[Sub-staff training program for community residents to provide community-based care services at day-care facilities].

Objectives　As the birthrate declines and the population ages, increase in the number of older adults certified as requiring long-term care and shortage of care staff are important issues to be considered. This study developed a sub-staff training program that trains community residents as sub-staff (paid auxiliary staff who possess knowledge and skills in care prevention and confidentiality) to provide care for enhancing independence of older adults with the support of staff in day-care facilities. The study also examined the program's feasibility and key factors, through the introduction of practical examples and surveys, for implementation in care prevention projects of local governments.Methods　The four-month training program included lectures on care prevention and provided job training to ensure participants understood the goals and contents of the care plan and learnt to provide care services with the assistance of facility staff. The training program was conducted at 14 facilities in Tokyo and Chiba from 2015 to 2017. The evaluation focused on the completion rate, change in understanding of care prevention and confidence regarding activities at the facility and in the community, participation in community activities after program completion, the psychological impact on care service recipients, and the perception of workload reduction by the facility staff.Results　A total of 96 out of 104 participants completed the training program (completion rate of 92.3%). The survey results showed that participants' confidence in activities at the facilities and understanding of care prevention increased significantly; 65.3% participated in new community activities after program completion, including activities at the facilities. The results of the survey of care service recipients showed that negative psychological effects did not increase among those who received care services from the participants compared to those who did not receive care from participants. Among the facility staff, 85.7% indicated that their workload had reduced after the community residents' participation in care services.Conclusion　The training program improved participants' confidence in care-related activities and their understanding of care prevention. More than half of them engaged in new community activities afterwards. Participants' provision of care services had a less negative impact on the service recipients and led to a reduction in workload for the facility staff. These results suggest high feasibility of the training program for care prevention projects.

[Factors associated with participation in community activities after receiving long-term care preventive services].

Objectives　Since amending the long-term care insurance system to cover community-based services in 2015, community activities led by older residents have become increasingly important in Japan. It is necessary for local governments to effectively promote participation in community activities during long-term care prevention services. This study aimed to identify the factors associated with participation in community activities and the contents of intervention after long-term care prevention services in which interventions were conducted to promote older residents' participation in community activities.Methods　A secondary analysis of data collected in two classes of long-term care preventive services of a local government in Tokyo was conducted. This service provided not only interventions to improve physical function but also initiatives to promote participation in community activities after the service, such as learning and group-work activities. We analyzed participants' responses to self-administered questionnaires in 2016 and 2017; three months after the service started (T1) and six months after the service ended (T2). A total of 216 people (51 men and 165 women; age range: 65-95 years) responded to the questionnaires. Types of intervention, self-rated health, responses to the Kihon Checklist, and social capital, which was measured through items such as "Interaction with neighbors (SC1)," "Participation in groups other than preventive activity (SC2)," "Strength of trust for neighbors (SC3)," and "Mutual trust with neighbors (SC4)," were assessed at T1. Engaging in community activities was assessed to determine whether they participated in the self-motivating group for preventive activity at T2. Logistic regression analyses were conducted to examine the factors associated with participation in community activities by adjusting for each variable.Results　Totally, 113 respondents participated in community activities (participation rate=52.3%), and 103 did not participate (47.7%). Univariate logistic regression analyses revealed that types of intervention was significantly associated with participation in community activities (OR: 0.31, 95% CI: 0.15-0.63, P=0.001). Multivariate logistic regression models adjusted for all independent variables also indicated that types of intervention was significantly associated with participation in community activities (OR: 0.29, 95% CI: 0.14-0.62, P=0.001).Conclusion　The results showed that approximately 50% of the participants were involved in community activities because participation in such activities was promoted in long-term care preventive services. Types of intervention was a significant factor associated with participation in community activities. These findings highlight the importance of program contents in community activities during preventive services.

[Effectiveness of a program promoting community activities for the prevention of frailty using a community assessment].

AIM: We developed a program to promote community activities for preventing frailty using the Community-as-Partner model. We aimed to clarify whether or not participants' extent of practice relating to frailty prevention activities increased after the classroom, as well as the effectiveness of the program for preventing frailty. METHODS: The participants were recruited from among pre-frailty and frailty individuals in a cohort study of community-dwelling older adults. Thirty-two participants completed the classroom intervention. Thereafter, every three months, through a telephone survey, the participants were asked about the extent of practice regarding their frailty prevention activities. The Kihon Checklist and Japanese version of the Cardiovascular Health Study (J-CHS) frailty index were surveyed as outcome measures during the cohort study conducted six months before the classroom (baseline [BL]) as well as approximately one year after this intervention (follow-up [FL]). The changes in the outcome measures between the BL and FL in the intervention group were compared to those in the control group matched by the propensity score. RESULTS: The frailty prevention activities saw a maximum increase around six to nine months after the classroom. The J-CHS frailty index showed a group × time-of-survey significant interaction (F = 6.531, p=0.012) and significantly decreased from 1.3 at BL to 0.8 at FL in the intervention group (p=0.009). CONCLUSIONS: The practice of activities relating to frailty prevention increased after the classroom, and the participants also showed improvements in their physical frailty. The present program seems likely to be effective preventing frailty.

