Relationship between respiratory sarcopenia and respiratory muscle weakness in community-dwelling older adults: a preliminary cross-sectional study.

[Purpose] Using new diagnostic criteria, this study aimed to clarify the relationship between respiratory sarcopenia and respiratory muscle weakness in community-dwelling older adults. [Participants and Methods] Basic information, body composition, motor function, respiratory function, and respiratory muscle strength were analyzed for 43 elderly community residents who participated in a health promotion program between 2021 and 2023. Respiratory sarcopenia and respiratory muscle weakness were evaluated based on maximal intraoral pressure and skeletal muscle index. We conducted a comparison among the three groups-respiratory sarcopenia, respiratory muscle weakness, and robustness. [Results] The respiratory sarcopenia group tended to have lower trunk muscle mass compared to the robust group and had significantly lower trunk muscle mass than the respiratory muscle weakness group. The incidence of systemic sarcopenia was significantly higher in the respiratory sarcopenia group than in the other two groups. [Conclusion] These results indicate that respiratory sarcopenia may be associated with the loss of limb muscle mass observed in patients with systemic sarcopenia and a reduction in trunk muscle mass. The risk factors influencing the prognosis of respiratory sarcopenia may vary depending on the method used to assess respiratory muscle weakness. This study provides the foundational data for future research on respiratory sarcopenia.

Fetal ezrin expression affects macrophages and regulatory T cells in mouse placental decidua.

Ezrin is a cross-linker protein between membrane proteins and cytosolic actin, abundantly expressed in the placenta among the ERM protein family. Ezrin gene knockout mice exhibit fetal growth restriction after gestational day (GD) 15.5. This study aimed to clarify the effect of ezrin on immune cells that influence fetal growth and immune tolerance. Ezrin heterozygous knockout (Ez+/-) mice were interbred, and the gene expressions and immune cell distributions in the placentas of wild-type (Ez+/+) and ezrin knockout (Ez-/-) fetuses were analyzed. IL-6 expression in the placenta of Ez-/- fetuses was significantly higher than in Ez+/+ fetuses at GD 15.5. The mRNA expression of IL-6 in the uterine decidua attached to Ez-/- fetuses was higher compared to that attached to Ez+/+ fetuses but not in the junctional zone and labyrinth. Classical M1 and M2 macrophages in the decidua were analyzed by flow cytometry using CD86 and CD206 as markers. M1 macrophages increased in the decidua attached to Ez-/- mice compared to Ez+/+ mice, while M2 macrophages did not increase. CD4-positive T cells showed a reduction in the decidua attached to Ez-/- fetuses. Further analysis involved the subcutaneous administration of tacrolimus in pregnant Ez+/- mice from GD 8.5 to GD 15.5, which prevented the decrease in fetal body weight and decidual CD4-positive T cells in Ez-/- mice at GD 15.5. These results suggest that impaired expression of fetoplacental-derived ezrin induces inflammatory conditions in the uterine decidua through M1 polarization of macrophages, increased IL-6, and decreased CD4-positive T cells, including Treg cells.

Cerebellar Molecular Signatures in Non-Human Primates.

Cerebellar molecular signatures in primates remain largely unexplored. Here, we investigated the immunoreactivity of neuroplasticity-related molecular markers, including aldolase C (Aldoc), phospholipase C beta 3 (PLCB3), and phospholipase C beta 4 (PLCB4) in the cerebellar cortex and associated nuclei of rhesus macaque monkeys (Macaca mulatta). Our main findings are as follows: First, the cerebellar vermis in macaques exhibited striped compartmentalization for all markers, with the striped expression boundary of PLCB3 being less distinct than those of Aldoc and PLCB4. Second, the striped pattern was less pronounced in the cerebellar hemisphere compared to the vermis, with signals in the hemisphere being predominantly intense throughout. Third, distinct zonal patterns and elevated signals for Aldoc and PLCB3 were observed in the cerebellar deep nuclei. Specifically, the fastigial nucleus displayed intense Aldoc signals in both caudal and rostral regions, while the dentate nucleus displayed strong Aldoc signals in both ventral and dorsal regions. Compared to previous rodent studies, the macaque cerebellum demonstrated a higher proportion of intense signal areas and distinct compartmentalization patterns in both cortical and deep nuclei. These findings offer crucial insights into the unique molecular organization of the primate cerebellum, enhancing our understanding of the advanced neuroplasticity, cognitive, and motor capabilities in primates.

