What lifestyles are risk factors for low well-being of healthy elderlies dwelled in a local city in super-aging Japan? -Kizugawa cohort study.

The purpose of this cohort study is to clarify the risk factors of low well-being of elderly people who residing in a local city of a super-aging country, Japan. Subjects are people, who have selected randomly from healthy elderly people resided in Kizugawa City, Kyoto Prefecture, in 2010, followed until 2015. Question survey was conducted in both year, and questionnaire consisted of items such as basic attributes, lifestyles (health practices, consultation behaviors, social activities and so on) and well-being (WHO-5). In analysis we made multi-logistic regression analysis using lifestyle variables as an independent variable and well-being as a dependent variable. The results were as follows. 1. Risk factors were not to exercise, knowledge of appropriate diet, subjective feeling of stress for at least a month, not to participate in voluntary activities, age and bad subjective feeling of health. 2. Risk factors in regard to changes of lifestyles using good-good lifestyles as a reference were sustainment of having no time for hobby or relaxation, sustainment or deterioration of subject feeling of stress for at least a month, sustainment or deterioration of having no time for relaxation and deterioration of having no activities with pleasure or aim. A factor promoting well-being is to have more frequencies for going out home. This study shows that in a longevity society it is important for community-dwelling elderly Japanese to have good health practices, appropriate consultation behaviors and good social activities for the purpose of keeping good well-being, and that these results are contributed to health promotion policy for community-dwelling elderly people.

Safety and Efficacy of Ranibizumab and Luseogliflozin Combination Therapy in Patients with Diabetic Macular Edema: Protocol for a Multicenter, Open-Label Randomized Controlled Trial.

INTRODUCTION: Diabetic macular edema (DME) threatens daily life activities such as reading and driving and reduces the patients' quality-of-life. Recently, anti-vascular endothelial growth factor (VEGF) agents have become a first-line therapy in DME. However, therapy with anti-VEGF agents has several problems: repeated invasive injections are required; medical costs are high; and a certain proportion of patients with DME are resistant to treatment with anti-VEGF agents. While sodium-glucose co-transporter 2 (SGLT2) inhibitors have been widely used for the treatment of type 2 diabetes mellitus (T2DM), the effects of a combination therapy with anti-VEGF agent and SGLT2 inhibitor on DME are not yet known. METHODS: This study enrolls subjects with T2DM and DME, randomizes them into either a study agent treatment group (treated with ranibizumab as anti-VEGF agent and luseogliflozin as SGLT2 inhibitor) or a control group (treated with ranibizumab and glimepiride), and observes the subjects for 52 weeks after initiation of treatment. Planned outcomes: The primary endpoint is intergroup difference in the number of intravitreal anti-VEGF injections to the study eye from baseline to week 48. Secondary and exploratory endpoints include safety and ophthalmologic and internal medical clinical parameters. REGISTRATION: This study is registered at the University Hospital Medical Information Network Clinical Trial Registry (UMIN000033961) and Japan Registry of Clinical Trials (jRCTs031180210).

Primary Nonfunction on Kidney Transplant Recipients From Donation After Circulatory Death Donors.

BACKGROUND: The need for donor pool expansion remains an important task for kidney transplantation. The aim of this study is the evaluation of primary nonfunction (PNF) from donation after circulatory death (DCD) kidneys. METHODS: Between 1996 and 2017, 100 kidney transplants from DCD donors were conducted in our department. We retrospectively analyzed PNF of kidney transplant recipients from DCD donors in terms of donors' and recipients' epidemiologic characteristics. RESULTS: Of 100 grafts, 95 recipients (95.0%) had discontinued hemodialysis at the time of hospital discharge. Only 5 recipients (5.0%) developed PNF. All 5 PNF recipients received a single graft from an expanded criteria donor (ECD). The mean donor age in the PNF group was 65.0 (SD, 6.2) years. Significant differences between the PNF group and discontinued dialysis group were found for donor age (P < .01) and for the use of ECD kidneys (P < .02). Nevertheless, no significant difference was found between groups for several factors: a history of hypertension and cerebrovascular events, terminal creatinine levels, and graft weight. CONCLUSION: The incidence of PNF from DCD kidneys was very low. Although ECD kidneys in older donors might be a significant risk factor for PNF, these findings suggest that DCD kidneys should be used more frequently for donor expansion.

