Caregiver burden mediates between caregiver\u27s mental health condition and elder\u27s behavioral problems among Japanese family caregivers

Objectives: In Japan, the prevalence of depression has been reported to occur among 1 in 4 family caregivers. The purpose of this study was to investigate the self-rated burden associated with mental health conditions among caregivers.Methods: We studied 95 caregivers aged 38-87 years in a cross-sectional study. The General Health Questionnaire (GHQ-12) score of 4 or more was defined as poor mental health.Results: The proportion of caregivers with poor mental health was 24%. Caregivers with a high GHQ-12 score had the number of caregiver burdens increased by 2.5-fold compared to those with a low GHQ-12 score (p = 0.001). The proportion of caregivers with a high GHQ-12 score was significantly higher with an increasing number of behavioral problems among care recipients (p = 0.003). A mediational model was used to identify the underlying mechanism of the relationship between the number of behavioral problems and poor mental health in caregivers. Consequently, we found that mental health conditions in caregivers were associated with both the number of caregiver burdens and behavioral problems among care recipients.Conclusions: It is vital to provide support not only to the caregivers but also to their elderly relatives, paying particular attention to early identification of poor mental health in caregivers so as to administer effective interventions, and to offer useful advice concerning how to deal with behavioral problems

Impact of Hypertension, Diabetes and Dyslipidemia on Ischemic Heart Disease among Japanese: A Case-Control Study Based on National Health Insurance Medical Claims

Aim Although the important role of conventional risk factors (cigarette smoking, hypertension, diabetes and dyslipidemia) inthe pathogenesis of ischemic heart disease (IHD) has been established, how frequently IHD is preceded by exposure to conventionalrisk factors remains controversial. The present study aimed to identify the prevalence of hypertension, diabetes anddyslipidemia among patients with IHD and examine associations between each of them with IHD in a Japanese population.Methods Data were collected from health insurance claims in May 2010 for National Health Insurance beneficiaries aged 40-79 years in Nagasaki Prefecture, Japan. One sex- and age-matched control was randomly selected for each of 42,236 patientswith IHD (International Classification of Diseases, 10th Revision code: I20-25). The prevalence of hypertension, diabetes anddyslipidemia and the number of these risk factors were compared between the patients and controls. Associations betweenrisk factors and IHD were examined using a conditional logistic regression model.Results Over 90% of patients with IHD had at least one of hypertension, diabetes or dyslipidemia. The odds of IHD were 4.5-fold (95% confidence interval [CI]: 4.3, 4.7), 4.2-fold (95% CI: 3.9, 4.6) and 5.3-fold (95% CI: 4.9, 5.7) higher for patients withhypertension, diabetes and dyslipidemia, respectively, compared with patients without any of these risk factors. Patients withseveral risk factors were at increased risk for IHD.Conclusion Comprehensive risk reduction strategies that encourage a healthy lifestyle and diet and promote the recognition,evaluation and management of conventional risk factors are important to prevent IHD

Gene gun-mediated skin transfection with FL gene suppresses the growth of murine fibrosarcoma

Aim : Particle-mediated transfection is known as an efficient method of nonviral gene transfer. Flt3 ligand (FL) is a growth factor for hematopoietic progenitors ; it promotes the growth of dendritic cells (DC). DCs are powerful antigen-presenting cells (APCs) and show a remarkable capacity to stimulate antigen-specific T-cell responses. In this study, we intended to investigate the suppressive effect on tumor growth by gene gun-mediated transfer of FL in a murine model. Methods : C57BL/6J mice were injected intradermally with MCA205 cells. DNA (pNGVL-hFLex)-coated gold particles were delivered to themouse skin surrounding the target tumor. The expression of FL was determined by RT-PCR. Analyses by immunohistochemistry and fluorescence-activated cell sorter (FACS) revealed an increase in the number of DC after treatment with FL. Results : Gene gun-mediated pNGVL-hFLex transfer significantly inhibited the growth of the MCA205 tumor. FL transfer markedly increased the number of CD11c+ DCs in the tumor tissue. Further, the FL-transfected mice exhibited a significantly higher number of CD80+ MHC-II cells. Conclusion : We successfully performed FL therapy using an in vivo gene gun in order to effectively mobilize DCs in situ and induce suppressive immunity