Effects of multimorbidity and polypharmacy on physical function in community-dwelling older adults: A 3-year prospective cohort study from the SONIC.

BACKGROUND: We prospectively examined the effect of baseline multimorbidity and polypharmacy on the physical function of community-dwelling older adults over a three-year period. METHODS: The analysis included 1,401 older adults (51.5 % women) who participated in both wave 1 and wave 2 (3-year follow-up) of the Septuagenarians, Octogenarians, and Nonagenarians Investigation with Centenarians (SONIC) study. Grip strength and walking speed were binarized into poor/not poor physical function according to the frailty definition. The number of chronic conditions and the number of prescribed medications were categorized into 3 and 4 groups, respectively. Multivariable logistic regression was used to examine associations between the number of chronic conditions, medication use at baseline, and poor physical function over a three-year period. RESULTS: After adjusting for confounding factors, hyperpolypharmacy (≥ 10 medications) demonstrated associations with weak grip strength (adjusted odds ratio [aOR] = 2.142, 95 % confidence interval [CI] = 1.100-4.171) and slow walking speed (aOR = 1.878, 95 % CI = 1.013-3.483), while co-medication (1-4 medications) was negatively associated with slow walking speed (aOR = 0.688, 95 % CI = 0.480-0.986). There was no significant association between the number of chronic conditions and physical function. CONCLUSION: The findings suggest that the number of medications can serve as a simple indicator to assess the risk of physical frailty. Given that many older individuals receive multiple medications for extended durations, medical management approaches must consider not only disease-specific treatment outcomes but also prioritize drug therapy while actively avoiding the progression towards frailty and geriatric syndromes.

Factors influencing interprofessional collaboration in long-term care from a multidisciplinary perspective: a case study approach.

Systematic assessments of interprofessional collaboration barriers and enablers in long-term care settings are critical for delivering person-centered healthcare. However, research on factors influencing interprofessional collaboration in long-term care settings is limited. For this study, 65 healthcare professionals across multiple facilities experienced in long-term care in Japan participated in online focus group discussions and individual interviews to discuss cases. The qualitative data were analyzed using qualitative content analysis. Seven themes emerged: coordination, the need for care manager training, hierarchy among healthcare professionals, specialization but not the mind-set of overspecialization, casual conversations, electronic group communication tools, and excessive fear of personal information protection. These findings highlight the need to develop coordinator roles and for interprofessional education on the proper approach to personal information protection laws. Furthermore, daily casual conversations, the use of online platforms, and the prevention of patients being left behind due to overspecialization are required.

Helicobacter pylori Eradication Does Not Adversely Affect the Clinical Course of Gastric Cancer: A Multicenter Study on Screening Endoscopic Examination in Japan.