A relapsing case of pulmonary-renal syndrome after a sequential rise in MPO-ANCA and anti-GBM antibodies.

A 69-year-old woman who presented with severe renal dysfunction and diffuse alveolar hemorrhage was diagnosed with pulmonary-renal syndrome (PRS) based on the coexistence of serum myeloperoxidase (MPO)-antineutrophil cytoplasmic antibodies (ANCA) and anti-glomerular basement membrane (GBM) antibodies (Ab). Hemodialysis was started; plasma exchange and intravenous methylprednisolone pulse therapy were administered followed by oral prednisolone administration. Pulmonary hemorrhage decreased; however, renal dysfunction persisted. On maintenance hemodialysis and prednisolone therapy, MPO-ANCA and anti-GBM Ab became negative at 4 and 10 months, respectively; thereafter, they became positive again at 18 and 35 months, respectively. At 36 months, there was relapse of pulmonary hemorrhage. Plasma exchange and intravenous methylprednisolone pulse therapy were administered; pulmonary hemorrhage ceased, and both antibodies became negative. It is known that PRS cases that are double positive for ANCA and anti-GBM Ab occasionally relapse after remission, and, even though they are double positive at initial diagnosis, most relapses occur with reappearance or re-elevation of ANCA but with absence of anti-GBM-Ab. Therefore, this was a rare relapsing case that presented with double-positive serology. Further, our observation that the reappearance of ANCA preceded that of anti-GBM-Ab suggests that ANCA contribute to the reproduction of anti-GBM Ab.

The relationship between the houseboundedness and frailty of community-dwelling elderly persons.

This study aimed to verify whether the incidence of frailty in elderly individuals is higher among those who are housebound than those who are not. This study found no correlation between elderly people's houseboundedeness and physical, mental, social, and overall frailty. However, the Tilburg Frailty Indicator (TFI) frailty score and grip strength value were higher in non-housebound elderly persons than in housebound elderly ones. This suggests that being housebound may lead to frailty. On the other hand, it is thought that individual interaction with family and friends, and lack of anxiety about falls correlates with the prevention of frailty in housebound elderly persons. The results of the study also suggest that the basic checklist may be effective for ascertaining the actual situation of housebound elderly people who may be manifesting frailty.

[Factors related to eating behaviors in early childhood: Relationships between autistic tendency, sensory characteristics, and childcare environment].

Objective　The objective of this study was to examine the influence of environmental factors on eating behaviors of children.Method　The participants were the caregivers of 1,678 children attending nursery schools or kindergartens in two different cities of a prefecture. We distributed several self-administered questionnaires to the caregivers in conjunction with collaborating organizations. The participants returned the questionnaires either to collection boxes placed at the collaborating organizations facilities or by mailing them. The questionnaires included assessment of the child's basic attributes, caregiver assessments of eating behaviors, the Social Responsiveness Scale (SRS) measure of autistic traits, the Japanese Sensory Inventory-Revised (JSI-R), and the Index of Child Care Environment (ICCE). We conducted a chi-square (χ2) test, Fisher's exact test, and a multiple regression analysis.Results　We received responses from 843 participants (response rate=50.4%), and of those, 583 were considered valid (34.7%). The mean number of problematic eating behaviors for each child as perceived by the caregivers was 2.43±2.26. In general, caregivers thought that about 40% of the children had an unbalanced diet and about 30% had a problem of "not being able to sit still." The multiple regression analysis showed that the number of problematic eating behaviors was significantly and positively affected by the SRS T-score total (ß=0.188, P<0.001), sense of taste (ß=0.319, P<0.001) and auditory sense (ß=0.168, P<0.001) in JSI-R. A positive relationship was found between the environmental factors of human stimulation (ß=0.096, P=0.010) and social support (ß=0.085, P=0.022). A negative relationship was found between sense of smell (ß=-0.108, P=0.013), number of siblings (ß=-0.100, P=0.005), age (ß=-0.077, P=0.029), and sex (ß=-0.091, P=0.010).Conclusion　Our study results showed that having an unbalanced diet and "not being able to sit still" were typical features of eating behaviors. The number of problematic eating behaviors was associated with personal factors such as autistic tendency and sensory characteristics, and also with environmental factors, such as human stimulation and social support. Our findings show the importance of evaluating all relevant factors when dietary guidance is provided in the treatment of problematic eating behaviors.

