Risk Prediction Method for Anticholinergic Action Using Auto-quantitative Structure-Activity Relationship and Docking Study with Molecular Operating Environment.

Lower urinary tract symptoms (LUTS) induced by anticholinergic drug action impair the QOL of patients and are associated with a poor prognosis. Therefore, it is expedient to develop methods of predicting the anticholinergic side effects of drugs, which we aimed to achieve in this study using a quantitative structure-activity relationship (QSAR) and docking study with molecular operations environment (MOE; Molecular Simulation Informatics Systems [MOLSIS], Inc.) In the QSAR simulation, the QSAR model built using the partial least squares regression (PLS) and genetic algorithm-multiple linear regression (GA-MLR) methods showed remarkable coefficient of determination (R2) and XR2 values. In the docking study, a specific relationship was identified between the adjusted docking score (-S) and bioactivity (pKi) values. In conclusion, the methods developed could be useful for in silico risk assessment of LUTS, and plans are potentially applicable to numerous drugs with anticholinergic activity that induce serious side effects, limiting their use.

The creation and dissemination of downloadable information on dementia and driving from a social health perspective.

BACKGROUND: Driving cessation is a likely consequence of progressive dementia. Patients and families can benefit from support through this transition, both to safeguard the patient and public and to help preserve healthy social activity of the patient. METHODS: To provide appropriate supportive information, we developed a 35-page manual ('Supporting family caregivers of older drivers with dementia') available as a free download from our department website. We then informed municipal governments of its availability, tracked website access metrics, and followed up 7 months later with a postal survey to the heads of each municipal government's department of welfare for older citizens. RESULTS: From February to September 2010, the manual was accessed 33 494 times. Of the 1750 municipalities sent surveys, we received 1067 responses (61%). The responses showed that 943 professionals (94.6%) were able to obtain information they needed from the manual, 247 (23%) had used the manual to help residents during the 7 months, and 89% of those who used the manual used it to provide relevant advice to family caregivers. The responses also showed that significantly more use occurred in towns and villages as opposed to cities, consistent with the limited public transportation options in smaller municipalities (P = 0.002). CONCLUSIONS: We anticipate that use of this manual will raise general awareness of this social health issue and facilitate collaborations to provide more social support for those with dementia and their family members.

Depression among family caregivers of community-dwelling older people who used services under the Long Term Care Insurance program: a large-scale population-based study in Japan.

OBJECTIVE: To identify predictors for depression among family caregivers of community-dwelling older people under the Long Term Care Insurance (LTCI) program in Japan through a large-scale population-based survey. METHOD: All 5938 older people with disabilities, using domiciliary services under the LTCI in the city of Toyama, and their family caregivers participated in this study. Caregiver depression was defined as scores of ≥16 on the Center for Epidemiological Studies Depression Scale (CES-D). Other caregiver measures included age, sex, hours spent caregiving, relationship to the care recipient, income adequacy, living arrangement, self-rated health, and work status. Care recipient measures included age, sex, level of functional disability, and severity of dementia. The data from 4128 pairs of the care recipients and their family caregivers were eligible for further analyses. A multiple logistic regression analysis was used to examine the predictors associated with being at risk of clinical depression (CES-D of ≥16). RESULTS: Overall, 34.2% of caregivers scored ≥16 on the CES-D. The independent predictors for depression by logistic regression analysis were six caregiver characteristics (female, income inadequacy, longer hours spent caregiving, worse subjective health, and co-residence with the care recipient) and one care-recipient characteristic (moderate dementia). CONCLUSION: This is one of the first population-based examinations of caregivers of older people who are enrolled in a national service system that provides affordable access to services. The results highlighted the importance of monitoring caregivers who manifest the identified predictors to attenuate caregiver depression at the population level under the LTCI.

Factors influencing caregivers' burden among family caregivers and institutionalization of in-home elderly people cared for by family caregivers.