BACKGROUND: Since gastric cancers (GCs) detected after Helicobacter pylori (HP) eradication present with different morphological characteristics from conventional HP-positive GCs, delayed detection of early-stage GCs may be observed. This study aimed to investigate the clinical impact of HP eradication on diagnosing GC during screening endoscopy. METHODS: Eleven health checkup institutions in Japan participated in the present study. All GC cases newly diagnosed by screening endoscopy between January 2016 and December 2020 were included. After propensity score matching, multivariable regression analysis was performed to estimate the effect of HP eradication on deep tumor invasion among HP-eradicated and HP-positive GC cases. RESULTS: A total of 231 patients with GCs (134 HP-eradicated and 97 HP-positive cases) were enrolled. After propensity score matching, there were 81 cases in each group. The distribution of the depth of tumor invasion (pT1a, pT1b1, pT1b2, and pT2) between the HP-eradicated group and HP-positive group was similar (p = 0.82). In the propensity analysis, with HP-positive as the reference value, HP eradication was not significantly associated with T1b-T4-GCs and T1b2-T4-GCs, with odds ratios (95% confidence intervals) of 1.16 (0.48-2.81) and 1.16 (0.42-3.19), respectively. CONCLUSIONS: HP eradication does not adversely affect the clinical course of GCs, supporting the recommendation of HP eradication in screening programs to reduce the total number of GC cases without delaying diagnosis.

Reappraisal of a Renovated Cell-free and Concentrated Ascites Reinfusion Therapy for Malignant Ascites.

BACKGROUND/AIM: Cell-free and concentrated ascites reinfusion therapy (CART) was established for refractory ascites and renovated CART (Keisuke Matsusaki (KM) -CART) has been recently developed especially for malignant ascites; however, the actual clinical efficacy of KM-CART has been rarely reported. PATIENTS AND METHODS: We performed 226 KM-CART procedures in 104 patients with malignant ascites in three hospitals from August 2013 to September 2018. Medical records were retrospectively reviewed for ascites data, related complications, symptoms before and after each CART and prognosis after the first CART. The modified Glasgow Prognostic Score (mGPS) was reviewed before every procedure, as an indicator of nutritional status. RESULTS: Pancreatic cancer was the most common indication for the KM-CART procedure, followed by gastric cancer, hepatocellular carcinoma, ovarian cancer, and cholangiocarcinoma (five major diseases). The 50% survival times of these five major diseases after the first procedure were 25, 39, 31, 49, and 33 days, respectively. The mean survival time for all patients was 73.5 days, and 75.6 days for those with the five major diseases. All patients experienced symptomatic relief, and complications were rare. Repeated KM-CART was performed in 47.1% of the patients, most often in those with ovarian cancer (66.7%). Regarding the mGPS at the first CART procedure, 89% of patients were in the group with the poorest nutritional status. Patients who underwent KM-CART three or more times had longer survival than those who were treated once or twice. CONCLUSION: Repeated KM-CART provides a survival benefit for patients with malignant ascites, even in cases of poor nutritional status.

Association of Spousal Social Support in Child-Rearing and Marital Satisfaction with Subjective Well-Being among Fathers and Mothers.

This study explored the association of spousal support and marital satisfaction with the subjective well-being of fathers and mothers using a mediation analysis. Data were gathered from 360 fathers and 338 mothers (aged 25-50 years). Subjective well-being was measured as an outcome using the Japanese version of the World Health Organization-Five Well-Being Index. Marital satisfaction was measured as a mediating variable using the Japanese version of the Marital Relationship Satisfaction Scale. Spousal social support (including instrumental, emotional, and appraisal support) was measured as an independent variable using four-point scales. Control variables were the father's and mother's ages, number of children, age of the youngest child, children going to nursery school or kindergarten, use of childcare services, self-evaluated low economic status, and weekday working hours. Among fathers, instrumental and emotional support had significant direct and indirect effects, with the latter mediated by the impact of marital satisfaction on subjective well-being; appraisal support had only significant indirect effects. Among mothers, instrumental support had significant direct and indirect effects; emotional and appraisal support had only significant indirect effects. Our findings indicate that social support from spouses has protective direct and indirect effects on subjective well-being among parents and suggest the need for mutual support between spouses to facilitate effective co-parenting.

Effect of number of medications on the risk of falls among community-dwelling older adults: A 3-year follow-up of the SONIC study.

