Clinical practice guidelines for rehabilitation nutrition in cerebrovascular disease, hip fracture, cancer, and acute illness: 2020 update.

BACKGROUND: Individuals undergoing rehabilitation often experience nutritional problems such as malnutrition, but there are no clinical practice guidelines (CPGs) specifically tailored to the combination of rehabilitation and nutritional care for these patients. The Japanese Association for Rehabilitation Nutrition aimed to develop CPGs for rehabilitation nutrition to support clinical decision making in daily practice. METHODS: A CPG committee and development process based on the Grading of Recommendations Assessment, Development and Evaluation system and the Minds Handbook for Clinical Practice Guideline Development 2014 was established. Four clinical questions were defined for patients undergoing rehabilitation for cerebrovascular disease, hip fracture, cancer, and acute illness. Literatures of randomised control trials (RCTs) up to April 2020 were searched for using the MEDLINE, EMBASE, CENTRAL, and Ichushi-web databases. After screening, full-text papers were assessed for eligibility for analysis. Subsequently, studies included in the systematic review were examined regarding their risk of bias, and underwent meta-analyses. A CPG development committee drafted the guidelines based on the systematic review report. Final recommendations were determined by the panel members. RESULTS: Four recommendations were made based on 4 to 9 RCTs for each disease/condition. The certainty of the evidence ranged from very low to low. Overall, the enhanced nutritional care was weakly recommended for rehabilitation patients with cerebrovascular disease, hip fracture, cancer, and acute illnesses. CONCLUSIONS: This CPG provides tentative recommendations for nutritional care of individuals undergoing rehabilitation. Due to low certainty of evidence and small sample sizes of the included studies, more high-quality and larger RCTs are needed to develop more practical CPGs.

Relationship between Mortality and Oral Function of Older People Requiring Long-Term Care in Rural Areas of Japan: A Four-Year Prospective Cohort Study.

Oral ingestion influences the life sustenance, quality of life, and dignity of older adults. Thus, it is an important issue in medical care and the welfare of older adults. The purpose of this four-year prospective cohort study was to investigate the relationship between mortality and oral function among older adults who required long-term care and were living in different settings in a rural area of Japan. This study included 289 participants aged 65 and older who required long-term care and lived in the former Omorimachi area in Yokote City, Akita Prefecture, located in northern Japan. Following the baseline survey, mortality data were collected over four years; 102 participants (35.3%) died during that time. A significant difference was noted in the overall survival rates between the groups with good and deterioration of oral function such as oral dryness, rinsing ability, swallowing function, and articulation, based on Log-rank test results. After adjusting for various potential confounders using Cox proportional-hazards regression, oral dryness (HR: 1.83, 95% confidence interval: 1.12-3.00) was significantly associated with mortality within four years. This study revealed that oral dryness influences the life prognosis of older adults who receive long-term care in different settings.

One-leg standing time with eyes open: comparison between the mouth-opened and mouth-closed conditions.

OBJECTIVE: Many studies report a significant relationship between the one-leg standing time with the eyes open and the occlusal relationship. To determine the association between proprioception (the periodontal membrane vs muscle spindle) to the one-leg standing time, the authors compared the one-leg standing time with eyes open between mouth-opened and mouth-closed conditions. METHODS: The study participants were 107 healthy, elderly patients. The authors measured the one-leg standing time with eyes open between mouth-opened and mouth-closed conditions. RESULTS: The one-leg standing time was significantly shorter with the mouth opened (21·1±19·1 seconds) than with the mouth closed (25·1±21·4 seconds). Patients whose one-leg standing time was equal or shorter with the mouth opened than with the mouth closed were not different from the other patients with regard to age, handgrip strength, BMI, and the number of remaining teeth. DISCUSSION: The vertical mandibular position may affect body balance.

Perspectives on a new educational system for dental hygiene students in Japan.

The purpose of this article is to report changes to dental hygiene education in Japan and to evaluate the successful implementation of these changes in 2010. The legislative change that began in 2005 revised the length of education for dental hygiene students from two years to three or four years (the mandate was three years), which has led to a dramatic change in program curriculum. After a five-year moratorium, a new curriculum has been established for dental hygiene education in Japan. The new curriculum provides students the requisite knowledge to effectively perform the latest dental hygiene procedures. Although the change of the educational system from the present mandatory three-year to the new four-year programs poses many administrative problems, we believe this shift will ultimately provide a more thorough and in-depth education for students.

Body weight and serum albumin change after prosthodontic treatment among institutionalized elderly in a long-term care geriatric hospital.

OBJECTIVES: An important purpose of denture treatment is the improvement of nutritional intake. This is especially important for the dependent elderly who have a high risk of protein-energy malnutrition. To evaluate the impact of denture treatment on such a population, we compared body weight as an indicator of nutritional status before and 6 months after prosthodontic treatment. METHODS: This study was conducted in a long-term care geriatric hospital in Hiroshima, Japan from October 2004 to September 2006. One hundred and four patients received complete or partial denture treatment in both jaws. Nineteen patients were lost to the study because of the development of severe physical conditions or death. Among the remaining 85 patients, 66 used their new prostheses and 19 did not. Body weight and serum albumin levels were examined at prosthesis insertion and 6 months after treatment. RESULTS: Six months after prosthodontic treatment body weight changes were significantly different between users and non-users regardless of denture type and, in addition, serum albumin level were significantly increased among individuals using partial denture in either or both jaws (P < 0.05). CONCLUSION: It can be concluded that prosthodontic treatment may improve the nutritional status of institutionalized elderly.