Mental health problems and influencing factors in Japanese women 4 months after delivery

BACKGROUND: Postpartum mental health problems are a major public health issue; however, studies on the mental health status of mothers and its influencing factors between 8 weeks and 1 year postpartum are scarce. Furthermore, it would be necessary to examine the factors influencing mothers\u27 mental health in order to evaluate their physiological adaptations to the nursing environment.METHODS: We examined the mental health status of postpartum women and the factors influencing poor mental health at 4 months after delivery. A cross-sectional study of 584 postpartum women was conducted. Information on mental health status, delivery, and other factors was collected using a self-administered questionnaire. Women were asked about their age, height, weight, gestational or marital status, whether they were eating regular meals, appetite, frequency of going out, financial difficulty, stressful life events, and history of depression. The Japanese version of the 12-item General Health Questionnaire (GHQ-12) was used to identify potential poor mental health status. Participants with GHQ-12 scores of ?4 were classified as the high GHQ-12 score group (poor mental health status) and participants with GHQ-12 scores of ?3 were classified as the low GHQ-12 score group (good mental health status).RESULTS: Forty-five women (7.7%) were classified as having high GHQ-12 scores. Multiple logistic regression analysis revealed that older age, not eating meals regularly, and history of depression were significantly associated with poor mental health. Financial difficulty had a borderline association with poor mental health in this model.CONCLUSIONS: These risk factors might help practitioners identify women at high risk of poor mental health after delivery

Importance of feeding status evaluation in older patients undergoing hemodialysis

Older hospitalized patients undergoing hemodialysis are increasingly experiencing malnutrition caused by dysphagia. However, only a few studies have focused on this problem. We used the Kuchikara Taberu Balance Chart (KTBC) to evaluate the patients’ feeding status and examined its association with their nutritional status and prognosis. This study included elderly patients undergoing hemodialysis who were hospitalized at Nagasaki Renal Center for > 3 days between June 2021 and February 2022. In total, 82 inpatients were included [mean age, 73.4 ± 10.0 years; men, 57.3%; median dialysis vintage, 79.0 months (interquartile range, 37.3–164.8)]. We classified patients with lower than the median KTBC score (57 points) as being at risk for dysphagia; 37 patients (45.1%) were at risk for dysphagia. Spearman’s rank correlation coefficient (ρ) elucidated that the KTBC total score was significantly associated with each nutritional indicator [serum albumin level (ρ = 0.505, p < 0.001); geriatric nutritional risk index (ρ = 0.600, p < 0.001); and nutritional risk index (ρ = -0.566, p < 0.001)]. The KTBC score was also closely associated with the body mass index (ρ = 0.228, p = 0.04). Patients with a lower KTBC score showed poor prognosis (log-rank test: p = 0.001), and age- and sex-adjusted Cox proportional analysis showed that the KTBC score was associated with life prognosis (hazard ratio, 0.90; 95% confidential interval, 0.86–0.94; p < 0.001). Therefore, we concluded that the patients at risk of dysphagia, identified using the KTBC score, were malnourished and had a poor prognosis. Hence, the evaluation of dysphagia using the KTBC is encouraged to prevent malnutrition in vulnerable older patients undergoing hemodialysis

Evaluation of Quality of Life in Japanese Normal Pregnant Women

To evaluate QOL changes during pregnancy in developed country, we analyzed 159 pregnant Japanese women (67 nulliparous and 92 multiparous) who had no complications during pregnancy. Subjects were asked to complete the Medical Outcomes Study Short Form (SF-36) every 4 weeks up to 24 weeks of gestation, and every 2 weeks from 24 weeks of gestation until delivery. Subscales that reflect "Physical functioning (p?0.001)", "Role-physical (p?0.001)" and "Bodily pain (p?0.001)" showed significant declines throughout the entire pregnancy. On the other hand, subscales that reflect "Vitality," "General health" and "Mental health" did not change substantially with gestational age. Furthermore, subscales that reflect "Physical functioning," "Role physical," "General health" showed no significant differences between nulliparous and multiparous women. Although subscales that reflect "Bodily pain," "Vitality," "Social functioning," "Role emotional" and "Mental health" showed significant differences between nulliparous and multiparous women, these subscales showed significant interactions. Our results suggest that pregnant women need support, regardless of the number of deliveries. Appropriate supports to pregnant women will be available to improve the birth rate in developed countries