AIM: This study examined the association between the number of prescribed medications and falls among community-dwelling older adults. METHODS: We conducted a geriatric comprehensive health-checkup on community-dwelling adults aged 69-91 years who participated in the Septuagenarians, Octogenarians, and Nonagenarians Investigation with Centenarians study. The final analysis of this study included 1,076 participants with complete data. The participants were divided into four groups based on the number of medications at baseline: 0, 1, 2-4, and ≥5. At the 3-year follow-up, the participants were asked whether they had fallen in the past year. Multivariable logistic regression analysis was performed to assess the relationship between the number of medications taken and falls after adjusting for confounding factors. RESULTS: The prevalence rates of falls were 10.5%, 18.2%, 18.3%, and 19.8% in the no-medication, one-medication, comedication, and polypharmacy groups, respectively. In the one-medication prescription group, 59% of prescriptions were for fall-risk-increasing drugs (FRID). Multivariable analysis showed a significantly higher incidence of falls in the one-medication group (adjusted odds ratio [OR], 1.91; 95% confidence interval [CI], 1.04-3.54), co-medication (OR, 1.89; 95% CI, 1.09-3.29), and polypharmacy groups (OR, 1.94; 95% CI, 1.09-3.45) than in the no-medication group. CONCLUSIONS: The study showed that polypharmacy, as well as just taking one medication, can affect the occurrence of falls. This suggests that in addition to the number of medications and polypharmacy, the type of medication, such as FRID, affects the risk of falls. Therefore, pharmacotherapy should consider the risk of falls in older adults when prescribing medications. Geriatr Gerontol Int 2024; 24: 306-310.

Good death for people living with dementia: a qualitative study.

BACKGROUND: Ensuring a good death is one of the primary objectives of palliative care and end-of-life care. There is insufficient evidence regarding what defines a good death for people living with dementia. Obtaining an understanding of what constitutes a good death could help improve dementia care. This study aimed to explore how multiple stakeholders perceive a good death for people living with dementia. METHODS: This qualitative study was carried out across six prefectures in Japan. Enrollment of participants took place within dementia outpatient clinics, hospitals, daycare centers, and community centers. A total of thirty-three in-depth interviews with people living with dementia, physicians, and nurses were conducted. Six focus group discussions were performed with family caregivers and care workers. Verbatim transcripts of the interviews were prepared, and inductive content analysis was used to examine the data. FINDINGS: Regarding the perception of a good death, the following themes were derived: (1) painless death; (2) dying in a preferred environment; (3) family's coping with loss; (4) maintaining regular life; (5) living with respect; and (6) preparation for death. All these themes are interrelated. Participants viewed a good death as a process rather than a single event. CONCLUSION: This study identifies crucial components of a good death for people living with dementia. The findings could be used to improve dementia care.

Neonatal malnutrition impacts fibroblast growth factor 21-induced neuron neurite outgrowth and growth hormone-releasing hormone secretion in neonatal mouse brain.

Neonatal malnutrition is one of the most common causes of neurological disorders. However, the mechanism of action of the factors associated with neonatal nutrition in the brain remains unclear. In this study, we focused on fibroblast growth factor (FGF) 21 to elucidate the effects of malnutrition on the neonatal brain. FGF21 is an endocrine factor produced by the liver during lactation which is the main source of nutrition during the neonatal period. In this study, malnourishment during nursing mice induced decreased levels of Fgf21 mRNA in the liver and decreased levels of FGF21 in the serum. RNA-seq analysis of neonatal mouse brain tissue revealed that FGF21 controlled the expression of Kalrn-201 in the neonatal mouse brain. Kalrn-201 is a transcript of Kalirin, a Ras homologous guanine nucleotide exchange factor at the synapse. In mouse neurons, FGF21 induced the expression of Kalirin-7 (a Kalirin isoform) by down-regulating Kalrn-201. FGF21-induced Kalirin-7 stimulated neurite outgrowth in Neuro-2a cells. FGF21 also induced Growth hormone-releasing hormone (GHRH) expression in Neuro-2a cells. Kalirin-7 and GHRH expression induced by FGF21 was altered by inhibiting the activity of SH2-containing tyrosine phosphatase (SHP2) which is located downstream of the FGF receptor (FGFR). Additionally, malnourished nursing induced intron retention of the SHP2 gene (Ptpn11), resulting in the alteration of Kalirin-7 and GHRH expression by FGF21 signaling. Ptpn11 intron retention is suggested to be involved in regulating SHP2 activity. Taken together, these results suggest that FGF21 plays a critical role in the induction of neuronal neurite outgrowth and GHRH secretion in the neonatal brain, and this mechanism is regulated by SHP2. Thus, Ptpn11 intron retention induced by malnourished nursing may be involved in SHP2 activity.