A cohort study on elderly individuals newly certified as requiring long-term care: comparison of rates of care-needs certifications between basic checklist respondents/specific health examinees and non-respondents/non-examinees of 37,000 elderlies in a city.

Objective: The rates of care-needs certification were mainly compared between two cohorts: 7,820 specific health checkup examinees/basic checklist respondents and 29,234 non-examinees/non-respondents. Subjects and Methods: Among approximately 37,000 elderly citizens of X City, the number of individuals newly certified as requiring long-term care were observed from the date of the first specific health checkup in 2008 to March 31, 2013. The aggregated totals of these individuals and associated factors were evaluated. Results: 1. Support Required 1, Support Required 2, and Long-term Care Required (level 1) certified individuals accounted for approximately 80% of newly certified individuals aged 65-74 years. Newly certified individuals aged 75 years and over had similar results with 37.2% of them being certified Support Required 1, 19.4% certified Support Required 2, and 22.9% certified Long-term Care Required (level 1). 2. The primary factors for care-needs certification in individuals aged 65-74 years were arthritic disorder in 27.6%, falls and bone fractures in 11.3%, and malignant neoplasm and cerebrovascular disease, among others. This was similar for individuals aged 75 years or over. 3. Of the 7,820 specific health checkup examinees/basic checklist respondents, 1,280 were newly certified as requiring long-term care (16.4%) compared to 7,878 (26.9%) of the 29,234 non-examinees/non-respondents. Therefore, the latter cohort had a significantly higher rate of individuals who were newly certified as requiring long-term care. Conclusion: Both specific health checkups and basic checklists are effective health policies to protect frailty in community elderlies.

A retrospective cohort study on the risk assessment of newly certificated long-term care need of elderly individuals in a community: Basic checklist and specific health checkup.

Objective: This study aimed to examine the factors influencing the requirement of a certificate of long-term care using a basic checklist and items listed in the Special Health Checkup. Method: This study included 7,820 individuals living in Uji city, who were selected from among 8,000 elderly individuals who, in 2008, underwent a specific health checkup (hereafter referred to as the 'specific health checkup for the old-old elderly individuals') for those aged 75 years and above. They answered questions from basic checklists at the time, and 180 individuals were excluded as they had already qualified for requiring the certificate of long-term care at the time of the checkup. The follow-up period extended from the day of the specific health checkup for the old-old elderly individuals to March 31, 2013. The data were analyzed using the certificate of needing long-term care as the response variable. The explanatory variables were the basic attributes, items listed in the specific health checkup for the old-old elderly individuals, interview sheets, and basic checklists. Cox proportional hazards regression analysis was conducted. Results: In total, 1,280 elderly individuals qualified for requiring the certificate of needing long-term care. The risk factors for the young-old elderly individuals aged 65 to 74 years were as follows: hepatic dysfunction (hazard ratio {HR}=1.69), the presence of subjective symptoms (HR=1.41), an above-normal abdominal circumference (HR=1.36), old age (HR=1.13), a reduced frequency of going out since the previous year (HR=1.87), the use of support for standing up after being seated on a chair (HR=1.86), no deposit or withdrawals made (HR=1.84), the anxiety of falling down (HR=1.50), an inability to climb stairs without holding a railing or wall (HR=1.49), as well as an increased difficulty in eating tough food items compared with 6 months prior (HR=1.44). The risk factors for the old-old elderly individuals were as follows: a positive reaction on proteinuria (HR=1.27), anemia (HR=1.18), old age (HR=1.10), inability to travel on a bus or train by themselves (HR=1.53), the inability to climb stairs without holding a railing or wall (HR=1.48), weight loss (HR=1.36), a reduced sense of appreciation of the activities they had previously participated in, over a span of 2 weeks (HR=1.30), the use of support for standing up after being seated on a chair (HR=1.23), and the anxiety of falling down (HR=1.20). Conclusion: The items listed in the specific medical checkup as well as the basic checklists were found to be risk factors for both the young-old elderly individuals and the old-old elderly individuals, indicating the need to utilize these lists for the prevention of nursing even in the late stages of life. Moreover, these results suggest the importance of screening elderly individuals suffering from hyperkinesis using the basic checklist and conducting preventive interventions in order to maintain and improve their physical functions.