[An implementation study of a program supporting frailty-prevention community activities using the "Community-as-Partner" model].

Objectives　We hypothesized that the motivation for improving physical function could be increased by increasing the awareness of social role expectations among frail community-dwelling older adults through an intervention based on the Community-as-Partner (CAP) model. We also developed a program for supporting community activities to prevent frailty, utilizing the CAP model. Program feasibility was assessed by implementing it under the local government's frailty prevention service.Methods　The CAP-based program consisted of a "learning period," a "regional issue extraction period," and a "practice period," scheduled once a week for four months. Public health nurses and/or physical therapists assisted with the program. The intervention was conducted with a cohort study of community-dwelling older adults. About 160 participants identified as frail and pre-frail on the Kihon Checklist were recruited. Program feasibility was assessed through participation rate, number of pre-frail and frail individuals, and drop-out rate; scores of a pre-post intervention questionnaire assessing the understanding of frailty and regional resources; and behavioral change stage on frailty prevention.Results　A total of 42 participants were recruited (participation rate=26.3%; 25 were pre-frail and 17 were frail). The drop-out rate was 23.8% (n=10). The scores on four out of five items and six out of eleven items on the understanding of frailty and regional resources, respectively, improved significantly after the intervention. Regarding the behavioral change stage, 26 participants (81.2%) maintained or improved.Conclusion　The participation rate was approximately 30%, similar to conventional programs with direct professional intervention. Conversely, a higher drop-out rate compared to conventional programs suggested the importance of explaining the workshop in the program introduction and publicizing the workshop. The results indicated that the program improved the understanding of frailty and regional resources, and led to behavioral change for frailty prevention.

Hepcidin-25/erythroferrone ratio predicts improvement of anaemia in haemodialysis patients treated with ferric citrate hydrate.

BACKGROUND/AIMS: Hepcidin-25 (HEP-25) and erythroferrone (ERFE) are key regulators of iron homeostasis. Correlations among serum ferritin, ERFE and HEP-25 levels and improvements in anaemia have not been evaluated after administration of ferric citrate hydrate (FCH). METHODS: This retrospective observational study investigated 24 patients on haemodialysis with both anaemia (haemoglobin (Hb) < 12 g/dL) and hyperphosphatemia (inorganic phosphorus ≥6 mg/dL). The patients who were administered FCH (1500 mg/day) for 12 consecutive weeks and 12 control patients who were administered a phosphate binder other than FCH were included. Correlations among Hb, HEP-25 and ERFE levels were studied. We then stratified the FCH group into two subgroups using the median baseline values of ferritin, HEP-25, ERFE and HEP-25/ERFE ratio to predict whether these markers could serve as prognostic indicators in the treatment of anaemia. RESULTS: In the FCH group, Hb, transferrin saturation, ferritin, HEP-25 and ERFE levels were all significantly increased, while inorganic phosphorus levels, dosage of erythropoietin-stimulating agent, and erythropoietin resistance index were all significantly decreased after drug administration. A significant inverse correlation was apparent between Hb and HEP-25 levels, and a significant positive correlation was seen between Hb and ERFE levels. A significant inverse correlation was found between HEP-25 and serum ERFE levels. Compared with the high HEP-25/ERFE ratio group, only the low HEP-25/ERFE ratio group exhibited significantly increased Hb levels at 12 weeks. CONCLUSION: HEP-25/ERFE ratio could be a novel prognostic marker for increases in Hb levels following FCH administration.

Walking is regulated by environmental temperature.

The mechanisms that regulate human walking are not fully understood, although there has been substantial research. In our study, we hypothesized that, although walking can be volitionally modified, it is also involuntary and controlled by evolutionary factors, such as the relationship between temperature and movement speed in poikilotherms. This study aimed to determine the effects of environmental temperature on speed, step length, and cadence during unrestrained walking over long periods. Customers of a private insurance company were asked to use a background smartphone GPS application that measured walking parameters. Participants were 1065 app users (298 men and 767 women) aged 14-86 years. Observed walking speed and cadence were higher in winter (average maximum temperature: 10.2 °C) than in summer (average maximum temperature: 29.8 °C) (p < 0.001). The walking parameters were closely related to environmental temperature, with cadence most strongly correlated with daily maximum temperature (r = - 0.812, p < 0.001) and indicating a curvilinear relationship. A decrease in environmental temperature was found to increase cadence when the temperature was below 30 °C. The findings suggest that walking may be regulated by environmental temperature and potentially by the autonomic nervous system's response to environmental temperature.