Effects of Daily Consumption of Soy Products on Basic/Instrumental Activities of Daily Living in Community-Dwelling Japanese Women Aged 75 Years and Older: A 4-Year Cohort Study.

Introduction: Since soy isoflavones compensate for age-related estrogen reduction, adequate intake of soy products may prevent the decline in activities of daily living (ADL) due to estrogen reduction in women. However, it is unclear whether regular soy product intake prevents ADL decline. This study examined the effects of soy product consumption on basic/instrumental ADL (BADL/IADL) in Japanese women 75 years or older for 4 years. Materials and Methods: The subject population consisted of 1289 women aged 75 years or older living in Tokyo who underwent private health examinations in 2008. For 1114 (or 1042) participants without baseline BADL (or IADL) disability, we examined the association between baseline soy product consumption frequency and the BADL (or IADL) disabilities 4 years later using logistic regression analyses. The models were adjusted for baseline age, or further for dietary variety for food groups other than soy products, exercise and sport participation, smoking, pre-existing disease number, and body mass index. Results: Regardless of adjustment for potential confounding factors, less frequent soy product consumption was associated with higher BADL or IADL disability incidence. In the fully adjusted models, the trend toward a higher incidence of disabilities with less frequent soy product consumption was statistically significant for both BADL (p = 0.001) and IADL (p = 0.007). Conclusions: Those who consumed soy products more frequently at baseline were less likely to develop BADL and IADL disabilities after 4 years than those who did not. The results show that daily soy product consumption may prevent functional ADL decline in older Japanese women.

A case report of a prolonged decrease in tacrolimus clearance due to co-administration of nirmatrelvir/ritonavir in a lung transplant recipient receiving itraconazole prophylaxis.

BACKGROUND: Drug-drug interaction management is complex. Nirmatrelvir/ritonavir is a potent cytochrome P450 (CYP) 3A inhibitor and influences pharmacokinetics of co-administered drugs. Although there are several reports about drug-drug interactions of nirmatrelvir/ritonavir, an influence of a concomitant use of nirmatrelvir/ritonavir and another potent CYP3A inhibitor on tacrolimus remains unclear. Here, we experienced a lung transplant patient with the novel coronavirus disease 2019 (COVID-19). In this patient, nirmatrelvir/ritonavir was administered, and the inhibitory effect of itraconazole on CYP3A was prolonged. CASE PRESENTATION: We present a case in forties who had undergone lung transplantation. He was administered itraconazole and tacrolimus 1.0 mg/d, with a trough value of 8-12 ng/mL. The patient contracted the COVID-19, and a nirmatrelvir/ritonavir treatment was initiated. During the antiviral treatment, tacrolimus administration was discontinued for 5 d. Tacrolimus was resumed at 1.0 mg/d after completion of the nirmatrelvir/ritonavir treatment, but the trough value after 7 d was high at 31.6 ng/mL. Subsequently, the patient was placed on another 36-h tacrolimus discontinuation, but the trough value decreased to only 16.0 ng/mL. CONCLUSIONS: Co-administration of ritonavir caused a prolonged decrease in tacrolimus clearance through its inhibitory effects on CYP3A in a patient taking itraconazole. Management of drug-drug interaction by pharmacists can be important for patients with multiple medications.