OBJECTIVES: The purpose of this study was to determine the factors related to changes in the burden of caregivers who look after the elderly at home, as well as factors related to the institutionalization of the elderly who require care. The types of care services associated with reducing caregivers' burden and continuing in-home care were also studied. METHODS: The study subjects were adults aged ≥65 years who used the services of in-home care management centres located in Osaka Prefecture, Japan, and their caregivers. This 2-year longitudinal study began in October 2007, with a total of three surveys undertaken once a year. The survey methods included self-administered questionnaires and the review of clinical records. RESULTS: Dementia and its accompanying behavioural disturbances were found to be significantly related to the increased burden of caregivers and the institutionalization of those requiring care. A significantly higher proportion of caregivers with an increasing burden or those who maintained a high level of burden used day care services compared to those in the other groups. CONCLUSION: Preventive intervention against dementia and its accompanying behavioural disturbances should be considered in the day care service to reduce caregivers' burden and to decrease institutionalization.

Exploring strategies to alleviate caregiver burden: effects of the National Long-Term Care insurance scheme in Japan.

The ever-increasing population of older people with disabilities, including dementia, has been accompanied by a corresponding growth in the number of family caregivers, who are themselves at risk of developing mental and physical health problems. As a result, the need for practical and effective approaches for alleviating caregiver burden has become a major public health concern. One approach involves the development of public policy initiatives to allow the caregiver burden to be borne partly by society as a whole, rather than falling solely on individuals. In 2000, Japan introduced a National Long-Term Care (LTC) insurance scheme that requires adults over the age of 40 years to pay compulsory monthly premiums, with one aim of the program being to reduce caregiver burden. The present paper reviews the effects of this scheme on caregivers' and the general public's perception of caregiver burden and assesses what other measures are needed to further reduce and/or prevent burden. Drawing on recent studies, four questions are addressed: (i) have caregivers' attitudes towards caregiving changed since the implementation of the scheme; (ii) do services provided under the scheme alleviate caregiver burden; (iii) what are the general public's attitudes to and understanding of family caregiving; and (iv) what is the general public's level of understanding of dementia? Results from recent studies suggest that the LTC insurance scheme in Japan appears to be an effective measure for alleviating the burden of caregiving among current family caregivers, but larger studies are needed to determine overall effectiveness.

Differences in perceptions regarding driving between young and old drivers and non-drivers in Japan.

OBJECTIVE: The issue of driving cessation for dementia patients is one of the urgent public health priorities in Japan and is often complicated, with family or social barriers yet to be sufficiently addressed. Because the possibility of dementia or family caregiving can befall anyone, we focused on the disparity in people's perceptions of driving as possible barriers. The present study aimed to assess perceptions of driving among the general public and examine differences in perceptions based on age and driving status. METHODS: A survey was conducted in a sample of the general public aged 40 and over in Japan. Respondents were 1010 people who received a self-administered questionnaire that included questions regarding perceptions about driving and sociodemographic factors. RESULTS: The drivers that participated in this study tended to highly agree that 'driving is a "right" which we all deserve', compared with the non-drivers. The most common reason for reluctance to stop driving among drivers was the possible loss of personal mobility. Apart from transportation, older drivers were more likely than younger drivers to value the qualitative aspects of driving, for example, driving was viewed as 'a motivating factor in my life'. CONCLUSIONS: These disparities in the general public's perceptions about driving may be possible family or social barriers to driving cessation in the case of drivers with dementia. Our findings also suggest that when addressing the need for driving retirement, not only mobility but also the qualitative aspects of driving be paid more attention.

[Attitudes towards family caregiving of people with dementia among the general public in Japan: scale development and validation].