Concept of successful ageing among the community-dwelling oldest old in Japan.

AIM: In Japan, increasing human longevity has forced society to rethink the notion of what constitutes 'successful ageing'. This study attempts to advocate a new concept of successful ageing that involves complete acceptance of the ageing process. METHOD: Research was based on semi-structured interviews with 15 community dwelling oldest-old (aged 85 years and above) participants. The analysis was completed using a grounded theory approach. FINDINGS: Successful ageing for the oldest old was grouped into six categories. Within these categories, we discovered the structure of successful ageing, which synthesises ideas from the adaptation process with those of physical and cognitive decreased function as well as spirituality. CONCLUSION: The oldest old in Japan work to arrive at a conclusion with their lives, all the while coping with the drawbacks of ageing, such as declining physical and cognitive functions. This resilient and flexible way of life makes their form of ageing an equally 'successful' one.

An Analytical Model / Emotional Intelligence Quotient and QOL in Mothers with Infants in Japan.

OBJECTIVE: The purpose of this study was to examine the relationship between the emotional intelligence quotient and health-related quality of life using structural equation modeling. METHODS: A self-administered questionnaire survey was conducted among 1,911 mothers who visited the Health Center for an infant medical examination. A hypothetical model was constructed using variables of the emotional intelligence quotient, social support, coping, parenting stress, and perceived health competence. RESULT: There were a total of 1,104 valid responses (57.8%). Significant standardized estimates were obtained, confirming the goodness of fit issues with the model. The emotional intelligence quotient had a strong impact on physical and psychological quality of life, and showed the greatest association with coping. This study differed from previous studies in that, due to the inclusion of social support and explanatory variables in coping, an increase in coping strategies was more highly associated with emotional intelligence quotient levels than with social support. CONCLUSION: An enhanced emotional intelligence quotient should be considered a primary objective to promote the health of mothers with infant children.

The development of a town of safety, security and health project in an area with a very high population aging rate: -the activities of a community salon on a shopping street and their assessment-.

OBJECTIVE: The aim of this study was to assess the "Health Care Town in Kyoto" project designed to promote health and safety for health conscious people in a small community. We conducted a survey involving the users of the salon and local residents to examine the effects of the activities in the salon. METHODS: We recorded the activities of salon and conducted semi-structured interviews with ten local residents to ask their opinions about the salon. The data from the interviews were analyzed using the Grounded Theory Approach. We distributed a questionnaire and collected 215 valid responses (valid response rate: 67.8%). RESULTS: 1) Purpose of using the salon was categorized into health consultation, conversation with others, rest and other purpose. 2) The significance of the salon for users was categorized into usability, acquisition of useful information, changes in daily habits and their maintenance, diversion, interaction with other people and acceptance by the shopping center. 3) The results of the questionnaire survey showed marked relations between Well-Being Index (WHO-5), age, employment and family budget, self-rated health and ability to perform daily activities (TMIG), whereas use of the salon was not associated with Well-Being Index (WHO-5). On the other hand, there were marked relations between loneliness (LSO), educational background and use of the salon, demonstrating that the facility helped its users reduce loneliness (LSO). CONCLUSION: In this town, the salon has served as a place providing effective preventive support for the health of individual users.

Visual recognition of the elderly concerning risks of falling or stumbling indoors in the home: -comparison of visual attention points among elderly, middle aged and young individuals-.