Criterion validity of the health assessment questionnaire for the national screening program for older adults in Japan: The SONIC study.

AIM: In our previous study, we proposed that the total score of the 12 frailty-related items in the health assessment questionnaire for the national screening program for older adults could be used as an indicator of frailty. We aim to examine the criterion validity of the 12 frailty-related items for frailty. METHODS: The data used in this study were from older Japanese individuals aged 78-81 years (n = 461) who participated in the in-venue (2019) and mailed questionnaire (2020) surveys of the Septuagenarians, Octogenarians, Nonagenarians Investigation with Centenarians study. A receiver operator characteristic (ROC) curve analysis was used to evaluate the criterion validity of the 12 frailty-related items for frailty defined based on the Japanese version of the Cardiovascular Health Study criteria. A multivariable logistic regression model was used to examine the independent association of the 12 frailty-related items with frailty. RESULTS: The area under the ROC curve of the scores of the 12 frailty-related items for frailty was 0.79 (95% confidence interval [CI] = 0.73-0.85, P < 0.001). The cut-off value for frailty was 3 and 4 points, and the sensitivity and specificity were 55.9% and 85.8%, respectively. The multivariable logistic regression model showed that four or more scores of the 12 frailty-related items were significantly associated with frailty (adjusted odds ratio = 7.75, 95% CI = 4.10-14.65, P < 0.001). CONCLUSIONS: The results of this study suggest that the 12 frailty-related items in the health assessment questionnaire for older adults may be useful for assessing frailty in community-dwelling older adults in a simplified manner. Geriatr Gerontol Int 2023; 23: 437-443.

[Association between gender role attitudes and social support from mothers and paternal involvement in childcare].

Objective　Paternal involvement in child-rearing is an action goal of Healthy Parents and Children 21 (Tier 2), and should be actively promoted. Clarifying the related factors may contribute to countermeasures for promoting paternal involvement in child-rearing. This study aimed to examine the association between fathers' gender role attitudes and social support from their spouses (i.e., the mothers of the children) and their involvement in child-rearing.Methods　We obtained the data of fathers involved in childcare (aged 25-50 years; all full-time workers) through an internet research company. The paternal involvement in childcare scale (11 items, 4-point scale, e.g., "taking care of children," "cooking") was used as the dependent variable. The independent variables were gender role attitude ("Husbands should work outside the home and wives should take care of the home," 4-point scale) and social support from the mothers of the children (including appraisal, emotional, and instrumental support). The control variables were father's age, mother's employment status, number of children, the age of the youngest child, children going to nursery school or kindergarten, use of childcare services, self-evaluation of low economic status, work hours on weekdays, and marital relationship satisfaction.Results　The data of 360 men were analyzed (mean age 36.8 years, standard deviation 5.6). The results of the multivariable regression analyses with interaction terms are as follows: gender role attitude was significantly associated with childcare (ß=-0.103) and housework (ß=-0.125); appraisal support was significantly associated with childcare (ß=0.142) and housework (ß=0.199); and the interaction between gender role attitude and instrumental support was significant (ß=0.176), indicating that, in individuals with a high gender role attitude score, a higher level of instrumental support was related to a higher childcare score (ß=0.242).Conclusions　Fathers with egalitarian gender role attitudes and those who receive appraisal support from the other parent are more likely to participate in childcare. In addition, fathers with traditional gender role attitudes who receive instrumental support from the other parent may tend to participate in childcare.

Immature functional development of lumbar locomotor networks in adult Irf8-/- mice.

