The Combination of Hearing Impairment and Frailty Is Associated with Cognitive Decline among Community-Dwelling Elderly in Japan.

Hearing impairment and frailty are associated with cognitive decline in older people. This study aimed to investigate the effect of the interaction between hearing impairment and frailty on cognitive decline in community-dwelling older people. A mail survey of community-dwelling, older people (age ≥ 65 years) who lived independently was conducted. Cognitive decline was defined using the self-administered dementia checklist (≥18 out of 40 points). Hearing impairment was assessed using a validated self-rated questionnaire. Furthermore, frailty was assessed using the Kihon checklist, and robust, pre-frailty, and frailty groups were identified. Multivariate logistic regression analysis, adjusted for potential confounding factors, was performed to determine the association of the interaction between hearing impairment and frailty with cognitive decline. Data obtained from 464 participants were analyzed. Hearing impairment was independently associated with cognitive decline. Additionally, the interaction term of hearing impairment and frailty was significantly related to cognitive decline. For participants in the robust group, hearing impairment was not associated with cognitive decline. In contrast, for participants in the pre-frailty or frailty groups, hearing impairment was associated with cognitive decline. The association between hearing impairment and cognitive decline was affected by frailty status in community-dwelling, older people.

The Effects of Neighborhood Physical and Social Environment on Physical Function among Japanese Community-Dwelling Older Adults: A One-Year Longitudinal Study.

Previous studies have shown a relationship between physical and social aspects of the neighborhood environment (e.g., built environment, safety) and physical function in older adults. However, these associations are unclear in older Asian adults because longitudinal studies are lacking. This study examined the effects of neighborhood physical and social environment on longitudinal changes in physical function among Japanese older adults. We analyzed 299 Japanese community-dwelling adults aged ≥65 years. Neighborhood environment was assessed using the International Physical Activity Questionnaire Environment Module. Physical function was assessed using handgrip strength, knee extension muscle strength, 5-m walking time, and a timed up-and-go test (TUG) in baseline and follow-up surveys. Changes in physical function over one year were calculated and classified into decline or maintenance groups based on minimal detectable changes. Multiple logistic regression analysis showed that even after adjusting for confounding factors, good access to recreational facilities affected the maintenance of 5-m walking time (odds ratio [OR] = 2.31, 95% confidence interval [CI]: 1.02-5.21) and good crime safety affected the maintenance of TUG (OR = 1.87, 95%CI: 1.06-3.33). Therefore, it is important to assess both physical and social environmental neighborhood resources in predicting decline in physical function among Japanese older adults.

The influence of ageism on stereotypical attitudes among allied health students in Japan: a group comparison design.

BACKGROUND: Ageism is a serious problem in medical care. The importance of ageism-related education for students has been emphasized. To determine the most effective approach to ageism-related education for allied health students, this study examined ageism among this group of students, with the hypothesis that ageism was expressed not only toward elderly adults but also toward individuals other than elderly adults. METHODS: A questionnaire survey was conducted among 154 allied health students in Japan. The questionnaire involved tree drawings to evaluate the drawer's personality and a measurement of the participants' ageism. There were two display conditions for tree drawing. In the elderly display condition, participants were informed that the drawer was an elderly person, and in a control condition, participants were not informed of the drawer's age. Participants were randomly assigned to each condition and were required to evaluate the drawer's personality based on 5 personality traits. After the evaluation, all participants were required to complete the Japanese short version of the Fraboni Scale of Ageism (FSA-J). RESULTS: The participants were 123 allied health students, 61 of whom were in the elderly display condition and 62 of whom were in the control condition. Based on the mean score on the FSA-J (M = 29.80), we divided the participants into a low-FSA-J group (N = 64) and a high-FSA-J group (N = 59). There was no significant difference between the display conditions on the FSA-J score. In the high-FSA-J groups, the control condition evaluated the drawer's personality as more timid than did the elderly display condition (F = 4.26, df = 1, 119). For negligence, the high-FSA-J group evaluated the drawer's personality as more negligent than did the low-FSA-J group (F = 4.08). For broad interests, the main effects of condition and groups were significant (F = 4.23). CONCLUSIONS: The results suggested that ageism indicated a negative evaluation not only of elderly adults but also of individuals other than elderly adults, and students with negative ageism might evaluate the elderly drawer more positively. We have discussed the possibility that negative ageism among allied health students in Japan might underlie these positive stereotypes.

Fall-related efficacy is a useful and independent index to detect fall risk in Japanese community-dwelling older people: a 1-year longitudinal study.