Change in subjective health status among frail older Japanese people owing to the coronavirus disease pandemic and characteristics of their responses.

AIM: The coronavirus disease 2019 (COVID-19) pandemic remains a major global public health issue, and it has led to restrictions in physical and social activities among community-dwelling people, including frail older adults. This study aimed to determine the impact of the pandemic on the subjective health status and characteristics of community-dwelling frail older adults by assessing their knowledge of infection, behaviors and negative psychological response. METHODS: During October 2019, 720 older adults participated in "The Otassha Study." A year after the COVID-19 outbreak, between June 29 and July 31, 2020, a health status questionnaire, comprising questions concerning knowledge about infection, behaviors and psychological responses during the pandemic, was sent to all participants of the health examination in 2019. Respondents were divided into the robust and frail groups, and their responses were compared. RESULTS: Although the self-reported health status of the older adults in both groups was worse in 2020 than in 2019, differences were not observed in the degree of deterioration between the groups. Those in the frail group had fewer resources of information related to COVID-19 and had fewer coping behaviors for health maintenance compared with the robust group. CONCLUSION: Information gathering and actions aimed at health maintenance tended to be weaker among older adults with frailty, although the influence of COVID-19 on subjective health status did not differ significantly between robust and frail adults. Therefore, robust and frail older adults may need to adopt different countermeasures to prevent worse health during this pandemic. Geriatr Gerontol Int 2021; 21: 1053-1059.

Postmortem computed tomography of gas gangrene with aortic gas in a dialysis patient.

Recently, postmortem imaging is sometimes used as an alternative to conventional autopsy. However, there are few case reports of postmortem imaging of dialysis patients. Here, we report a fatal case of gas gangrene involving a 76-year-old man who underwent dialysis. He died suddenly before a diagnosis could be established. Immediately after his death, postmortem computed tomography (PMCT) revealed gas accumulation in his right upper extremity and ascending aorta. Gas gangrene progresses rapidly and may sometimes result in sudden death before it is diagnosed. In this case, PMCT findings were useful to diagnose gas gangrene. Intravascular gas is a common finding on PMCT and is generally caused by cardiopulmonary resuscitation and decomposition. However, the detection of gas in the ascending aorta by PMCT was not described previously. Moreover, Gram stain and culture of the exudate showed anaerobic Gram-positive bacilli which suggested that the gas generation in the blood was caused by Clostridia species. To the best our knowledge, this is the first report of a dialysis patient whose cause of death was determined as gas gangrene using PMCT.

A surgical case for a Carbomedics stuck valve due to thrombotic pannus formation in the mitral position.

The patient was a 61-year-old female. She underwent mitral valve replacement (MVR) with a 27 mm Carbomedics valve and tricuspid valve annuloplasty using the DeVega method in September 1997. She has received anticoagulant therapy by aspirin and warfarin in a nearby hospital. Because of aggravating dyspnea and chest pain after an acute upper respiratory inflammation, she was transferred to our hospital on an emergency basis on April 14, 2003. Upon admission she went into cardiogenic shock and multiple-organ failure. Biolite carbon coating prevents adhesion of thrombus or pannus on the sewing cuff of Carbomedics valve, and there were few reports of Carbomedics valve dysfunction by pannus formation. But in this case cineradiography demonstrated the prosthetic valve was fixed in the closed position. We diagnosed acute heart failure due to a stuck valve in the mitral position, and redo MVR was performed in emergency. Thrombotic pannus extended from the sewing cuff and into the orifice on the inflow and outflow sides of the valve, and fixed both leaflets in a closed position. The postoperative course was uneventful, and she was discharged on the 20th postoperative day, and now anticoagulant therapy is managed in the outpatient clinic of our hospital. A combination of cineradiography and echocardiography provides a detailed diagnosis of asymptomatic valve dysfunction. Periodical examination by a prosthetic valve specialist is necessary in order to perform adequate anticoagulant therapy, echocardiography and cineradiography after prosthetic valve replacement.

[Evaluation of lesions of malignant lymphoma using histograms of regional SUV].

We designed new evaluation method using histogram of regional standardized uptake value (SUV) of every pixels of box shape volume of interest (VOI) on 18F-FDG PET. We evaluate lung and liver of normal volunteers and also the lesions of 4 cases of patients with non Hodgikin's malignant lymphoma using this method. SUV of pixels of pretreatment lesions shows log-normal distribution, whereas SUV of lung and liver show normal shape distribution. The next day of chemotherapy, 2 cases of them showed changes of distribution pattern from long-normal to normal with decrease of component of higher SUV values. No remarkable changes of distribution pattern were observed on other 2 cases, whereas decrease of regional mean values and max values of SUV were observed. And these findings were continued to 3 weeks later. These findings suggest that regional evaluation using histograms of SUV gives additional and predictive information for tumor therapies soon after the end of course.