To date, research on the role of the brainstem and spinal cord in motor behavior has relied on in vitro preparations of the neonatal rodent spinal cord, with or without the brainstem; their spatial and temporal scope are subject to technical limitations imposed by low oxygen tension in deep tissues. Therefore, we created an arterially perfused in situ preparation that allowed us to investigate functional interactions in the CNS from the neonatal to adult period. Decerebrated rodents were kept alive via total artificial cardiopulmonary bypass for extracorporeal circulation; the plasma oxygen and ion components needed for survival were supplied through the blood vessels. Interferon regulatory factor 8 (IRF8) is a transcription factor that promotes myeloid cell development and stimulates innate immune responses. In the brain, IRF8 is expressed only in microglia and directs the expression of many genes that serve microglial functions. Recent evidence indicates that IRF8 affects behavior and modulates Alzheimer's disease progression in a mouse model. However, whether this immune deficiency arising from the absence of IRF8 influences the development of the neuronal network in the spinal cord is unknown. We applied the above methodology to mice of all ages and electrophysiologically explored whether the absence of IRF8 influences the development of lumbar central pattern generator (CPG) networks. In mice of all ages, bilateral neuronal discharges by the normal CPG networks activated by the modulated sympathetic tone via descending pathways at high flow rates became organized into discharge episodes punctuated by periods of quiescence. Similar discharge episodes were generated by the adult CPG networks (≥P14 days) activated by drug application. However, discharge episodes elicited by activating the neonatal-juvenile CPG networks (

Cognitive changes with psychomotor skill acquisition through blended learning among nursing students: A qualitative study.

AIM: This study described nursing students' cognitive changes as they acquire psychomotor skills through blended learning. BACKGROUND: Deliberate practice, including feedback from teachers, is vital for acquiring psychomotor skills. Blended learning, a program that allows students to deepen their learning and improve their skills even when students and faculty are physically separated has attracted significant attention in recent years. Although blended learning has been used for learning in the cognitive domain, no study has examined its effectiveness in the acquisition of psychomotor skills. Understanding how students' cognition changes as they acquire skills in a blended learning environment could be a valuable resource for effective teaching. DESIGN: An inductive, qualitative description approach was adopted. METHODS: The program involved a basic nursing skill: making an occupied bed. Eleven second-year nursing students participated. The participants attended face-to-face lectures and e-learning courses comprising self-study content that was designed for easy and frequent reference. Students practiced for a skill test, which was conducted one month after the first lecture. Two interviews were conducted approximately one month apart. Before each interview, the participants' current practices were videotaped. During the interviews, they explained their thought processes and conscious awareness of their actions as they watched the videos. This study was conducted between April and May 2019. RESULTS: Six categories related to changes in participants' cognitive processes while acquiring the skill of making an occupied bed were identified: "feeling that it is easy to acquire," "practicing without much thought," "realizing the difficulty in translating thoughts into practice," "experiencing a sense of purpose in each technique," "gaining a perspective to evaluate one's skills," and "developing one's unique approach." CONCLUSIONS: In a blended learning environment, where a practice environment and audiovisual materials were provided, students could practice and improve their skills at their own pace even without the instructor's frequent advice. The findings show that metacognitive skills are essential to the development of psychomotor skills in a blended learning program because this program requires practicing while monitoring one's skills. Metacognitive skills affect the development of psychomotor skills and the ability to provide care. Therefore, initiatives that address the development of metacognitive skills, such as the current program, during the early stages of basic education programs can contribute to the development of nursing students' practical skills.

Physical performance reference values for Japanese oldest old: a SONIC study.