BACKGROUND: Fall-related efficacy has been found to be associated with both falls and fall risk factors such as physical performance. The aim of the present study was to clarify whether fall-related efficacy is, independent of physical performance and other potential risk factors, associated with future falls in community-dwelling older people. METHODS: The study participants were 237 Japanese older people aged 65 years and over who were living independently in their community. Fall-related efficacy and physical performance were assessed at baseline using the short version of the Falls Efficacy Scale-International (short FES-I) and 5-m walking time, the Timed Up and Go Test, the 5 Times Sit to Stand Test, and grip strength. Physical performance was then again assessed at 1-year follow-up. The number of falls was obtained every 6 months for 1 year after the baseline survey. Instrumental activities of daily living (IADL), depression, fall history, current medications, medical history, and pain were also investigated as potential confounding factors that have possible associations with falls. The associations between the short FES-I, physical performance, and number of falls were analyzed using Poisson regression analysis adjusted for physical performance and potential confounding factors. RESULTS: The mean age of the participants (75.9% women) was 71.1 ± 4.6 years, and 92.8% could perform IADL independently. The total numbers of falls and fallers during the 1-year follow-up period were 70 and 42, respectively. On Poisson regression analysis adjusted for walking time and potential confounding factors, independent of physical performance, the short FES-I was found to be significantly associated with number of falls (relative risk = 1.09, p < 0.05). On the other hand, physical performance was not significantly associated with the number of falls. CONCLUSIONS: The findings of the present study suggest that the short FES-I, independent of physical performance and other potential risk factors, is a useful index to detect fall risk in community-dwelling older people, and that fall-related efficacy is an important factor in terms of fall prevention.

Second-order asymmetric transformation and its application for the practical synthesis of α-amino acids.

We report a discovery of a new rimantadine [1-(1-adamantyl)ethanamine]-derived chiral ligand and its application for the preparation of α-amino acids using the second-order asymmetric transformation approach. The operational ease of experimental procedures coupled with excellent chemical yields and stereochemical outcome suggests some potential synthetic generality of this approach.

Hyperstabilization of Tetrameric Bacillus sp. TB-90 Urate Oxidase by Introducing Disulfide Bonds through Structural Plasticity.

Bacillus sp. TB-90 urate oxidase (BTUO) is one of the most thermostable homotetrameric enzymes. We previously reported [Hibi, T., et al. (2014) Biochemistry 53, 3879-3888] that specific binding of a sulfate anion induced thermostabilization of the enzyme, because the bound sulfate formed a salt bridge with two Arg298 residues, which stabilized the packing between two ß-barrel dimers. To extensively characterize the sulfate-binding site, Arg298 was substituted with cysteine by site-directed mutagenesis. This substitution markedly increased the protein melting temperature by ∼ 20 °C compared with that of the wild-type enzyme, which was canceled by reduction with dithiothreitol. Calorimetric analysis of the thermal denaturation suggested that the hyperstabilization resulted from suppression of the dissociation of the tetramer into the two homodimers. The crystal structure of R298C at 2.05 Å resolution revealed distinct disulfide bond formation between the symmetrically related subunits via Cys298, although the Cß distance between Arg298 residues of the wild-type enzyme (5.4 Å apart) was too large to predict stable formation of an engineered disulfide cross-link. Disulfide bonding was associated with local disordering of interface loop II (residues 277-300), which suggested that the structural plasticity of the loop allowed hyperstabilization by disulfide formation. Another conformational change in the C-terminal region led to intersubunit hydrogen bonding between Arg7 and Asp312, which probably promoted mutant thermostability. Knowledge of the disulfide linkage of flexible loops at the subunit interface will help in the development of new strategies for enhancing the thermostabilization of multimeric proteins.

Advanced asymmetric synthesis of (1R,2S)-1-amino-2-vinylcyclopropanecarboxylic acid by alkylation/cyclization of newly designed axially chiral Ni(II) complex of glycine Schiff base.

Asymmetric synthesis of (1R,2S)-1-amino-2-vinylcyclopropanecarboxylic acid (vinyl-ACCA) is in extremely high demand due to the pharmaceutical importance of this tailor-made, sterically constrained α-amino acid. Here we report the development of an advanced procedure for preparation of the target amino acid via two-step SN2 and SN2' alkylation of novel axially chiral nucleophilic glycine equivalent. Excellent yields and diastereoselectivity coupled with reliable and easy scalability render this method of immediate use for practical synthesis of (1R,2S)-vinyl-ACCA.