Association of Physical Performance and Pain With Fear of Falling Among Community?Dwelling Japanese Women Aged 65 Years and Older

Our aim was to explore the association of physical performance and pain with fear of falling among community-dwelling Japanese women. The subjects were 278 women aged 65 years and over. We collected information on fear of falling, painful joints, comorbidities, falls in the previous year, and cataracts. Walking time (distance of 6 m), chair stand time (5 times), grip strength, the timed up and go test (TUG), and functional reach were measured. The prevalence of fear of falling was 36.3%, and it increased with age, but it was not significant (P=0.081). Multivariate logistic regression analysis showed that poor physical performance (longer walking time, longer chair stand time, weaker grip strength, and longer TUG) and pain (low back, and upper and lower extremity pain) were significantly associated with fear of falling after adjusting for age, body mass index, comorbidities, falls in the previous year, and cataracts. Maintaining physical functioning and managing pain may be important for elderly women with fear of falling

Public transportation and the disabled person

機能訓練事業として実施している「生活リハビリ教室」の教室生208名を対象に，公共交通機関を利用して外出するために障害になっている要因を明らかにする目的で，郵送法による自記式アンケート調査を行った。回答は125名（60.1％）からあった。外出経験がある者は67名（53.6％）で外出経験がない者が58名であった。外出時に付添いが必要と思っている者は，外出経験のない者に多かった。公共交通機関を利用しての外出を阻害している要因には，乗り物の昇降口に段差があることや早く発車して危険である，また周囲の人に介助を依頼しにくいことなどが挙げられている。身体機能障害者が外出できない理由は個人によって異なってはいるが，地域社会に身体機能障害者を受け入れる環境を整えていく必要がある。A survey was distributed by mail to disabled people who received functional training in 1997. Of 208 questionnaires sent, 125 (60.1%) were returned. Sixty-seven (53.6%) of the respondents had experience traveled outside. People who participate in functional trainning for disability hope to have an attendant to accompany them when traveling. One primary factor that hinders traveling outside and using public transportation is that they cannot ask for help because of shyness. Another factor is the construction of entrances (e.g.,bumps) for vehicles which cannot be traversed easily. Reasons differed among those who had traveled outside and those who had not. It is necessary to prepare an environment (e.g., public transportationto) for ease of use for disabled persons in regional communities

Vitamin K deficiency, evaluated with higher serum ucOC, was correlated with poor bone status in women

BACKGROUND: An increase in serum undercarboxylated osteocalcin concentrations suggests vitamin K deficiency. Clinical intervention studies suggested that the vitamin K supplementation might contribute to preventing bone loss in postmenopausal women. Evidence on the relationship between serum undercarboxylated osteocalcin (ucOC) levels and bone parameters of quantitative ultrasound (QUS) is limited. We examined the correlation between serum ucOC concentrations and bone status as measured by QUS among middle-aged and older Japanese men and women. METHODS: The subjects were community-dwelling men (n = 358) and women (n = 503) aged ? 40?years in Japan. Heel QUS parameters, including the stiffness index, speed of sound, and broadband ultrasound attenuation, were measured. Serum ucOC concentrations were measured by electrochemiluminescence immunoassay. Grip strength was measured in the dominant hand. Information on alcohol drinking, current smoking, exercise, and menopause in women was collected. RESULTS: Serum ucOC concentrations were significantly associated with age in both sexes. Serum ucOC concentrations in men were higher at ? 80?years than those in the age groups of 40-49, 50-59, and 60-69?years. Serum ucOC concentrations in women were higher in the age groups of 50-59 and 60-69?years than those at 40-49?years. Partial correlation analysis adjusting for covariates (age, body mass index, grip strength, alcohol drinking, current smoking, and exercise in men; age, body mass index, grip strength, alcohol drinking, current smoking, exercise, and menopause in women) showed that serum ucOC concentrations were negatively significantly correlated with all QUS parameters in women. Serum ucOC concentrations were not correlated with them in men. CONCLUSIONS: Vitamin K deficiency, evaluated with higher serum ucOC, was correlated with poor bone status in women