Effects of a Fall Prevention Program on Physical Abilities of Elderly People Living in a Rural Region: an Intervention Trial

本研究の目的は、農村部在宅高齢者を介入群と対照群に分け、筋力向上運動、バランス向上運動を主とした運動プログラムの効果を両群間で比較検証することである。新潟県加治川村における60歳以上の在宅自立高齢者52名を年齢でマッチングして介入群29名、対照群23名の2群に無作為に分けた。6ヶ月後に再調査できた介入群25名、対照群18名の計43名(82.7%)について比較した。介入群には、筋力向上運動、バランス向上運動を中核とした7種目の運動と歩行運動(散歩)を実施した。対照群には、月1回のレクリェーションを行った。調査は、介入前の調査・測定、介入の実施、介入後の調査・測定の流れで行った。その結果、介入群の10m全力歩行の分速・歩幅、膝伸展筋力トルク値、対照群の最大1歩幅左側、10m全力歩行の分速・歩幅・歩行率、膝伸展筋力トルク値が有意に改善した。ただし、転倒、社会生活及び疾病のアンケート調査では両群間に有意差は認められなかった。介入群、対照群がともに改善したことによって、運動プログラムの効果を明確にできなかった。今後、効果を明確に検証するためには、(1)参加者の抽出方法、(2)参加地域を日常的に交流のない地域にする、(3)対象者数を増やす、(4)運動負荷量の把握、といった課題があげられた。The purpose of the present study is to evaluate the effects of a fall prevention program on the physical abilities of elderly people in a rural area by comparing muscular strength and balance before and after an exercise program. The subjects were 52 elderly (above 60 years) residents Kajikawa village, Niigata prefecture, Japan, who lived at home. They were divided randomly into an intervention group of 29 and a control group of 23 persons. The intervention group underwent a training program of seven items of physical activity and walking movements including muscular strengthening and balance improvement, while the control group had a recreational activity once every month. After six months, the intervention group of 25 persons and the control group of 18 persons were available for analysis. The data were obtained from surveys taken before and after the intervention and measured the change during this period. Significant improvements were observed in the speed of full-powered walking for 10 meters, step length, walking ratio, and torque of knee extension muscles in the intervention group, but some improvements were observed also in the control group. From the survey, we were unable to detect any difference between groups in the frequency of falls, mode of social life, or occurrence of disease. Since both groups showed various similar improvements, the effects of the physical intervention program remain unclear. Our future studies should be concerned with (1) the selection methods of participants, (2) choice of independent regions for an intervention group and a control group to minimize intermingling (3) the number of participants, and (4) clear measurements of the physical loads in the exercise

The practice of child and adolescent psychiatry: a survey of early-career psychiatrists in Japan

<p>Abstract</p> <p>Background</p> <p>Child and adolescent psychiatry (CAP), a subspecialty of psychiatry in Japan, is facing a serious workforce shortage. To resolve this situation, the Japanese government has organized a task force and has been working to increase psychiatrists' clinical skills to improve care for children and adolescents with mental health problems. Using an online questionnaire system, the authors have conducted a survey to investigate the perceptions, experiences, and interests of early-career psychiatrists in CAP.</p> <p>Methods</p> <p>The subjects of this study were 182 psychiatrists in Japan whose individual clinical experiences did not exceed 15 years. The authors of this study created an online questionnaire system and e-mailed the URL and login password to all subjects. Respondents anonymously answered the questions. Most questions required an answer indicating a level of agreement scored on a nine-point scale. Responding to the questionnaire was considered to constitute consent, and all respondents' privacy was carefully protected.</p> <p>Results</p> <p>The mean age and clinical psychiatric experience of the subjects were found to be 33.1 ± 4.5 years and 5.43 ± 3.5 years, respectively. On a nine-point scale (with nine being the highest), experience and interest in CAP measured 3.05 ± 1.9 and 5.34 ± 2.5, respectively; further, these two factors showed significant correlation (r = 0.437, p < 0.0001). The mean score for the early-career psychiatrists' confidence in their ability to diagnose and appropriately treat was notably low, at 3.13 ± 1.9.</p> <p>Conclusion</p> <p>Our results demonstrated that early-career psychiatrists self-evaluated their CAP clinical experience as insufficient, and these clinicians' CAP experiences and interests correlated significantly. Therefore, in order to improve child and adolescent medical care, we need to expose young psychiatrists to sufficient CAP cases and explore the factors that could attract them to this field.</p

Voluntary cough intensity and its influencing factors differ by sex in community-dwelling adults

Background: Cough peak flow (CPF) is widely used for measuring voluntary cough intensity. However, the respective factors that affect CPF are not known. The aim of this study was to determine the factors affecting CPF by sex in community-dwelling adults. Method: We recruited participants using posters exhibited at a public gymnasium. Participation was voluntary, and all participants provided informed consent. Nonsmoking community residents (102 males, 49.6 ± 20.2 years of age; 101 females, 51.4 ± 18.4 years of age) participated in this study. The main outcome measures were sex differences in CPF, respiratory function, respiratory muscle strength, thorax extension, and grip strength. Factors affecting CPF by sex were analyzed using multiple regression analysis. Results: All parameters were higher in men than in women. CPF was affected by thorax expansion at the tenth rib, inspiratory muscle strength and forced expiration in 1 s in men, and thorax expansion at the tenth rib, inspiratory reserve volume, and expiratory muscle power in women. A weak negative correlation was observed between CPF and age ( p = −0.24, p < 0.05) in women. Conclusions: The factors affecting CPF differed by sex in community-dwelling adults. Clinical Trial Number: UMIN00002391

The Murakami Cohort Study of vitamin D for the prevention of musculoskeletal and other age-related diseases: a study protocol

Abstract Background Age-related musculoskeletal diseases are becoming increasingly burdensome in terms of both individual quality of life and medical cost. We intended to establish a large population-based cohort study to determine environmental, lifestyle, and genetic risk factors of musculoskeletal and other age-related diseases, and to clarify the association between vitamin D status and such diseases. Methods We targeted 34,802 residents aged 40–74 years living in areas of northern Niigata Prefecture, including Sekikawa Village, Awashimaura Village, and Murakami City (Murakami region). The baseline questionnaire survey, conducted between 2011 and 2013, queried respondents on their lifestyle and environmental factors (predictors), and self-reported outcomes. Plasma 25-hydroxyvitamin D (25[OH]D) concentration, an indicator of vitamin D status, was determined with the Liaison® 25OH Vitamin D Total Assay. The primary outcome of this study was osteoporotic fracture; other outcomes included age-related diseases including knee osteoarthritis, perception of chronic pain, dementia, and long-term care insurance use. Mean ages of men and women were 59.2 (SD = 9.3, N = 6907) and 59.0 (SD = 9.3, N = 7457) years, respectively. From the blood samples provided by 3710 men and 4787 women, mean 25(OH)D concentrations were 56.5 (SD = 18.4) nmol/L (22.6 ng/mL) and 45.4 (SD = 16.5) nmol/L (18.2 ng/mL), respectively. Discussion Follow-up surveys are planned every 5 years for 15 years, and incident cases of our targeted diseases will be followed at hospitals and clinics in and nearby the cohort area. We anticipate that we will be able to clarify the association between vitamin D status and multiple disease outcomes in a Japanese population

Odds ratios (ORs) of cognitive impairment (MMSE score <24) according to levels of demographic factors.

<p>Odds ratios (ORs) of cognitive impairment (MMSE score <24) according to levels of demographic factors.</p