suggest that even partial restoration of α-dystroglycan glycosylation and laminin-binding activity by replacing or augmenting glycosylation-related genes might effectively deter dystroglycanopathy progression and thus provide therapeutic benefits