Chemical dynamic kinetic resolution and S/R†interconversion of unprotected α-amino acids.

Reported herein is the first purely chemical method for the dynamic kinetic resolution (DKR) of unprotected racemic α-amino acids (α-AAs), a method which can rival the economic efficiency of the enzymatic reactions. The DKR reaction principle can be readily applied for S/R interconversions of α-AAs, the methodological versatility of which is unmatched by biocatalytic approaches. The presented process features a virtually complete stereochemical outcome, fully recyclable source of chirality, and operationally simple and convenient reaction conditions, thus allowing its ready scalability. A quite unique and novel mode of the thermodynamic control over the stereochemical outcome, including an exciting interplay between axial, helical, and central elements of chirality is proposed.

Design and synthesis of (S)- and (R)-α-(phenyl)ethylamine-derived NH-type ligands and their application for the chemical resolution of α-amino acids.

This work presents the first chemical approach for the resolution of α-amino acids offering the following advantages: (1) The specially designed resolving reagent is derived from α-(phenyl)ethylamine, the most inexpensive chiral auxiliary, which can be recycled and reused, rendering the cost structure of the complete process very attractive; (2) the time-efficient two-step process can be conducted under operationally convenient conditions with virtually quantitative yields; and (3) the process can readily be adapted to large-scale use.

Chemical ligation of epoxide-containing fusicoccins and peptide fragments guided by 14-3-3 protein.

The template effect of 14-3-3 protein on the chemical ligation of fusicoccin derivatives containing an epoxide group and the pentapeptide QSYDC was investigated. HPLC analysis of the epoxide-opening reaction demonstrated that 14-3-3ζ protein improves the yield of the conjugate product compared to the protein-free control.

Phosphopeptide-dependent labeling of 14-3-3 ζ proteins by fusicoccin-based fluorescent probes.

Fluorescent combination: Cell-penetrating probes derived from the diterpene fusicoccin can form ternary complexes with 14-3-3 proteins and phosphopeptide ligands, whereupon the probes site-specifically attach a fluorescent tag onto the surface of the 14-3-3 proteins.

The guideline of the personal health data structure to secure safety healthcare. The balance between use and protection to satisfy the patients' needs.

PURPOSE: To inform about the impact of a recent movement towards a policy to develop integrative networked electronic health record (EHR) as a basis for cooperation among care teams and with patients and in support of safe patient care in Japan. METHODS: The author headed a commission developing policy for health record (HR) structure and its computerization. It executed two questionnaire surveys as the basis for its work. One survey assessed the current state of computerization of health record in the hospitals certified by Japan Council for Quality Health Care (JCQHC). The other survey assessed the attitudes towards a specific EHR system in the Hiroshima University Hospital and its affiliate hospitals. RESULTS: The survey of the above hospitals showed that most have computer supported administrative procedures, but only few computer-based health records. The attitudes of the Hiroshima EHR users show that while they expect efficiency and quality improvements, there is also apprehension that the system in use might lower practical efficiency and compromise patient safety. Accordingly, health recording requirements and storage policy have been restructured and communicated to the hospitals. CONCLUSION: These insights led to the initiation of curricula educating "Health Information Technologist" which is promoted by Japan Association Medical Informatics and the criterion of Chart Review Promotion of JCQHC. They will also lead to recommendation for improved and advanced EHR.

A clinical management system for patient participatory health care support. Assuring the patients' rights and confirming operation of clinical treatment and hospital administration.

We conducted a drastic change in our hospital information system to support patient participatory health care provided in the New Hiroshima University Hospital (HUH). The new information system in HUH (HU-MIND II-Hiroshima University Hospital Medical Intelligence and Notice Delivery system II) is designed as "clinical management system" (CMS). The core of this CMS is the electronic health record (EHR), which aims to assure both the patients' right to know, and the attendants' accountability. It is evident that the team practice including patients requires close communication. Data in the EHR are written not only by physicians, but also by all coworkers, which will enable them to realize the team communication and the ordering in a reliable way and to leave the evidence of conducted practices. Moreover, the bedside information systems were set-up at all 700 beds. Patients can access their anamnesis and future clinical care procedures themselves. Based on the demand outlined above, the new regulations of HUH are composed of 21 requirements, conditions of information collection, accumulation and use. Our focus was how to make patients' right compatible with attendants' accountability. As the data owners, patients have the facility to access their own data at their bedsides. They can view their own health condition and treatment program and can control the data flow.