BACKGROUND: The oldest old, defined as those aged 90 or over, is now the fastest-growing population sector. This study aimed to determine reference values for several physical performance measures (PPMs) among 90-year-olds using internationally standardized measurements and to clarify the characteristics of these indices by comparing their results for 90-year-olds with those for older people 70 and 80. METHODS: We used the Septuagenarians, Octogenarians, and Nonagenarians Investigation with Centenarians (SONIC) study data from 2010 to 2018. The study subjects were 70, 80, and 90-year-olds in the target area eligible to participate in the venue. Excluding those certified for long-term care, the final number of eligible persons is 70s cohort 1000 (2010), 80s cohort 973 (2011), and 90s cohort 690. 90s cohort only consisted of three survey waves: 2012, 2015, and 2018. We used hand grip strength and score on the Short Physical Performance Battery (SPPB) for our physical performance measurements. In addition, we statistically analyzed sex and age differences. RESULT: The simple mean ± standard deviation (SD) for the 90-year-old respondents were in men, 24.1 ± 5.4 kg in hand grip strength, 0.80 ± 0.22 m/s in usual gait speed, 17.2 ± 6.73 s in 5times chair stand, 5.89 ± 4.42 s in tandem balance, and 8.3 ± 2.2 in SPPB respectively and in women, 14.4 ± 4.0 kg in hand grip strength, 0.72 ± 0.20 m/s in usual gait speed, 17.8 ± 7.89 s in 5times chair stand, 4.72 ± 4.35 s in tandem balance, and 7.5 ± 2.4 in SPPB, respectively. For all PPMs, the age 90 cohort was statistically significantly different from the age 70 and 80 cohorts (all trends P <  0.001). Hand grip strength decreased with a similar gradient with age cohort increase of 10 years for both sexes. In contrast, SPPB lower limb score showed a larger drop between the age 80 and 90 cohorts than between the age 70 and 80 cohorts. We also constructed sex-specific appraisal standards according to quintiles. CONCLUSIONS: Our study yielded inclusive sex-specific reference values and appraisal standards for major physical performance measures not certified as requiring long-term care, community-dwelling, oldest old Japanese. The characteristics of age-related decline in physical performance differed between the upper and lower extremity assessments.

Construct Validity of a New Health Assessment Questionnaire for the National Screening Program of Older Adults in Japan: The SONIC Study.

The Japanese government has implemented a new screening program to promote measures to avoid worsening lifestyle-related diseases and frailty among the older population. In this effort, the government formulated a new health assessment questionnaire for the screening program of old-old adults aged ≥75 years. The questionnaire comprises 15 items, of which 12 address frailty, two address general health status, and one addresses smoking habits. This study examined the construct validity of this questionnaire, using the explanatory factor analysis (EFA) and confirmatory factor analysis (CFA). The data used in this study were drawn from a mail-in survey conducted in 2020 as part of the Septuagenarians, Octogenarians, Nonagenarians Investigation with Centenarians study. A total of 1576 respondents (range, 78-99 years of age) were included in the study. Although the EFA did not show an interpretable factor structure of the questionnaire with 15 items, the CFA using only 12 frailty-related items showed the goodness of fit for a higher-order factor "frailty", and the five frailty-related sub-factors model was acceptable. These results suggest that the total score of the 12 frailty-related items in the questionnaire can be used as an indicator of the degree of "frailty".

Association between Neutrophil-to-Lymphocyte Ratio and Physical Function in Older Adults: A Community-Based Cross-Sectional Study in Japan.

Inflammatory responses contribute to physical decline in older adults. Clinical studies have shown that the neutrophil-to-lymphocyte ratio (NLR), a marker of inflammation, is associated with physical decline. However, its association with physical function in community-dwelling older people is still unclear. Hence, we used cross-sectional data to investigate the relationship between NLR and physical function in community-dwelling older adults. Specifically, we analyzed data corresponding to 818 individuals (336 men and 482 women) aged ≥ 75 years, all of whom participated in comprehensive health examinations, including face-to-face interviews, biochemical analyses, and physical function tests. Using these data, we performed multivariable logistic regression analysis to assess the relationship between NLR and physical function, adjusting for sex, age, education, alcohol consumption, smoking, instrumental activity of daily living, body mass index, chronic disease, physical activity, serum albumin level, and depressive mood. The results showed that a higher NLR was associated with a lower grip strength, lower knee extension strength, and slower walking speed. Importantly, the relationship between NLR and physical function was maintained after adjusting for the confounding factors. Thus, we showed a significant association between NLR and physical function, supporting the use of NLR as a marker of physical function in community-dwelling older adults.