AIM: To develop a scale for attitudes towards family caregiving of people with dementia among the general public in Japan. METHODS: We conducted a postal self-administered questionnaire survey in a sample of the general population aged 20 and over: there were 2,161 (86%) valid responses. Question items in the survey included sociodemographic characteristics, attitude towards family caregiving for people with dementia, and the following three variables associated with dementia and caregiving: respondents' personal anxiety about developing dementia, their knowledge about the Long-Term Care insurance service, and their experiences of caregiving. RESULTS: Factor analysis revealed the following four subscales within this scale: feelings of obligation towards family caregiving (F1), expected feelings of caregiving burden (F2), expectation of personal growth through family caregiving (F3), and negative attitudes towards family caregiving (F4). The Cronbach alpha coefficients for these four subscales ranged from 0.73 to 0.82. In addition, analysis of covariance (ANCOVA), with sociodemographic characteristics as covariates, showed significant relationships (1) between personal anxiety about developing dementia and both F1 and F2, (2) between personal experience of caregiving and F3, and (3) between each of the three variables associated with dementia and caregiving and F4. CONCLUSIONS: The present study confirmed the reliability and validity for the scale of attitudes towards family caregiving of people with dementia among the general public in Japan.

[Advance care planning among the general public in Japan: association with awareness about dementia].

AIM: To explore attitudes towards advance care planning among the general public in Japan and to examine the association between the advance care planning and awareness about dementia. METHODS: We conducted a postal self-administered questionnaire survey in a sample of the general population aged 40 and over and 86% (n=2,161) of the sample were eligible for analysis. The question items included sociodemographic characteristics, awareness about dementia (anxiety about dementia and knowledge about dementia), and advance care planning (decision making on own care preference if extra assistance were required and disclosure of their care preferences to family members). RESULTS: More than a half of the participants had yet to consider what kind of care they preferred to receive if extra assistance were required, especially in men and younger people. Although some people had made a decision regarding care preferences, only 39% of those had disclosed their wishes for care to family members. People who had higher awareness (anxiety and knowledge) about dementia were more likely to consider or make a decision about care preferences, irrespective of age and gender. On the other hand, the disclosure of care preferences to family members was associated with the age groups but not with the extent of awareness about dementia. CONCLUSIONS: The general public in Japan are not used to determining and disclosing their own preferences on advance care planning. There is clearly a need for greater public awareness and further study about an effective method for enhancement of advance care planning.

[Preferred and actual place of death among community-dwelling disabled older people: findings from a survey of visiting nurses].

AIM: The purpose of this study was to examine the relationship between preferred and actual place of death in community-dwelling disabled older people, based on a survey of visiting nurses. METHODS: The present study was a two-year longitudinal study. At Time 1, 398 disabled older people were living together with their family caregivers. At Time 2 (two years later), the visiting nurses responded to a survey for these 398 disabled older people. The relationship between preferred and actual place of death of disabled older people was examined. RESULTS: Of these disabled older people, 26.4% had died by Time 2. The preferences of the place of death of 60% of the disabled older people were not identified by the visiting nurses. Approximately 40% of the family caregivers' preferences concerning the place of death for their older adults were not identified by the visiting nurses. The disabled older adults tended to die at their preferred place of death if the visiting nurses had identified the preferences. CONCLUSION: In order to assist disabled older people to die at their preferred place of death, visiting nurses should identify the preferences of disabled older people or their family concerning the place of death of the disabled older people.

Introversion associated with large differences between screening blood pressure and home blood pressure measurement: The Ohasama study.

OBJECTIVE: To explore the effect of personality on screening blood pressures measured in clinical settings and home blood pressure measurements. METHODS: From 1997 to 1999, 699 participants underwent screening and home blood pressure measurements and completed the Japanese version of the short-form Eysenck personality questionnaire. An increased screening blood pressure was defined as screening blood pressure > or = 140/90 mmHg and an increased home blood pressure was defined as home blood pressure > or = 135/85 mmHg. RESULTS: Participants with lower extroversion scores (i.e., introversion) showed a greater difference between screening and home systolic blood pressure. The association between introversion and differences was statistically significant, even after adjustment for other possible factors (younger age, female, wide screening pulse pressure, never smoked, and no antihypertensive medication). The adjusted means of SBP differences were 7.3 and 4.4 mmHg among the lowest and highest extroversion quartiles, respectively (P for trend = 0.02). Other personality scores (psychoticism or neuroticism) were not associated with screening and home blood pressure differences. The incorporation of an extroversion score in the basic model consisting of the above factors that affected the difference between screening and home blood pressure slightly improved the prediction of a high home blood pressure. The area under the receiver operating characteristic curve increased by 0.037 among participants with high screening blood pressure and 0.006 for those with normal screening blood pressure compared with the basic model. CONCLUSION: Physicians may need to be aware of 'introverted' patients who have high blood pressure in clinic settings, because they have the potential for 'white-coat' hypertension.