OBJECTIVE: The objective of this study was to verify the recognition of dangers and obstacles within a house in the elderly when walking based on analyses of gaze point fixation. MATERIALS AND METHODS: The rate of recognizing indoor dangers was compared among 30 elderly, 14 middle-aged and 11 young individuals using the Eye Mark Recorder. RESULTS: 1) All of the elderly, middle-aged and young individuals showed a high recognition rate of 100% or near 100% when ascending outdoor steps but a low rate of recognizing obstacles placed on the steps. They showed a recognition rate of about 60% when descending steps from residential premises to the street. The rate of recognizing middle steps in the elderly was significantly lower than that in younger and middle-aged individuals. Regarding recognition indoors, when ascending stairs, all of the elderly, middle-aged and young individuals showed a high recognition rate of nearly 100%. When descending stairs, they showed a recognition rate of 70-90%. However, although the recognition rate in the elderly was lower than in younger and middle-aged individuals, no significant difference was observed. 2) When moving indoors, all of the elderly, middle-aged and young individuals showed a recognition rate of 70%-80%. The recognition rate was high regarding obstacles such as floors, televisions and chests of drawers but low for obstacles in the bathroom and steps on the path. The rate of recognizing steps of doorsills forming the division between a Japanese-style room and corridor as well as obstacles in a Japanese-style room was low, and the rate in the elderly was low, being 40% or less. CONCLUSION: The rate of recognizing steps of doorsills as well as obstacles in a Japanese-style room was lower in the elderly in comparison with middle-aged or young individuals.

Binocular summation in visual evoked cortical potential in patients who have significantly different P100 peak latencies in their two eyes.

PURPOSE: To determine whether binocular summation in visual evoked cortical potential (VEP) is present in patients who have significantly different P100 peak latencies in their two eyes. METHODS: Twelve patients with unilateral optic neuritis (ON) and 11 normal controls were studied. All of them had visual acuity of > or = 20/20 in both two eyes and good stereoacuity. Transient and steady-state VEPs were recorded with monocular and binocular pattern-reversal stimulation. RESULTS: In normal controls, the binocular summation ratio was 1.05 with transient stimulation and 1.21 with steady-state stimulation, and in ON patients it was 1.19 and 1.30, respectively. In ON patients, the peak latency of P100 components was delayed significantly when the affected eye was stimulated, but with binocular stimulation the waveform was very similar to that when the fellow eye was stimulated. CONCLUSION: Binocular summation of VECP is not present in ON cases with large differences in the peak latency between the two eyes even if they have good stereoacuity. Binocular summation may not be correlated with stereopsis in adults whose binocular function has already matured.

Morphological and functional changes of the macula after vitrectomy and creation of posterior vitreous detachment in eyes with diabetic macular edema.

The purpose of this study was to determine the morphological and functional changes in the macula after pars plana vitrectomy with the creation of a posterior vitreous detachment in eyes with diabetic macular edema (DME). A simple posterior vitreous detachment was created during pars plana vitrectomy accompanied by simultaneous cataract surgery in 19 eyes of 17 patients with DME. The visual acuity (log MAR units), multifocal electroretinograms (mfERGs), and optical coherence tomographically (OCT)-determined foveal thickness were determined preoperatively and at 6 months postoperatively. The median preoperative log MAR visual acuity was 0.7 (20/100; range, 0.3-1.1), and it improved significantly to 0.4 (20/50; range, 0.15-1.0) postoperatively (p = 0.016). The median foveal thickness was 510 (range, 194-800) microm preoperatively and was significantly reduced to 201 (range, 60-631) microm postoperatively (p =0.0002). The median of response density of the mfERGs in the macular area was 6.3 nV/ deg2 (range, 2.8-14.8) preoperatively, and 6.1 nV/deg2 (range, 2.4-14.3) postoperatively, a non-significant change (p = 0.27). The median of peak latency of the macular response was 30.0 ms (range, 25.0-44.2) preoperatively and it decreased significantly to 28.3 ms (range, 26.7-35.0) postoperatively (p = 0.003). In conclusion, vitrectomy with the creation of a PVD in eyes with DME improved the visual acuity and foveal thickness significantly. In addition, a decrease of the peak latency of the macular mfERGs suggested an improvement of the physiological function of the macula although the amplitude of the mfERGs was not changed significantly.