Characterization and crystal structure of cadmium(II) halide complexes with amino acids and their derivatives: VII. Crystal structures of aquadibromo(3-aminopropanoic acid)cadmium(II), dichloro(4-aminobutanoic acid)cadmium(II), diaquabis(aminohexanoic acid)cadmium(II) tetrachlorocadmium(II), and dibromo(azetidine-3-carboxylic acid)cadmium(II).

Seven cadmium complexes: [CdX2(Hapro)(H2O)n] (X: Cl(1), Br(2)), [CdX2(Hgaba)] (X: Cl(3), Br(4)), [Cd(Hahex)2(H2O)2][CdCl4] (5), and [CdX2(Haze-3)](H2O)n (X: Cl(6), Br(7)) have been prepared and investigated by means of IR and FT Raman spectra. The crystal and molecular structures of 2, 3, 5 and 7 were determined by a single-crystal X-ray diffraction method. In complex 2, the cadmium atom is in a distorted octahedral geometry, ligated by two carboxyl oxygen atoms of Hapro, a water molecule, and three bromine atoms; one is terminal and each of the other two is bridging two cadmium atoms to make a polymer. The structure of 3 consists of one-dimensional polymers bridged by two chlorine atoms and a carboxyl group. The carboxyl oxygen atoms of Hgaba coordinate forkedly to two cadmium atoms. The cadmium atom of [Cd(Hahex)2(H2O)2]2+ in complex 5 is in a distorted octahedral geometry, ligated by four carboxyl oxygen atoms of two molecules of Hahex and by two water molecules. [Cd(Hahex)2(H2O)2]2+ exists between two layers which are formed of infinite [CdCl4]2- chains. The carboxyl oxygen atoms of Hahex coordinate to the same cadmium atom. In complex 7, the cadmium atom is ligated by two carboxyl oxygen atoms and four bridging bromine atoms to make a polymer.

[Validation of the Home Care Quality Assessment Index (HCQAI)].

AIM: To confirm the convergent validity of the Home Care Quality Assessment Index (HCQAI), developed by Dr. Arai et al., which is used for overall assessment of home care in three areas: 1) conditions of the disabled elderly (outcome); 2) caregiver and caregiving situation (process); and 3) the home care environment (input), based on professional staff observation. METHODS: We surveyed 102 pairs of disabled elderly and their family caregivers who used the visiting nurse station of the Okazaki Medical Association were surveyed. The validity of HCQAI was investigated by computing the Spearman rank correlation coefficient between the subscales of the HCQAI and the variables measuring "outcome", "process" and "input", respectively. "Yokaigodo" (Government-Certified Disability Index), the Activities of Daily Living (ADL) of the disabled elderly, severity of dementia, the Short-Memory Questionnaire (SMQ) and Troublesome Behavior Scale (TBS) were used for the "outcome" variables."The impression of home care", a new scale developed for this study, was used as a variable to evaluate "process and input". RESULTS: The HCQAI subscales for "outcome" indicators were significantly correlated with the other above-described variables measuring "outcome", but not with "the impression of home care", the variable evaluating "process and input". All 5 HCQAI subscales for "process" and "input" were significantly correlated with "the impression of home care", but 4 out of 5 HCQAI subscales were not significantly correlated with the variables measuring "outcome". CONCLUSION: These findings indicate that each subscale of the HCQAI has the expected properties. Therefore, the convergent validity of the HCQAI is confirmed.